User:Keochui ucsf/Anal plug

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Not to be confused with butt plug or rectal dilator or anal fistula plug.

An anal plug (anal tampon or anal insert) is a medical device that is often used to treat fecal incontinence by physically blocking involuntary loss of fecal material.^{[1] [2]} They vary in design and composition, but they are typically single-use intra-anal disposable devices made out of soft materials for containing fecal material.^[2] The idea of anal insert for fecal incontinence first evaluated in a study of 10 participants with three different designs of consul anal inserts.

Use

Populations

Anal plugs may be beneficial to certain risk groups including, but not limited to, frail older people, women following childbirth, people with neurological or spinal disease, severe cognitive impairment, urinary incontinence, pelvic organ prolapse, and so on. Typically, anal plugs are used in patients 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, etc. 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. The one common feature of people who use anal plugs is they all experience fecal incontinence.

Pros and Cons

The plug allows individuals control over their bowel movements and may decrease negative side effects due to leakage. Decreases in the number of anal rashes, general soreness, and smelling like feces have been reported.

At the same time, people have reported that the plugs may be difficult to insert or keep in place. Leaks do still occur, just less frequently. Some patients may also find plugs are uncomfortable.

^ how many inserts on average are used per day (ref 5 says 2.6)

Products

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.

Peristeen Anal Plug

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

A-tam Anal Tampon

The polyvinyl-alcohol anal tampons A-tam produced by Med SSE-System in Germany are similarly made of foam and come in various sizes and shapes including cone, cylindrical, spiral, concave, convex, and ball-headed. The different shapes add additional functionality, based on anal sphincter muscle function, remaining muscle tissue, and gassiness. A starter assortment of individually packaged plugs is initially sent so the best shape and size can be chosen. The plug is soaked in warm water before insertion, and 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.

Renew Insert

Renew Inserts from Renew Medical are single-use silicone plugs that come in two sizes. Each plug is made of two attached disks and comes connected to a fingertip applicator which is disposed after insertion. It can be removed either by pulling it out or through defecation, removing the concern of losing the plug in the anal canal.

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. The catheter is inserted into the anal canal and the balloon cuff is inflated with water 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.

Vaginal Plugs

The Eclipse System Vaginal Insert is a silicone coated stainless steel base device, and is also a pressure regulated pump. There is a dual layer balloon on the posterior side of the device, used to provide reversible occlusion of the rectum and helps with bowel movement for the user. The inflated balloon places pressure on the rectum, which keeps the stools from passing. During the evacuation of faeces, the insert get deflated instead of removed. In addition, the device should be removed for cleaning once a week, and prior to any sexual activity.

Tolerability and Risks

A 2015 systematic review found that anal plugs may be helpful in treating fecal incontinence, provided that they are tolerated and that people comply with them. A 2001 study found that a majority of people could not tolerate that majority of patients cannot tolerate an anal plug due to discomfort. Only 20% wished to continue the plug on a regular basis, however it was successful at controlling fecal incontinence. Anal plugs are considered an invasive strategy, which can result in pain, soreness, irritation, fecal urgency, and societal embarrassment. Bleeding hemorrhoids were a rare adverse event. There is not a lot of evidence reported on the efficacy on the different types of anal plugs. 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. Anal plugs of smaller volume may resolve some people's discomfort.

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.

References