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Have any of you guys or gals tried using anal tampons (disposable anal plugs) to help control your fecal incontinence? It is not a subject that receives a lot of public discussion.

Anal tampons or plugs are devices that are worn internally to provide a barrier to prevent anal leakage. They can be either single-use or reusable. What distinguishes anal plugs from other attempts at containment is that they effectively prevent the odors normally associated with fecal incontinence. When effective for the user, anal tampons can permit those who are only bowel incontinent to skip the use of a diaper.

It may come as a surprise to some that many with bowel incontinence experiment with various feminine hygiene tampons for use as an anal plug to help control bowel accidents. They may not completely block defecation, but usually are effective enough to provide the wearer with the control, and time, to find a restroom. I used them successfully while traveling through three countries in Europe.

If you try using feminine hygiene tampons for fecal incontinence, you may be surprised to learn that they expand in a variety of dimensions and shapes. Some elongate, some expand primarily in width, and others expand both in width and length. Those that expand radially in width are more desirable for our intended use.

The best performer of which I am aware (and have tested) is the O.B. brand of feminine hygiene tampon. This tampon lacks an applicator and is inserted by a finger. The base of this tampon can be flared with the string just prior to insertion to create a cavity for the finger. The flaring also contributes to the “flowering” of the tampon once it becomes moist. As this tampon does not require the use of an applicator, it is much smaller than most tampons and more easily concealed. Some form of lubricant is necessary. Small packets of surgical lubricant are great for this purpose and easily concealed. The tampon is expelled at defecation or can be removed by pulling on the string. It is recommended not to flush the tampons down the toilet. Wrap them in toilet paper and dispose of them in the trash.

Feminine hygiene tampons that are larger (and thus highly absorbent) are more likely to provide a more effective anal plug. As our individual rectal anatomies can vary, this may not be the case for all. As they were designed to be used in an environment that is moister than the rectum, these tampons are far more absorbent than we need for use anally. Initially upon insertion large tampons may feel dry and irritating. After inserting the tampon, it can be helpful to use a small syringe (the size of an ear syringe) and inject about 1 ounce of water into the rectum. Upon absorbing this liquid, the tampon will become softer and more comfortable and will begin to expand, becoming more effective as a plug. Anal tampons can be removed by pulling on the string, usually just prior to having a bowel movement. They normally should not be left in the rectum for more than 12 hours. Upon being removed, the used tampon can be wrapped in toilet paper and put in a small plastic baggie for disposal.

Medical anal tampons also are available, manufactured specifically for bowel incontinence. Tomorrow I will post more about these professional anal plugs.

--John

I swear I have way too much experience with incontinence in general....

Yeah, I've been there- done that. My proctologist had once recommended I temporarily use a anal tampon when my bleeding anal fissure was so bad it was causing me to leak stool too. (thank god I'm always diapered anyways) Well, this and combined with a medicated ointment called proctozone and a weird foam called proctofoam. Since it was temporary he gave me the option to get a prescription tampon, or to just buy one over the counter made for women's menstruation. Pro tip- remove the tampon from the applicator before trying to insert it!

Thankfully it was only temporary (about a month or so), but it did work. I have to say it took a LOT of getting used to having something always in there, but it was never painful. In fact, it was probably better of a relief overall as I didn't have a constant buildup of blood and poo to irritate me into making things perpetually worse. Luckily for me, this gave me enough of a rest to focus on strengthening my anal sphincter enough to where the bleeding is now usually stopped (it still comes every month or so then after a few days heals closed again). I do not have bowel leakage anymore but still have little ability to hold back gas, and I did not ever try the prescription tampons though.

Thanks for this useful tip. My bowel incontinence is somewhat predictable, so I would only need to use these when I'm using a liquid diet. Still, knowing that they are available and that they work will be valuable when the time comes.

I have posted about the use of feminine hygiene tampons to aid in controlling fecal incontinence. Most may not be aware that there also are professional medical anal tampons.

Single-use disposable anal plugs, such as the Peristeen anal plug, usually consist of devices that look like small tampons that are inserted into the anus to block the passage of stool. Such anal plugs can be highly effective. A lubricant is used to coat the plug prior to insertion. A string or tape attaches to the perineum for retrieval. Anal plugs are not 100% efficient, particularly with regard to diarrhea, but should provide most users the time necessary to find a toilet.

When plugs are available in more than one size, it is recommended to begin with the smallest size. Some vendors provide a sample kit of plugs in various sizes to make this easier.

A certain amount of hand dexterity is necessary to insert and remove the anal plug. The plugs expand after they are inserted into the anal canal. The plugs can be removed either by pulling on the string or during a normal bowel movement.

Not everyone tolerates anal plugs well and there is a high dropout rate among users. Some find the plugs to be irritating, difficult to tolerate, or difficult to retain. Nonetheless anal plugs are considered highly effective for those who tolerate them.

Disposable anal plugs are not inexpensive and your health insurance may not cover them.

One advantage of the anal plug is that it is quick and convenient to use. They can be used selectively only for social events, if desired. Anal plugs also can be used in combination with pullups or diapers, if desired.

Although a wide variety of disposable anal plugs are available in Europe, in the U.S., the only disposable anal plugs currently approved by the FDA are the Coloplast Peristeen Anal Plug and the Renew inserts. Of the two, some medical studies found that patients generally expressed more satisfaction with the Peristeen plug.

The Peristeen Anal Plug consists of a soft foam device about the size of a suppository that looks like a small tampon. A thin, water-soluble film covers the plug. Using a lubricant, it is inserted into the anus, with a gauze string remaining to facilitate withdrawal. Using the warmth and moisture of the anus, the film will dissolves within 30 or more seconds, allowing the plug to expand into a cup-like shape. The plug expands in width to 3 to 4 times its original size, shaping itself to the shape of the anus and blocking the leaking of feces. The plug is made of porous, slightly absorbent foam that is able to let flatulence pass through it. It may be left in place for 12 hours and must be removed for a bowel movement. It is a disposable, single-use device.

In 2012 the FDA approved a new device for the management of accidental bowel incontinence – Renew Inserts. Renew Inserts consist of a soft silicone insert and a soft, deformable plastic fingertip applicator that is removable. The Inserts come in Regular and Large sizes (uses are advised to try the Regular size first). The inserts are for single use only, but may be worn continuously, day and night.

The user inserts the Renew Insert through the anus and into the anal canal. The insert has a soft disk that will expand once inserted into the rectum. The top disk of the Insert rests against the bottom of the rectum to help prevent bowel leakage. The elastic stem of the Insert passes through the anus to the bottom disk that remains outside the anus. The bottom disk keeps the Insert in place by resting against the outer part of the anus. The applicator is discarded after use. The insert is naturally expelled during a normal voluntary bowel movement, or can be manually removed, if desired. During trials most users found the device to be easy to use and reported a high degree of satisfaction with the device.

Reusable devices also are available. One example of a reusable device is the ProCon2 Catheter. The user inserts a single-use disposable balloon cuff silicone catheter into the rectum and inflates the balloon cuff. After inflation, the balloon acts like a plug, preventing the loss of stool. A filter permits gases to escape. For a bowel movement, the balloon must be deflated and the device is removed. A prescription is required. The device is intended for use when other measures have failed. The ProCon2 is sold by Incontinence Control Devices. As is the case with most such medical devices, the cost usually is not insignificant if not covered by insurance.

An order of Peristeen anal plugs are en route to me and I will post my observations after some time for a reasonable trial.

--John

I promised to post my review of the Coloplast Peristeen anal plug after I had a chance to test it. I believe this is the only such review anywhere, outside of medical papers.

My test of the Coloplast Peristeen anal plug was a huge success. I wore the plug on multiple occasions during a three-week period, both during the day and overnight and it worked effectively for me every time.

Despite my satisfaction with the plug, I can understand why some people do not tolerate it well. The plug absolutely must be positioned correctly by being inserted deep enough - past the internal anal sphincter - or it will be uncomfortable. Insertion must not be hesitant as the outer protective film will dissolve and the plug will begin to expand after 30 seconds. The anus and the plug both must be very well lubricated in advance and then the plug should be inserted deeply in one smooth motion.

Once inserted, the plug is not uncomfortable, but the presence of something in the rectum definitely can be felt. The sensation can be a bit annoying, although I felt that was a small price to pay for the benefits.

Removal of the plug is accomplished while sitting on the toilet by pulling on the flat gauze string. The process was not uncomfortable.

On two occasions the plugs saved me from having bowel accidents – once right in the middle of a class I was teaching. Otherwise I would have suffered a most humiliating public fecal accident.

I think a phrase I read in a medical paper about the use of enemas for fecal incontinence also may apply here - “well-motivated patients tolerate the procedure well.” If you are FI and searching for a new solution, this may be worth a try.

The Peristeen anal plug worked so well for me that I am adding it to my incontinence “bag of tricks” on a permanent basis. I will not be using them daily, primarily on those days when I do not use enemas (my usual therapy to manage my fecal incontinence) or when there are important social events.

As I am double incontinent, I will need wear a diaper even when I use a plug. However, if you are not also urinary incontinent, the Peristeen anal plug offers you the advantages of no odor and no diaper bulges.

Peristeen anal plugs come in two sizes - once expanded they are 37mm and 45mm in diameter. Peristeen plugs are sold by the case or in a box of 20 anal plugs, each individually wrapped. A plug will fit in your pocket and you would not even notice it. The package includes a small tube of lubricating gel. I would save that gel for when you are out of the home in case you need to change anal plugs. At home I would use ordinary surgical lubricant.

--John

Thank you for this review. Your information makes it seem especially useful for me when I'm on a liquid diet.

I again want to tell all my fellow sufferers of bowel incontinence how satisfied I am with the Peristeen anal plug as a means of managing fecal incontinence. However, there was a small learning curve and here is a small tip that may be helpful for those contemplating trying an anal plug.

In using the Peristeen anal plug, I have found that, for comfort, the anal plug must be inserted just a bit more deeply than many people (including me) can reach with their fingers. In such an instance, it may be necessary to use a makeshift “tool” as a “pusher.” Choose a narrow object with a smooth and rounded tip (definitely not pointed). I have used a flexible nozzle designed for Barium enemas as it is both safe to insert and easy to clean. After manually inserting the lubricated anal plug, I use the nozzle to nudge the plug inward about another ¾.” This makes a significant difference in comfort and my ability to tolerate the plug. When properly inserted (deeply), the plug is almost insensate and you forget it is there.

--John

Interesting tip. Are you saying you insert the plug past your anal sphincter though? I though it had to be sticking out just a slight bit in order to work properly.

I have an appointment with my gastroenterologist tomorrow. I intend to ask him about this. Thanks for the information.

To clarify, the anal plug, despite the name, is not left sticking into the anus. That would be exceedingly uncomfortable. It must be inserted completely past the internal anal sphincter. It expands and "plugs" at the inside of the internal anal sphincter. Although the manufacturer and I use the term "plug," it actually expands and forms a curved barrier that is pushed by feces against the internal sphincter to form a blocking "plug."

Once the plug has expanded it then stays in position. There also is a sturdy gauze cloth strip for removing the plug, so there is no danger of the device becoming "lost" in the rectum. Once inserted I pull the gauze string up into the crack of my buttocks and it remains there until removal. I don't notice it.

The first time I used the Peristeen anal plug I made the mistake of not inserting the plug well and left some of it in the anus. Once the plug expanded that was so uncomfortable that I immediately removed it.

Next I learned to insert the plug a little better. I then was able to tolerate the sensation of having the plug and benefited from its effectiveness. However, I still could feel the plug. It was not exactly uncomfortable but was annoying. However, an article I read indicated that many people did not have long enough fingers or agility for proper insertion. That made me think that perhaps I still was not inserting it deeply enough. I then experimented using a "pusher" to achieve slightly deeper insertion and that was a big success. When properly inserted you do not notice the plug.

I just wish the manufacturer had provided better directions. However, I suspect that the manufacturer expected the user to receive instruction as to its use from a nurse in a clinic. As it is relatively new in the U.S. there is not a lot of useful information here.

I am completely satisfied with the Peristeen anal plug and have had absolutely no fecal leakage at all when wearing one. I wish I could say that about other incontinence products. To let you know how securely the plug performs its blocking function in the rectum, once it has been inserted and has expanded, I am unable to evacuate the plug by using anal muscles alone, even when bearing down and straining. I have no such difficulty when pulling on the gauze strip.

--John