Tampons for Urinary Incontinence and Pelvic Organ Prolapse
A specially designed vaginal tampon (Tampsec™) can effectively reduce stress urinary incontinence episodes by providing mechanical urethral support, achieving a ≥50% reduction in pad weight in 70% of women, though standard menstrual tampons are not designed for this purpose and lack evidence for efficacy. 1
Mechanism and Evidence for Vaginal Tampons
Specialized Incontinence Tampons
The Tampsec™ vaginal tampon works by mechanically supporting the urethra and bladder neck, similar to continence pessaries, restoring the urethrovesical angle and providing compression to prevent urinary leakage during activities that increase intra-abdominal pressure. 2
In a randomized controlled trial, women using the Tampsec™ tampon achieved a ≥50% reduction in pad weight in 69.9% of cases versus 26.1% in controls (RR 2.7; 95% CI 1.3-5.4), with 60.9% reporting successful treatment on the Patient Global Impression of Improvement questionnaire versus 17.4% of controls. 1
The tampon group experienced significantly greater decreases in stress urinary incontinence episodes per day (mean 2.0±2.2 vs 0.5±1.1; p = 0.007) and demonstrated good tolerance and usability in most women. 1
Position in Treatment Algorithm
Conservative management should be first-line treatment before considering surgical options:
Pelvic floor muscle training (PFMT) is the recommended first-line treatment for stress urinary incontinence, with up to 70% improvement in symptoms when properly performed, and can reduce urinary incontinence by 62% during pregnancy and 29% at 3-6 months postpartum. 2, 3
Continence pessaries and vaginal inserts are positioned alongside PFMT as key conservative modalities for women with stress urinary incontinence or stress-predominant mixed incontinence who prefer non-surgical management. 2
Specialized vaginal tampons like Tampsec™ represent an alternative conservative option that can be used throughout the day for mechanical support, particularly suitable for women not bothered enough to pursue surgical therapy. 2, 1
Comparison to Other Conservative Options
Pessaries vs Tampons
Continence pessaries work through the same mechanical principle as specialized tampons—supporting the urethra and bladder neck to restore the urethrovesical angle. 2
Ring pessaries are the most commonly used type for incontinence, though there are no comparative data on different pessary types for stress urinary incontinence management. 2
A critical limitation is that pessary recommendations are classified as "Expert Opinion" rather than evidence-based recommendations, reflecting the lack of high-quality comparative trials. 2
Pessaries may result in a large increase in risk of adverse events compared with PFMT (RR 75.25,95% CI 4.70 to 1205.45), including increased vaginal discharge, increased urinary incontinence, and erosion or irritation of vaginal walls. 4
Combined Approaches
Pessary plus PFMT probably leads to more women perceiving improvement in their prolapse symptoms compared with PFMT alone (RR 2.15,95% CI 1.58 to 2.94) at 12 months follow-up. 4
At 12 months, pessary plus PFMT probably improves women's prolapse-specific quality of life compared with PFMT alone (median POPIQ score: pessary plus PFMT 0.3 vs PFMT only 8.9; P = 0.02). 4
Important Caveats and Clinical Considerations
When Conservative Management Is Insufficient
If conservative treatment with PFMT, weight loss (for obese patients), and mechanical devices fails after at least 3 months, surgical options should be considered based on symptom severity and patient preference. 2
Midurethral slings are the most extensively studied surgical option with 84% cure rates, while autologous fascial slings show 66-85% success rates at 3-15 years follow-up. 5, 2
Diagnostic Considerations
Up to 60% of women presenting with pelvic organ prolapse are also diagnosed with urinary incontinence, and close to 40% of women presenting with urinary incontinence have some degree of pelvic organ prolapse. 6
All women with lower urinary tract symptoms should be screened for pelvic organ prolapse, as prolapse beyond the hymen may either cause or mask lower urinary tract dysfunction. 6
Urodynamics should be reserved for non-index patients with complicating features such as prior anti-incontinence surgery, significant urgency symptoms, mixed urinary incontinence, or unconfirmed stress urinary incontinence. 7
Standard Menstrual Tampons
Standard menstrual tampons are not designed or tested for urinary incontinence management and lack evidence for efficacy or safety in this indication—only specialized devices like Tampsec™ have demonstrated benefit in clinical trials. 1