In women with stress urinary incontinence, the normal spatial relationships between the urethra, bladder and pelvis are disrupted during increases in intra-abdominal pressure. Mechanical devices can be used to help control incontinence by transmitting appropriate closure pressure.
However, many devices have appeared on the market and been enthusiastically endorsed by manufacturers, only to vanish from commercial use due to lack of support from good quality clinical trial data.
Vaginal Devices
Pelvic floor devices that automatically squeeze your pelvic muscles are effective in treating some forms of urinary incontinence. They are often easier to use than Kegel exercises. Some are FDA-cleared for at-home use. Others, such as cube pessaries, are shaped like smooth weights (see image) and need to be lubricated before inserting into the vagina. Your doctor can teach you how to use them.
The newer energy-based vaginal rejuvenation options work by heating tissue and, in some cases, cooling it to induce collagen contraction and neocollagenesis. This improves elasticity and moisture of the vaginal walls.
NYU Langone specialists offer urethral bulking, which involves injecting a material around the urethra to build up its thickness and reduce leakage after you empty your bladder. This is a minimally invasive surgical procedure, which may need to be repeated periodically. This treatment can reduce stress incontinence in women after childbirth and at menopause. It can also help with mild stress incontinence caused by physical activities, sneezing or coughing.
Indwelling Devices
A urinary catheter is a tube that goes into your bladder. One end is open to allow urine to drain into a toilet, and the other end is attached to a collection bag strapped to your leg. A catheter is sometimes fitted with a valve that can be opened and closed to control the flow of urine into your bladder.
A catheter is replaced every 29 days (essentially monthly) by a healthcare worker. Infection and MDRO rates are significantly higher with indwelling catheters compared to intermittent catheters.
The inFlow intra-urethral valve-pump system compensates for impaired detrusor contractility of the neurogenic bladder by actively pumping urine, mimicking normal voiding. It consists of a short self-retaining silicone catheter, an internal valve-pump mechanism, and an activator. This urinary prosthesis device improves quality of life and decreases infection, encrustation, and urethral damage compared to traditional intermittent catheters.
External Collection Devices
Unlike an internal catheter, which drains urine from your bladder through a tube inserted into your urethra (Foley catheter) or via a small incision above your bladder (suprapubic catheter), external urinary collection systems collect urine as it exits your body. They are typically used by people with urinary incontinence who are unable to go to the bathroom on their own and who have trouble emptying their bladder.
For men, these systems use a latex sheath fitted over the penis and a drainage tube that connects to a urine collection bag strapped to your leg. Known as condom catheters or sheath-style catheters, these systems are less invasive than internal catheters and offer a more discreet alternative to adult diapers.
There are also sheath-style catheters for women. These devices have a curved tube, like a thin banana, covered with absorbent wicking fabric that runs from the labia to your pubic bone and draws urine into it, then suctioned into a collection container.
Drainage Bags
Drainage bags collect urine from a catheter that has been surgically placed into the bladder. They come in two forms: a large leg bag used during the day and a smaller night bag for use while sleeping. The catheter tube connects to the drainage bag, which must be emptied regularly.
When the bag is full, remove it from its catheter tube and hold it over a toilet or container (your doctor may give you one). Open the spout at the bottom of the drainage bag and drain the urine into the toilet or container. Then clean the tip of the catheter tube with an alcohol wipe and reinsert it into the bag.
There are several types of drainage bags that vary in bag size/capacity, tap design, tube length and mobility and fixation aids. Most are made of sturdy vinyl for safe handling and have an anti-reflux valve to prevent backflow and a convenient sampling port.
