Weighted vaginal cones for urinary incontinence
Abstract
Background
For a long time pelvic floor muscle training (PFMT) has been the most common form of conservative treatment for stress urinary incontinence (SUI). Weighted vaginal cones can be used to help women to train their pelvic floor muscles. Cones are inserted into the vagina and the pelvic floor is contracted to prevent them from slipping out.
Objectives
To evaluate the effectiveness of weighted vaginal cones in the treatment of female SUI.
Search methods
We searched the Cochrane Incontinence Group Specialised Trials Register (searched 25 June 2007), MEDLINE (January 1966 to June 2007), EMBASE (January 1988 to June 2007) and reference lists of relevant articles.
Selection criteria
Randomised or quasi‐randomised controlled trials comparing weighted vaginal cones with alternative treatments or no treatment.
Data collection and analysis
Three reviewers independently assessed studies for inclusion and trial quality. Data was extracted by one reviewer and cross checked by the others. Study authors were contacted for extra information.
Main results
Seventeen studies, involving 1484 women of whom 646 received cones, were included. All of the trials were small, and in many the quality was hard to judge. Outcome measures differed between studies, making the results difficult to combine. Some studies reported high dropout rates with both cone and comparison treatments. Six trials were published only as abstracts.
Cones were better than no active treatment (RR for failure to cure incontinence 0.88, 95% CI 0.79 to 0.98). There was little evidence of difference between cones and PFMT (RR 1.00, 95% CI 0.91 to 1.11), or electrostimulation (RR 1.00, 95% CI 0.86 to 1.13), but the confidence intervals were wide. There was not enough evidence to show that cones plus PFMT was different to either cones alone or PFMT alone. Only three studies used a quality of life measure and no study looked at economic outcomes.
Four of the studies recruited women with symptoms of incontinence, while the others required women with urodynamic stress incontinence, and the inclusion criteria for one trial were uncertain.
Authors' conclusions
This review provides some evidence that weighted vaginal cones are better than no active treatment in women with SUI and may be of similar effectiveness to PFMT and electrostimulation. This conclusion must remain tentative until larger, high‐quality studies, that use comparable and relevant outcomes, are completed. Cones could be offered as one treatment option, if women find them acceptable.
Plain language summary
Vaginal weights for training the pelvic floor muscles to treat urinary incontinence in women
Leaking urine when coughing, sneezing, or exercising (stress urinary incontinence) is a common problem for women. This is especially so after giving birth, when about one woman in three will leak urine. Training of the pelvic floor muscles is the most common form of treatment for this problem. One way that women can train these muscles is by inserting cone‐shaped weights into the vagina, and then contracting the pelvic floor muscles to stop the weights from slipping out again.
Seventeen small studies, involving 1484 women, were found. The results of these studies consistently showed that the use of vaginal weights is better than having no treatment. When vaginal weights were compared to other treatments, such as pelvic floor muscle training without the weights, and electrical stimulation of the pelvic floor, no clear differences between the treatments were evident. This may have been because the numbers of participants in the trials were small, and larger numbers may be required for any differences in the effectiveness of treatments to become clear.
Some women find vaginal weights unpleasant or difficult to use, so this treatment may not be useful for all women.
Many women with stress urinary incontinence will not be cured by these treatments, and so it is important for studies to assess quality of life during and after treatment, but few of these studies did. Most of the studies were fairly short term, so it is difficult to say what happens to women with stress urinary incontinence in the longer term.
