Anal plugs
What are anal plugs?
Anal plugs are shaped foam products that are inserted into the rectum to prevent the leakage of stool. They are made from medical grade foam that is slightly absorbent but can allow air to pass through. They are covered in a dissolvable film that keeps the plug in a size and shape similar to a suppository or small tampon for easy insertion. Once inserted, moisture from the lining of the rectum dissolves the film and the anal plug expands to a cup or mushroom shape. They have a string attached for easy removal. They can stay in place for a maximum of 12 hours but must be removed in order to pass stool.
Anal plugs work well for many people who experience a positive effect on their quality of life from them; however, their effectiveness has been found to vary and some people are unable to use them. 345
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Anal plug
| More likely to suit you if... |
Less likely to suit you if... |
- You wish to prevent leakage for a specific period e.g. During exercise or after an enema or rectal irrigation
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- You have disease of the bowel or rectum
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- Your leakage is associated with spina bifida, anorectal malformation, rectal sphincter damage / tear
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- You have spinal cord injury and are at risk from autonomic dysreflexia
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- Want to prevent leakage or sometimes must rush to the toilet to avoid leakage
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- Using a device is unacceptable to you
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- Have poor hand control and may find anal plugs difficult to insert and remove.3
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- You have an established bowel routine that might be disrupted by use of the devices
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What about fitting?
Correct fitting is important for comfort and to ensure they have the best chance of working. Anal plugs are available in different sizes. You are recommended to try the smallest size first and to ask a health care professional with experience of anal plugs for help.
Correct insertion is very important. They are inserted like a suppository using a lubricant gel. They must be inserted into the anal canal and not allowed to inflate near the entrance or lower end of the anal canal.
They are removed by pulling on the string. If you have difficulty gripping small items you might find this difficult. Try wrapping the string around a finger and then gently pulling. Alternatively they may be expelled by raising intra-abdominal pressure and pushing as during normal bowel movements (defecation).
What other products could ‘mix and match’ well with anal plugs?
If you have sensation around the bowel and find anal plugs uncomfortable, you might still find them tolerable for short periods whilst doing certain activities and prefer to use an alternative product such as pads the rest of the time.
Disadvantages of anal plugs
Some people find anal plugs:
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Difficult to insert and remove, and to retain in the anus.34678
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Uncomfortable. 345679 Anal plugs can cause local irritation, although they should not cause pain.10
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When in position, cause a sensation of the need to pass stool.4 This may be more of a problem for men than women.11
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Are not always effective and there is always the possibility of leakage from the product onto clothes or furniture.
How should I dispose of used anal plugs?
They can be placed in a nappy sack and disposed of in the normal household waste. They are not biodegradable and so should not be flushed down the toilet.
Where can I get anal plugs?
How you get anal plugs and where they are available varies according to local healthcare systems. Speak to your healthcare professional or contact the supplier using the link below.
Anal Inserts
Anal inserts are intended to work much like anal plugs but are made of soft silicone, with two disks connected by a soft spindle. They are inserted into the anus using a rigid applicator. The top (inner) disk is designed to sit inside the anus, forming a seal, while the outer (bottom) disk remains outside the anus to prevent the device from moving into the rectum.
In one research study, most women with bowel leakage who tested anal inserts found their bowel leakage was reduced by at least half and were very satisfied with the device. However, some women experienced discomfort, a feeling of needing to pass stool, and displacement of the insert into the rectum (although this was resolved with expulsion of the device during bowel movements).12
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Anal insertWhere can I get anal inserts?
How you get anal inserts and where they are available varies according to local healthcare systems. Speak to your healthcare professional or contact the supplier using the link below.
Faecal incontinence pads
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Butterfly faecal padFaecal pads are designed specifically for bowel leakage and are shaped to fit between and around the buttocks. They are disposable and some have an internal cuff (raised elasticated area) designed to hold liquid or solid stool in place.
A disposable gauze dressing placed between the buttocks has been found to be acceptable for light bowel leakage where the stool usually remains between the buttocks and doesn’t soil underwear.14
| More likely to suit you if... |
Less likely to suit you if... |
- Actually, they suit most men and women
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- You have skin problems in the anal area
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Standard incontinence pads
Products designed specifically for bowel leakage are not widely available so many people use pads that intended for bladder leakage instead, especially if they have both bladder and bowel leakage.
Pads vary in size and design so you may need to try different pads to find which works best for you. It is usually best to try smaller, more discreet pads first, and move to larger pads as necessary. You may find that only the larger pads for bladder leakage give sufficient cover for bowel leakage and that you have unnecessary bulk at the front of the pad.
Find out more about standard pads in Absorbent products for women and Absorbent products for men.
Where can I get faecal pads?
These products are available in supermarkets, online or direct from suppliers. Not all products are available in all parts of the world.Use the links below to find out how to get them where you are.
Faecal collection devices
Faecal collection devices are a group of devices that are intended to collect stool as it passes from the rectum. The stool is collected in a bag or pouch, which is periodically emptied.
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Faecal collection deviceSeveral kinds of devices are available:
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An external anal pouch consists of a flexible wafer that has an opening at its centre. One side of the wafer adheres to the skin around the anus and the other side is connected to a collection bag. The bag has a re-sealable port at the lower end through which faeces can be emptied without the need to remove the wafer from the skin. This port can also be connected to a larger gravity drainage bag. Some bags also have a flap to allow flatus to escape and prevent the bag filling with gas.
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An intra anal stool bag is made of latex (20cm non extended, 26cm extended) that is inserted into the anus and an adhesive attachment (10cm in diameter) applied round the anus to secure it in position.15
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Rectal tubes and catheters are inserted into the rectum to channel loose stool into a collection bag. A balloon near the tip of the catheter (inside the body) can be inflated once the catheter is in position to prevent leakage of stool around the catheter and to prevent the tube from coming out during a bowel movement.16
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A rectal trumpet is made up of a naso-pharyngeal airway connected to a drainage bag. The flange (wide) end of the trumpet is inserted into the rectum.17 A trumpet is shorter than a rectal tube so there is less chance of damaging the lining of the rectum. The other narrow end of the trumpet can be connected to a drainage bag.
Who are faecal collection devices good for?
They are used mainly by people who are very ill or confined to bed and need help with bowel management.1618192021 Faecal collection devices can help to prevent leaked stool coming into contact with the skin and causing skin damage. They can also be useful in allowing skin already damaged by incontinence-associated dermatitis or pressure ulcers to be treated. 22
Faecal collection devices are usually only suitable for loose stool - stool grades 6 or 7 on the Bristol Stool Chart. External anal pouches may be useful for firmer stool, but not when connected to an extra drainage bag. Rectal tubes and catheters work best with very liquid stool, which is most likely to flow without blocking the drainage hole.2123 They are often used in conjunction with bowel management programmes including daily saline irrigations through the rectal catheter to keep the stool liquid. It has been suggested that cutting the tip of the catheter off at an angle helps drain stool of a slightly thicker consistency.24
Faecal collection devices should not be used by people with intestinal mucosal disease, immunosuppression, gastrointestinal bleeding or bleeding tendencies, recent heart attacks or prostate surgery.2425
What about fitting?
Correct fitting and use is very important to give the best chance for all these devices to work and to minimise any risks associated with their use.
Applying an external anal pouch can be difficult especially for people who have a small space or severe oedema between the anus and vagina or scrotum. It can be difficult to maintain the seal round the anus, especially if the skin in the area is already damaged and pouches are not recommended for use if the skin is very sore.1720
Rectal trumpets offer an alternative to the rectal pouch when adherence to the skin is a problem and may help to keep skin healthy or promote healing by reducing the risk of stool in contact with the skin.1826 There is a risk of the trumpet inadvertently coming out with straining or coughing, or being pulled out with linen changes or accidental pulling on the collection bag.17
Disadvantages of faecal collection devices
External and internal anal pouches can cause skin damage from the effect of the adhesive on skin.1827
Use of a rectal tube (or trumpet) with or without inflating the balloon is controversial because of the risk of damaging the lining of the rectum or anal sphincter, or stimulating intestinal secretions, making diarrhoea and bowel leakage worse.232428
There have been reports of more serious complications from use of rectal catheters including rectal bleeding (on occasions requiring blood transfusion), mucosal pressure necrosis, fistula and autonomic dysreflexia. 293031
Because of these risks it is recommended that these products are only used under the supervision of a health care professional experienced in their use