Anal plug

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Anal plug. Analtampon.JPG
Anal plug.

An anal plug (anal tampon or anal insert) is a medical device that is often used to treat fecal incontinence, the accidental passing of bowel moments, by physically blocking involuntary loss of fecal material. [1] Fecal material such as feces are solid remains of food that does not get digested in the small intestines; rather, it is broken down by bacteria in the large intestine. Anal plugs vary in design and composition, but they are typically single-use, intra-anal, disposable devices made out of soft materials to contain fecal material and prevent it from leaking out of the rectum. The idea of an anal insert for fecal incontinence was first evaluated in a study of 10 participants with three different designs of anal inserts. [1]

Contents

Use

Populations

Anal plugs may be beneficial to certain risk groups including, but not limited to, frail older people, women following childbirth, people with some neurological or spinal diseases, severe cognitive impairment, urinary incontinence, pelvic organ prolapse, and so on. Typically, anal plugs are used in people whose symptoms do not improve with to typical treatments: this may include changes in diet, physical therapy, nerve stimulation targeting the sacral and tibial nerves, surgical repair of the anus, and utilization of a colostomy bag. [2] Nerve stimulation involves the placement of electrodes near the nerves that travel through a person's hips and down their legs. [3] Colostomy bags are bags that collect feces from their intestines through a surgically created hole in a person's belly. [4]

Children with certain conditions, including spina bifida and anal atresia, may struggle with leaks even after physical therapy and other interventions, so they may benefit from using anal plugs. [5] [6] Spina bifida is a birth defect where a part of the spinal cord is not surrounded by the vertebrae; either the spinal cord is still in the back, just not surrounded by the vertebral bones, or it can be bulging out in a sac. [7] Anal atresia is another birth defect where the rectum and/or anus is deformed: fecal incontinence is a side effect. [8]

The one common feature of people who use anal plugs is they all experience fecal incontinence, which is both uncomfortable and embarrassing. Some people may use it temporarily during certain events or while they have certain temporary medical conditions, such as women recovering from childbirth; others may need to use anal plugs for the rest of their lives. Others may opt to also use perineal pads or undergarments such as diapers to prevent the soiling of oneself. Management of fecal incontinence is very person-dependent, as anally inserted devices may not be for everyone.

Benefits

The plug allows individuals control over their bowel movements and may decrease negative side effects due to leakage. People have reported suffering from fewer of anal rashes, decreased soreness, and improved hygiene. [2] Anal plugs can also be an affordable option: some countries with universal healthcare, like Germany, buy anal plugs for people who need them. [9] During the development and approval of the Renew Insert, which is one of the types of anal plugs that have been developed, researchers found that on average people used 2.6 inserts per day. [2] However, this plug is designed to be worn for twelve-hours; the number of inserts needed per day increases when products that have to be changed four times a day are considered. [10]

Whether anal plugs are a good choice varies based on the person. Trials have shown anywhere from 25 to 80% of people were satisfied enough with plug to continue using it. [2]

Drawbacks

People who have to pay for anal plugs out of pocket may find them to be expensive. Although some countries, such as Germany, may subsidize the cost for people, private insurance may not cover anal plugs. [9] Plugs have to be changed a minimum of twice a day, some up to four times per day.

Tolerability

At the same time, discomfort, side effects, and occasional leaks from using anal plugs have been reported. [2] A 2015 systematic review found that anal plugs may be helpful in treating fecal incontinence, provided that they are tolerated and that people actually use them. [11] [12] A 2001 study found that a majority of people could not tolerate an anal plug due to discomfort. Although only 20% decided to continue using the plug on a regular basis, anal plugs were generally successful at controlling fecal incontinence. Since anal plugs are considered an invasive strategy, they can result in pain, soreness, irritation, fecal urgency, and societal embarrassment. [2] Bleeding hemorrhoids were a rare adverse event. [13] There is not a lot of evidence reported on the efficacy on the different types of anal plugs, so the choice of plug can be up to people and their doctors. [2] Some other challenges of the plug include occasional slippage with decreases the efficacy and increases discomfort, but people report more usage for occasions where anal leakage would be publicly troublesome. [2] [13] Anal plugs of smaller volume may resolve some people's discomfort, but still provide coverage for leakage. [13] [14]

Due to the complexity of fecal incontinence, the use of anal plugs are not well defined in guidelines and treatment pathways, which decrease the comfortability of medical professional on prescribing and usage of anal plugs. [2] Therefore, more studies are needed in order for healthcare providers and regular people to understand when anal plugs are an option worth considering.

Products

Anal plugs may come as tampons or inserts as detailed below. Tampons are similar to menstruation tampons, which can expand and absorb substances to prevent leakage. Inserts provide a physical blockage, and are inserted into the rectal cavity to stop feces from escaping. Plugs come in a variety of shapes, sizes, and materials. Polyurethane plugs have been found to be preferred over polyvinyl-alcohol plugs, and are also associated with less plug loss. [11] For all plugs that become stuck in the rectum, it is recommended to see a doctor if it does not come out in the next bowel movement.

Peristeen Anal Plug

The Peristeen (formerly Conveen) Anal Plug produced by Coloplast is a disposable polyurethane insert coated in a water-soluble film. [15] When exposed to warmth and moisture in the anal canal, the film dissolves, allowing the plug to expand. It has a conical tip and a cord to tug on for removal. [16] It comes in two sizes, and is inserted similarly to a suppository. This plug may remain inside the rectum for up to 12 hours.

An assortment of A-tam anal tampons produced by Med SSE-System. Analtampon-1.jpg
An assortment of A-tam anal tampons produced by Med SSE-System.

A-tam Anal Tampon

The polyvinyl-alcohol anal tampons A-tam produced by Med SSE-System in Germany come in various sizes and shapes including cone, cylindrical, spiral, concave, convex, and ball-headed. [9] The different shapes can address different concerns, based on anal sphincter muscle function, remaining muscle tissue, and gassiness. The plug should be soaked in warm water before inserted, similar to some rectal suppositories. While the plugs are single-use, the applicator may be used multiple times. Changing out the plug three times a day every 6-8 hours and anal hygiene are also recommended. A prescription is needed for this product.

Renew Insert

Renew Inserts are single-use silicone plugs that come in two sizes and require a prescription. [10] The large size is recommended for adults, while the regular size may be used for children and young adults. Each plug is made of two attached disks and comes connected to a fingertip applicator which is disposed after insertion. The top disk blocks the stool, while the bottom disk secures the insert in place to prevent displacement. It can be removed either by pulling it out or through defecation, removing the concern of losing the plug in the anal canal. [13]

ProCon2

The ProCon2 device by Incontinent Control Devices, Inc is composed of a blow-up balloon cuff attached to the end of a silicon catheter with vent holes at the tip for flatulence to escape. [17] The catheter is inserted into the anal canal and the balloon cuff is inflated with water or air through a syringe attached to the exposed portion of the catheter. Once inflated, the exposed end of the catheter is pulled until the balloon cuff is met with resistance within the anus. An infrared photo-interruptor sensor in the catheter senses stool in the anal canal, sending a notification to a pager. To remove the device, the catheter is cut to allow the balloon to deflate before pulling it out. Each device is made for single-use only.

SURGISPON anal tampon

The SURGISPON anal tampon is made of a gamma-sterilized gelatin sponge and, unlike the previously mentioned products, is used to stop bleeding in anal and rectal surgeries and post-surgery bleeding and pain. [18] The sponge can absorb up to 45 times its weight, liquefying and eventually being excreted in a bowel movement within 1-2 days. It also has an opening in the middle for gas to escape, and may be used as a carrier for delivery of antibiotics, thrombin, or chemotherapeutics. It is inserted either dry or wet, but for surgeries, it is inserted dry using a proctoscope.

Anal hygiene

Anal cleansing is the practice of proper sanitization and maintaining healthy hygiene in a person's rectal area. It is usually done post defecation. [19] From a science perspective, it helps prevent pathogen exposure, which could lead to infections or diseases. The cleansing process involves rinsing the rectal cavity with water and usually wiping the area with toilet paper or baby wipes. Sometimes, a hand is used for rubbing the area while rinsing it with water. Other times, bidet system could be used instead. [19] A bidet is a plumbing device that is usually installed as a separate unit beside the bathroom tub to wash one's inner buttocks and anal area.

Reasons to maintain anal hygiene:

Maintaining good anal hygiene contributes to an individual overall health. [20] Some of the key benefits include:

  1. It helps prevent infections - maintaining anal hygiene reduces the risk of fungal infections and other bacteria entering the anal area, and eventually entering the whole body.
  2. Prevent UTIs - urinary tract infection is a urinary infection in any part of the urinary system. By ensuring proper wiping and good anal hygiene, the risk of bacteria spreading from the anal area to the urinary tract will be reduced.
  3. Prevent anal fissures - anal fissures are very small tears around the anus. This could be very uncomfortable and painful to an individual. Assuring proper hygiene of the anal area will help reduce the chance of fissures.
  4. Minimize odor; unpleasant smell - having a regular cleansing routine of the anal area will help regulate odor with fecal matter.
  5. Assisting in sexual health and products - anal hygiene is very important for individuals that are sexually active, as well as for those using anal products. [21] It helps reduce the risk of a sexual transmitted infections (STIs); an infection transmitted through sexual contact, and maintain comfort during activities.

Related Research Articles

<span class="mw-page-title-main">Urinary incontinence</span> Uncontrolled leakage of urine

Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geriatric health care. The term enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis. UI is an example of a stigmatized medical condition, which creates barriers to successful management and makes the problem worse. People may be too embarrassed to seek medical help, and attempt to self-manage the symptom in secrecy from others.

<span class="mw-page-title-main">Fecal incontinence</span> Inability to refrain from defecation

Fecal incontinence (FI), or in some forms, encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred to as anal incontinence. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several interrelated factors, including the anal sampling mechanism, and incontinence usually results from a deficiency of multiple mechanisms. The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery, altered bowel habits. An estimated 2.2% of community-dwelling adults are affected. However, reported prevalence figures vary. A prevalence of 8.39% among non-institutionalized U.S adults between 2005 and 2010 has been reported, and among institutionalized elders figures come close to 50%.

In medicine, prolapse is a condition in which organs fall down or slip out of place. It is used for organs protruding through the vagina, rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes called "disc prolapse". Prolapse means "to fall out of place", from the Latin prolabi meaning "to fall out".

<span class="mw-page-title-main">Rectal prolapse</span> Protrusion of the walls of the anus outside the body

A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.

<span class="mw-page-title-main">Colorectal surgery</span> Field in medicine for disabilities in the rectum

Colorectal surgery is a field in medicine dealing with disorders of the rectum, anus, and colon. The field is also known as proctology, but this term is now used infrequently within medicine and is most often employed to identify practices relating to the anus and rectum in particular. The word proctology is derived from the Greek words πρωκτός proktos, meaning "anus" or "hindparts", and -λογία -logia, meaning "science" or "study".

<span class="mw-page-title-main">Fecal impaction</span> Medical condition

A fecal impaction or an impacted bowel is a solid, immobile bulk of feces that can develop in the rectum as a result of chronic constipation. Fecal impaction is a common result of neurogenic bowel dysfunction and causes immense discomfort and pain. Its treatment includes laxatives, enemas, and pulsed irrigation evacuation (PIE) as well as digital removal. It is not a condition that resolves without direct treatment.

<span class="mw-page-title-main">Anal fistula</span> Disease of the anus

Anal fistula is a chronic abnormal communication between the anal canal and the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. Anal fistulae commonly occur in people with a history of anal abscesses. They can form when anal abscesses do not heal properly.

Total mesorectal excision (TME) is a standard surgical technique for treatment of rectal cancer, first described in 1982 by Professor Bill Heald at the UK's Basingstoke District Hospital. It is a precise dissection of the mesorectal envelope comprising rectum containing the tumour together with all the surrounding fatty tissue and the sheet of tissue that contains lymph nodes and blood vessels. Dissection is along the avascular alveolar plane between the presacral and mesorectal fascia, described as holy plane. Dissection along this plane facilitates a straightforward dissection and preserves the sacral vessels and hypogastric nerves and is a sphincter-sparing resection and decreases permanent stoma rates. It is possible to rejoin the two ends of the colon; however, most patients require a temporary ileostomy pouch to bypass the colon, allowing it to heal with less risk of infection, perforation or leakage.

Sacral nerve stimulation, also termed sacral neuromodulation, is a type of medical electrical stimulation therapy.

<span class="mw-page-title-main">Malone antegrade continence enema</span>

A Malone antegrade continence enema (MACE), also known as an appendicostomy or Malone procedure, is a surgical procedure used to create a continent pathway proximal to the anus that facilitates fecal evacuation using enemas.

Bowel management is the process which a person with a bowel disability uses to manage fecal incontinence or constipation. People who have a medical condition which impairs control of their defecation use bowel management techniques to choose a predictable time and place to evacuate. A simple bowel management technique might include diet control and establishing a toilet routine. As a more involved practice a person might use an enema to relieve themselves. Without bowel management, the person might either suffer from the feeling of not getting relief, or they might soil themselves.

<span class="mw-page-title-main">Rectum</span> Final portion of the large intestine

The rectum is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. The adult human rectum is about 12 centimetres (4.7 in) long, and begins at the rectosigmoid junction at the level of the third sacral vertebra or the sacral promontory depending upon what definition is used. Its diameter is similar to that of the sigmoid colon at its commencement, but it is dilated near its termination, forming the rectal ampulla. It terminates at the level of the anorectal ring or the dentate line, again depending upon which definition is used. In humans, the rectum is followed by the anal canal, which is about 4 centimetres (1.6 in) long, before the gastrointestinal tract terminates at the anal verge. The word rectum comes from the Latin rēctumintestīnum, meaning straight intestine.

<span class="mw-page-title-main">Human anus</span> External opening of the rectum

In humans, the anus is the external opening of the rectum located inside the intergluteal cleft. Two sphincters control the exit of feces from the body during an act of defecation, which is the primary function of the anus. These are the internal anal sphincter and the external anal sphincter, which are circular muscles that normally maintain constriction of the orifice and which relax as required by normal physiological functioning. The inner sphincter is involuntary and the outer is voluntary. Above the anus is the perineum, which is also located beneath the vulva or scrotum.

<span class="mw-page-title-main">Anorectal manometry</span> Medical functional test of the anus and rectum

Anorectal manometry (ARM) is a medical test used to measure pressures in the anus and rectum and to assess their function. The test is performed by inserting a catheter, that contains a probe embedded with pressure sensors, through the anus and into the rectum. Patients may be asked to perform certain maneuvers, such as coughing or attempting to defecate, to assess for pressure changes. Anorectal manometry is a safe and low risk procedure.

Rectal discharge is intermittent or continuous expression of liquid from the anus. Normal rectal mucus is needed for proper excretion of waste. Otherwise, this is closely related to types of fecal incontinence but the term rectal discharge does not necessarily imply degrees of incontinence. Types of fecal incontinence that produce a liquid leakage could be thought of as a type of rectal discharge.

<span class="mw-page-title-main">Anismus</span> Failure to relax the pelvic floor muscles during defecation

Anismus or dyssynergic defecation is the failure of normal relaxation of pelvic floor muscles during attempted defecation. It can occur in both children and adults, and in both men and women. It can be caused by physical defects or it can occur for other reasons or unknown reasons. Anismus that has a behavioral cause could be viewed as having similarities with parcopresis, or psychogenic fecal retention.

Obstructed defecation syndrome is a major cause of functional constipation, of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of the rectum with or without an actual reduction in the number of bowel movements per week. Normal definitions of functional constipation include infrequent bowel movements and hard stools. In contrast, ODS may occur with frequent bowel movements and even with soft stools, and the colonic transit time may be normal, but delayed in the rectum and sigmoid colon.

In fecal incontinence (FI), surgery may be carried out if conservative measures alone are not sufficient to control symptoms. There are many surgical options described for FI, and they can be considered in 4 general groups.

Transanal irrigation of the rectum and colon is designed to assist the evacuation of feces from the bowel by introducing water into these compartments via the anus.

<span class="mw-page-title-main">Neurogenic bowel dysfunction</span> Human disease involving inability to control defecation

Neurogenic bowel dysfunction (NBD) is the inability to control defecation due to a deterioration of or injury to the nervous system, resulting in faecal incontinence or constipation. It is common in people with spinal cord injury (SCI), multiple sclerosis (MS) or spina bifida.

References

  1. 1 2 Mortensen, N.; Humphreys, M.S. (1991). "The anal continence plug: a disposable device for patients with anorectal incontinence". The Lancet. 338 (8762): 295–297. doi:10.1016/0140-6736(91)90428-r. ISSN   0140-6736. PMID   1677121. S2CID   37641453.
  2. 1 2 3 4 5 6 7 8 9 How P, Trivedi PM, Bearn PE, Thomas GP (2021). "Insert devices for faecal incontinence". Techniques in Coloproctology. 25 (3): 255–265. doi:10.1007/s10151-020-02317-3. PMID   32870438. S2CID   221381864.
  3. ↑ Dm, Hayden; Eg, Weiss (2011). "Fecal incontinence: etiology, evaluation, and treatment". Clinics in Colon and Rectal Surgery. 24 (1): 064–070. doi:10.1055/s-0031-1272825. ISSN   1530-9681. PMC   3140335 . PMID   22379407.
  4. ↑ Mulita, F.; Lotfollahzadeh, S. (2023). Intestinal Stoma. StatPearls [Internet]. PMID   33351447. NBK565910.
  5. ↑ Shoshan, Levana; Ben-Zvi, Dvora; Katz-Leurer, Michal (2008). "Use of the Anal Plug in the Treatment of Fecal Incontinence in Patients With Meningomyelocele". Journal of Pediatric Nursing. 23 (5): 395–399. doi:10.1016/j.pedn.2006.09.006. PMID   18804021.
  6. ↑ Van Winckel, M.; Van Biervliet, S.; Van Laecke, E.; Hoebeke, P. (2006). "Is an Anal Plug Useful in the Treatment of Fecal Incontinence in Children With Spina Bifida or Anal Atresia?". Journal of Urology. 176 (1): 342–344. doi:10.1016/S0022-5347(06)00302-8. ISSN   0022-5347. PMID   16753439.
  7. ↑ Brea, Cristina M.; Munakomi, Sunil (2023), "Spina Bifida", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32644691 , retrieved 2023-08-01
  8. ↑ Singh, Meenakshi; Mehra, Kashish (2023), "Imperforate Anus", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   31747191
  9. 1 2 3 "A-Tam® Analtampons". www.medsse.de (in German).
  10. 1 2 "About Renew Inserts". Renew Medical.
  11. 1 2 Deutekom M, Dobben AC (2015). "Plugs for containing faecal incontinence". The Cochrane Database of Systematic Reviews. 2015 (7): CD005086. doi:10.1002/14651858.CD005086.pub4. PMC   9058784 . PMID   26193665.
  12. ↑ Carter D (2014). "Conservative treatment for anal incontinence". Gastroenterology Report. 2 (2): 85–91. doi:10.1093/gastro/gou013. PMC   4020129 . PMID   24759347.
  13. 1 2 3 4 Buono K, Davé-Heliker B (2019). "Mechanical inserts for the treatment of faecal incontinence: A systematic review". Arab Journal of Urology. 17 (1): 69–76. doi:10.1080/2090598X.2019.1589776. PMC   6583709 . PMID   31258946.
  14. ↑ Maeda K, Mimura T, Yoshioka K, Seki M, Katsuno H, Takao Y, et al. (2021). "Japanese Practice Guidelines for Fecal Incontinence Part 2-Examination and Conservative Treatment for Fecal Incontinence- English Version". Journal of the Anus, Rectum and Colon. 5 (1): 67–83. doi:10.23922/jarc.2020-079. PMC   7843146 . PMID   33537502.
  15. ↑ "Peristeen® Anal Plug". products.coloplast.com.au.
  16. ↑ Doherty W (2004). "Managing faecal incontinence or leakage: the Peristeen Anal Plug". British Journal of Nursing. 13 (21): 1293–1297. doi:10.12968/bjon.2004.13.21.17116. PMID   15580080.
  17. ↑ Giamundo P, Welber A, Weiss EG, Vernava AM, Nogueras JJ, Wexner SD (2002). "The procon incontinence device: a new nonsurgical approach to preventing episodes of fecal incontinence". The American Journal of Gastroenterology. 9777 (9): 2328–2332. doi:10.1111/j.1572-0241.2002.05987.x. PMID   12358252. S2CID   10868008.
  18. ↑ "Anal Tampon Hemostatic Sponges". George & Georges MediSurg Limited.
  19. 1 2 McMahon, Shannon; Caruso, Bethany A.; Obure, Alfredo; Okumu, Fred; Rheingans, Richard D. (2011). "Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya: Anal cleansing practices and faecal contamination". Tropical Medicine & International Health. 16 (12): 1536–1540. doi: 10.1111/j.1365-3156.2011.02879.x . PMID   21906214.
  20. ↑ Chen, Ying; Bruning, Elizabeth; Rubino, Joseph; Eder, Scott E (2017). "Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage". Women's Health. 13 (3): 58–67. doi:10.1177/1745505717731011. ISSN   1745-5065. PMC   7789027 . PMID   28934912.
  21. ↑ Leichliter, Jami S.; Chandra, Anjani; Liddon, Nicole; Fenton, Kevin A.; Aral, Sevgi O. (2007-12-15). "Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States". The Journal of Infectious Diseases. 196 (12): 1852–1859. doi: 10.1086/522867 . ISSN   0022-1899. PMID   18190267.
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