Vaginal Cones Are Better Than Nothing for Urinary Incontinence

The use of vaginal weights to strengthen the pelvic floor muscles as a management strategy for stress urinary incontinence in women is better than no active treatment, concluded an intervention review conducted by the Cochrane Incontinence Group.¹

Stress urinary incontinence is characterized by the leakage of urine when coughing, sneezing, or exercising and is a common condition among women. Approximately one third of all women will experience stress urinary incontinence after giving birth. The most common treatment of this condition is pelvic floor muscle training (PFMT), with Kegal exercises being the most commonly known method. Another method for strengthening the pelvic floor muscles is the insertion of cone-shaped weights into the vagina; to prevent the weights from slipping out, the pelvic floor muscles must remain contracted.

There were 23 studies involving 1806 women included in this review. Of the 1806 participants, 717 women received weighted cones. This review was limited because the included studies were small, and the quality of each study was difficult to judge. Seven trials were published as abstracts only. In addition, the review authors reported that the study results were difficult to combine because the outcome measures varied greatly between trials.

The available evidence indicated that the use of weighted cones was better than no active treatment; the reported rate ratio for failure to cure incontinence was 0.84. As a subjective cure for stress urinary incontinence, there was little difference between the use of cones and PFMT or between cones and electrostimulation. The researchers were unable to determine if there was any difference between cones and PFMT in combination and cones alone or PFMT alone because of a lack of evidence. None of the studies reported economic outcomes, and only 7 trials included a quality of life measure.

The most significant barrier to this form of treatment is lack of acceptance. If a woman is willing to try them, weighted vaginal cones should be offered as a treatment option for stress urinary incontinence, suggested the review authors. This treatment is not for everyone; some women find cone-shaped vaginal weights to be unpleasant and difficult to use. The authors advised that these results should be considered tentative until larger, high-quality studies that use relevant and comparable outcomes, such as quality of life, are conducted and their results reported.

Pertinent Points:
- There is some evidence that weighted vaginal cones are better than no active treatment for women with stress urinary incontinence.
- The effectiveness of weighted vaginal cones is similar to that of traditional pelvic floor muscle training techniques and electrostimulation.

References:

1. Herbison GP, Dean N. Weighted vaginal cones for urinary incontinence. Cochrane Database Syst Rev. 2013;7:CD002114. DOI: 10.1002/14651858.CD002114.pub2.