Caps, Patches, and Inserts

By Barbara C. Bourassa

If you suffer from stress incontinence, you may be familiar with a number of devices designed to help prevent accidents or leaks. Generally speaking, these include three types of products: caps, patches, and inserts. While some women have had success with such devices, each type has pros and cons that you should take into account before use.

The term cap refers to a small, hollow device that fits over the external opening of the urethra. This silicone device comes with a sealing ointment that helps create suction to keep it in place. A cap works by "blocking the urine at the opening of the urethra without entering the sterile environment of the urethral tract," says Joan Marie Bengston, MD, an associate gynecologist with Brigham & Women's Hospital in Boston. The cap, which is available by prescription only, can be washed and dried and reused a few times. It must be removed before voiding, however.

The main problem with this device, says Bengston, is that "it is stuck on the outside, in a sensitive area. Patients are very aware of the device." For this reason, some women chose to use a cap only in certain instances, such as during exercise, when the risk of leakage is high.

In some cases, there's another drawback to the cap. "It's good to keep urine inside the urethra, but it's better to keep it inside the bladder," Bengston explains. When urine is in the urethra, the nerve receptors in the urethra may signal the bladder to contract. This can inadvertently cause urge incontinence, she notes, which is marked by sudden loss of urine or leakage.

The patch and the cap work in basically the same way: to block urine at the opening of the urethra. The patch, a soft foam pad about the size of a stamp, is stuck between the labia. If you need to urinate, you remove the patch.

Both types of devices are "good for a specific use, safe, and can keep the underclothes dry," says Bengston. The drawbacks to the patch, however, are that many people don't like the feel of the device in that area and that the adhesive may not work well in such a moist region of the body, she notes.

Urethral inserts, the third category of product for preventing leaks, work differently. This slim device is actually inserted into the urethra to "plug" it and prevent urine from escaping. Although the device is effective at keeping patients dry in theory, Bengston and many other bladder health experts do not prescribe these devices. The rate of infection, they say, is simply too high.

Although some women rely on tampons to prevent leaks, Bengston says that there are some drawbacks that all women should be aware of. "A tampon has to be changed regularly, as it obstructs the vaginal flow," she explains. "Also, because it's a dry device, it may abrade the vaginal opening, and if she's wearing one all the time, I would worry about infection and irritation."

In fact, although Bengston offers caps and patches to her patients, she actually prefers pessiaries over all of these "quick-fix" devices. For more information on pessiaries, consult your physician and visit Incontinence Rings and Pessaries.