A new polyurethane anal plug in the treatment of incontinence after anal atresia repair

38 totally or partially incontinent patients following imperforate anus rep air (age 6-15 years) tested a new polyurethane (PU) anal plug against anoth er, widely used anal plug (PVA) in a randomized crossover trial. Plugs were tested 3 weeks each, data concerning bowel habits, handling and plug-relat ed problems were collected by questionnaire before trial, at time of produc t change and after trial. Results: 15 of 38 patients did not complete the protocol, among them 6 with anal canal diameters too small for the smallest plug. During plug use, pat ients experienced enhanced awareness of repletion and urge. Stool consisten ce did not change in 82% of patients. There were no changes in children con stipated prior to study (n = 8/23). 12/23 children were absolutely clean du ring use of either plug. 15 patients (68%) using the PU plug and 10 (45%) u sing the PVA plug felt secure from soiling during plug use. 74% of patients preferred the PU plug. Painful plug insertion, a feeling of pressure insid e the anal canal and painful plug removal were reported with both plugs, bu t were less frequent with the PU plug. Conclusion: Anal plugs, regardless of their make, offer absolute cleanlines s for periods of several hours to 66% of our incontinent patients. The PU p lug (Conveen(R), Coloplast) is preferred by the patients and offers greater security than the PVA plug.