Pelvic Mesh Problems
What Are Pelvic Mesh Problems?
Pelvic mesh problems include pelvic nerve damage, mesh erosion, extrusion, bleeding, abnormal discharge, pain during intercourse, vaginal pain, abscesses and fistulas. Symptoms of mesh erosion into the bladder or urethra include painful voiding, urinary frequency, blood in the urine, recurrent urinary tract infections, urinary calculis and urinary fistulas. Due to the severity and frequency of these pelvic mesh problems, many of the pelvic mesh products have been removed from the medical device market.
What is Pelvic Organ Prolapse?
A woman’s pelvic organs, including the uterus, bladder and rectum, can slip and create a bulge in the vagina after the muscles supporting those organs weaken. Causes include: childbirth, hysterectomy, menopause, heavy lifting, chronic coughing, constipation, obesity, previous pelvic surgery, neurological conditions or injuries.
Pelvic organ prolapse affects one or several different organs and are classified as follows:
- Cystocele – also known as bladder prolapse, is one of the most common types of pelvic organ prolapse. A bulge or dropping of the anterior vaginal wall causes the bladder to slip into the bulge
- Urethrocele – the female urethra slips in the vagina
- Uterine prolapse – the uterus slips in the vagina
- Vaginal prolapse – the vaginal walls begin to drop and cause vagina to turn inside out
- Vaginal vault prolapse – the vagina’s upper portion slips in the vaginal canal or outside the vagina
- Rectal prolapse – the rectum turns inside out and protrudes through the anus
- Enterocele – the small intestines bulge between the uterus and rectum or bulge on the top of the vagina
- Rectocele – the rectum bulges into the posterior vaginal wall
Types of pelvic reconstructive surgery include the following:
- Surgery using vaginally placed mesh—Used to treat all types of prolapse. Can be used in women whose own tissues are not strong enough for native tissue repair. Pelvic mesh problems include mesh erosion, pain, infection, and bladder or bowel injury. This type of surgery should be reserved for women in whom the benefits outweigh the risks.
- Fixation or suspension using your own tissues (uterosacral ligament suspension and sacrospinous fixation)—Also called “native tissue repair,” this is used to treat uterine or vaginal vault It is performed through the vagina. The prolapsed part is attached with stitches to a ligament or to a muscle in the pelvis. A procedure to prevent urinary incontinence may be done at the same time.
- Colporrhaphy—Used to treat prolapse of the anterior (front) wall of the vagina and prolapse of the posterior (back) wall of the vagina. This type of surgery is performed through the vagina. Stitches are used to strengthen the vagina so that it once again supports the bladder or the rectum.
- Sacrocolpopexy—Used to treat vaginal vault prolapse and enterocele. It can be done with an abdominal incision or with laparoscopy. Surgical mesh is attached to the front and back walls of the vagina and then to the sacrum (tail bone). This lifts the vagina back into place.
- Sacrohysteropexy—Used to treat uterine prolapse when a woman does not want a hysterectomy. Surgical mesh is attached to the cervix and then to the sacrum, lifting the uterus back into place.
Symptoms of Pelvic Mesh Problems Include:
- A bulge outside the vagina
- Urination difficulty or frequent need to urinate
- Constipation or difficulty having a bowel movement
- Sensation of something falling out of the vagina
- Stress urinary incontinence
- Discomfort or pain in the vagina, pelvis, groin or lower abdomen or back
- Tender or bleeding tissue protruding from the vagina
- Painful intercourse
What Is Stress Urinary Incontinence (SUI)?
Stress Urinary Incontinence (SUI) or bladder control loss, can range from mild leakage to uncontrollable urine loss. Causes include: childbirth, aging, obesity, surgery involving the bladder or vagina in women, medications, diabetes, neurologic conditions, multiple sclerosis, Parkinson’s disease, stroke and spinal cord injury.
Diagnosing urinary incontinence tests might include: Urinalysis, bladder function tests, cystoscopy, cystogram, x-rays using dye to reveal urinary tract problems and ultrasound.
Urinary incontinence treatment may include: Botox injections, pessaries, pelvic floor physical therapy, medications, urethral bulking agent to reduce the opening of the urethra to prevent urine leakage, surgical sling procedure using body tissue or synthetic material to create a “sling or hammock” to keep the urethra closed and prevent urine leakage.
Surgical sling procedure: the surgeon uses strips of synthetic mesh, your own tissue, or sometimes animal or donor tissue to create a sling or “hammock” under the tube that carries urine from the bladder (urethra) or the area of thickened muscle where the bladder connects to the urethra (bladder neck). The sling supports the urethra and helps keep it closed so that you don’t leak urine.
Tension-free sling – No stitches are used to attach the tension-free sling, which is made from a strip of synthetic mesh tape. Instead, body tissue holds the sling in place. Eventually scar tissue forms in and around the mesh to keep it from moving. For a tension-free sling procedure, the surgeon may use one of three approaches:
- A small incision inside the vagina just under the urethra is made. with two small openings above the pubic bone. The surgeon uses a needle to pass the sling under the urethra and up behind the pubic bone. Absorbable stitches close the vaginal incision, and the needle sites may be sealed with glue or stitches.
- A small incision inside the vagina just under the urethra is made, with a small opening on each side of the labia. The sling passes a different pathway from the retropubic approach, but it’s still placed under the urethra. Absorbable stitches close the vaginal incision and the needle site with glue or stitches.
- Single-incision mini. One small incision in the vagina is made. The surgeon places the sling similar to the retropubic and transobturator approaches. No other incisions or needle sites are needed.
Conventional Sling. An incision in the vagina is made and a sling made of synthetic mesh tape is placed under the neck of the bladder. Through another incision in the abdomen, the surgeon pulls the sling to achieve the right amount of tension and attaches each end of the sling to pelvic tissue or the abdominal wall using stitches.
Serious complications occur in some women, including erosion of the material, infection, organ perforation, pudendal neuralgia and other injuries causing pain and suffering. We are not medical professionals examining your body. Therefore, we recommend that you contact your health care provider, conduct your own research and due diligence and, if necessary, obtain a second opinion from another urogynecologist before consenting to any medical treatment.
Contact Carolyn St. Clair, RN, BSN, JD, PLLC @ 1-800-814-4540 or carolyn@carolynstclair.com for a free consultation about your medical legal rights if you have been injured by a pelvic mesh product.