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.

Twenty-three small trials, involving 1806 women, were found. The results of these trials 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 trials to assess quality of life during and after treatment, but few of these trials did. Most of the trials were of fairly short duration, so it is difficult to say what happens to women with stress urinary incontinence in the longer term.

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 trials, that use comparable and relevant outcomes, are completed. Cones could be offered as one treatment option, if women find them acceptable.

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Background: 

For a long time pelvic floor muscle training (PFMT) has been the most common form of conservative (non-surgical) 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: 

The objective of this review is to determine the effectiveness of vaginal cones in the management of female urinary stress incontinence (SUI).

We wished to test the following comparisons in the management of stress incontinence:
1. vaginal cones versus no treatment;
2. vaginal cones versus other conservative therapies, such as PFMT and electrostimulation;
3. combining vaginal cones and another conservative therapy versus another conservative therapy alone or cones alone;
4. vaginal cones versus non-conservative methods, for example surgery or injectables.

Secondary issues which were considered included whether:
1. it takes less time to teach women to use cones than it does to teach the pelvic floor exercise;
2. self-taught use is effective;
3. the change in weight of the heaviest cone that can be retained is related to the level of improvement;
4. subgroups of women for whom cone use may be particularly effective can be identified.

Search strategy: 

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 19 September 2012), MEDLINE (January 1966 to March 2013), EMBASE (January 1988 to March 2013) 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: 

Two reviewers independently assessed studies for inclusion and trial quality. Data were extracted by one reviewer and cross-checked by the other. Study authors were contacted for extra information.

Main results: 

We included 23 trials involving 1806 women, of whom 717 received cones. All of the trials were small, and in many the quality was hard to judge. Outcome measures differed between trials, making the results difficult to combine. Some trials reported high drop-out rates with both cone and comparison treatments. Seven trials were published only as abstracts.

Cones were better than no active treatment (rate ratio (RR) for failure to cure incontinence 0.84, 95% confidence interval (CI) 0.76 to 0.94). There was little evidence of difference for a subjective cure between cones and PFMT (RR 1.01, 95% CI 0.91 to 1.13), or between cones and electrostimulation (RR 1.26, 95% CI 0.85 to 1.87), 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 seven trials used a quality of life measures and no study looked at economic outcomes.

Seven of the trials recruited women with symptoms of incontinence, while the others required women with urodynamic stress incontinence, apart from one where the inclusion criteria were uncertain.

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