Faecal incontinence is defined as the involuntary passage of faecal material through the anal canal and is a common and embarrassing problem. Different treatments exist, including dietary measures, drugs, specialized physiotherapy of the pelvic floor and surgery. However, not all patients can be cured. These patients might be helped by using anal plugs. Different types of anal plugs are known, all aiming to block the loss of stool to control their incontinence. Aim of this review was to assess the performance of different types of anal plugs for containment of faecal incontinence.
Four studies with a total of 136 participants were included. Two studies compared the use of plugs versus no plugs. The involuntary loss of stool was effectively blocked (pseudo-continence) in six (38%) participants who continued to use the plugs, at least in the short-term. One study compared two sizes of the same brand of plug, due to the high dropout in this study and the incomplete data, no results concerning this comparison are available. In one study a comparison of two different brands of plug was made. Loss of plug was reported by 7 patients (30%) with a polyurethane (PU) plug and by 15 patient (65%) with the polyvinyl-alcohol (PVA) plug. Overall satisfaction, defined as patients' opinion that the plug was good to very good, was reported more often for the PU plug (n=17) than for the PVA plug (n=8).
In all included studies there was considerable dropout; in total 48 participants (35%) dropped out before the end of the study for varying reasons. Data presented are thus subject to potential bias, and only tentative conclusions are possible. The available data suggest that anal plugs can be difficult to tolerate. However, if they are tolerated they can be helpful in preventing incontinence. Plugs could then be useful in a selected group of people either as a substitute for other forms of management or as an adjuvant treatment option. Plugs come in different designs and sizes; the review showed that the selection of the type of plug can impact on its performance.