In some circumstances, bladder control problems are difficult to manage. These effective and discreet incontinence products can help. By Mayo Clinic Staff

Although medical devices don't cure bladder control problems, they can help you manage urinary incontinence. A number of devices — including urethral inserts and pessaries — are available to reduce urine leakage or help you better control your urge to urinate.

Incontinence products fall into two main groups. One group consists of internal and external devices that keep urine from leaking out of the bladder. The other group includes various nerve stimulation devices that, when used over time, strengthen the muscles that support your pelvic organs and help maintain continence. Here's a rundown of different incontinence products that may help you.

An important benefit of these devices is that you can use them only when you think they'll be needed. The downside is that some people find them uncomfortable.

Urethral inserts
Urethral inserts are small, tampon-like disposable plugs that a woman inserts into her urethra to prevent urine from leaking out. Urethral inserts are generally worn before engaging in activities that might result in stress urinary incontinence, and they may be worn throughout the day. Whenever you need to urinate, you simply remove the device. Urethral inserts are not meant to be worn 24 hours a day. Urethral inserts are available by prescription.

One example of a urethral insert is the FemSoft Insert. The single-use disposable device — made of soft silicone — is a tube with a balloon-like tip. Encasing the tube is a sheath filled with mineral oil. The device is inserted into the urethra and up into the neck of the bladder with an applicator. Most of the mineral oil in the device then flows into the balloon tip. Because the balloon tip is soft and filled with fluid, it conforms to the shape of your bladder neck, creating a seal. This seal prevents urine from leaking out. When you need to urinate, you remove the insert.

Pessaries
Your doctor or nurse practitioner may prescribe a pessary (PES-uh-re) — a silicone or latex device, usually shaped like a ring or a disc, that's inserted into your vagina. You can wear a pessary all day. The device helps support your bladder to prevent urine leakage. You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.

A pessary usually is fitted and put into place by a doctor or nurse practitioner. If you have a pelvic infection, it should be treated before you're fitted with the device, to avoid complications. You usually don't need to remove the pessary to urinate, but you do need to regularly remove it to clean it. Some of the side effects of pessary use include an allergic reaction to the latex or silicone, infection and pressure sores. Pressure sores are more common if you're postmenopausal because vaginal tissue can become more sensitive and less elastic after menopause. Vaginal estrogen cream may help prevent this.

Absorbent products
There are a variety of products designed to absorb leakage, including specially designed briefs, liners and pads. Pads for urinary incontinence are not the same as menstrual pads and are able to hold much more moisture. These products come in a range of sizes, absorbency levels and materials, so look for one tailored to your body type and need.

These devices transmit electrical current to specific nerves or muscles with the goal of strengthening pelvic floor muscles or targeting nerves involved in creating urinary urgency. Unlike some types of nerve stimulation, such as sacral nerve stimulation, these therapies do not involve surgery.

Pelvic floor stimulation
If your pelvic floor muscles are extremely weak or if you have trouble telling what it feels like to tense them, electrical pelvic stimulation may be helpful. In this procedure, a weak electrical current is applied through electrodes that are placed either near the muscles or directly into the nerves they're designed to stimulate. The electrical stimulation causes your pelvic floor muscles to contract without effort on your part (passive contractions). If you're able to do Kegel exercises but your pelvic floor muscles remain weak, electrical pelvic stimulation may be used along with strengthening exercises.

Electrical pelvic stimulation can be effective for urge incontinence, but it often takes several months and multiple treatments to work. The procedure may be done in your doctor's or therapist's office, or you can do it at home with a portable battery-operated device.

Tibial nerve stimulation
Inspired by acupuncture, this method of electrical stimulation is used specifically to treat urge incontinence, often by people who have exhausted other conservative methods and would rather not have surgery. The tibial nerve — located in your lower leg — is connected to the sacral nerve group, which plays a direct role in regulating bladder contractions. Stimulation of the tibial nerve can help to moderate the imbalanced nerve messages an overactive bladder sends to the brain, reducing the number of bladder contractions and the symptoms of urgency and frequency.

Tibial nerve stimulation may be done in your doctor's office. During the procedure, a thin needle is inserted just above your anklebone. Low-frequency electrical stimulation is passed through the needle to your tibial nerve for approximately 30 minutes. The procedure is painless, but you might notice your toes spread out or your big toe curl. You may also feel a sensation spread through the sole of your foot. The stimulation is applied once a week for about three months and then as needed thereafter, depending on your response to the therapy.

As a last resort, your doctor or nurse practitioner may recommend that you use a urinary catheter. This is an option for those who don't have success with other treatments, who find other treatments unacceptable or who need help while waiting for a treatment such as surgery.

A catheter is a thin tube that's placed in your urethra to allow you to drain your bladder manually. This may be done for you, or you can learn to do it yourself. In some cases, the catheter may be left in. The catheter connects to an external bag that holds urine. You empty the bag as needed.

If you have nerve damage, using a catheter at regular intervals can help empty your bladder completely and prevent overflow incontinence.

Common side effects of using a catheter include urinary tract infections and skin irritation. Careful maintenance of sterile techniques while using the catheter can help you avoid these problems.

Jan. 29, 2011