Shhhh….. another scandalous topic about your pelvic floor

My previous article explains what pelvic floor muscles are and how they are related to incontinence. If you haven’t read it already, please do! It is ‘hilarious’, or so I’ve heard.

This article is a continuation of the previous topic, and it is not meant for the faint-hearted.

 

Let’s start with two simple definitions

  • Stress urinary incontinence is a condition where there is involuntary leak of urine when you sneeze, jump, cough etc
  • Pelvic organ prolapse (slipping down or forward) occurs when organs within a woman’s pelvis (bladder, uterus and rectum) bulge into the vagina

Stress incontinence and pelvic organ prolapse are common complications following childbirth. Approximately 2 in 5 women will have stress incontinence while 3 in 5 women who have had childbirth will have some degree of pelvic organ prolapse.

 

Non-surgical versus surgical options

Stress incontinence and pelvic organ prolapse can be treated using non-surgical and surgical options. Many women are able to manage the conditions using non-surgical methods such as lifestyle changes, pelvic floor muscle training or use of removable devices (pessaries). For more information regarding the treatment options, talk to your doctor or pharmacist,

Surgical treatments are usually performed after non-surgical methods have failed. The transvaginal mesh (figure) is an example of a device used to surgically treat stress incontinence and pelvic organ prolapse. The mesh became widely used since it became available in the market in 2002.

Figure: Example of a mesh used in prolapse
Figure: Example of a mesh used in prolapse

 

Moving on to the gory details

In recent years, reports of women suffering from severe adverse events following implant of the mesh have sparked international attention. Some women experienced severe chronic pain. Some women had infection and bleeding. Others complained that they were no longer able to have sexual intercourse. In 2011, the United States Food and Drug Administration issued a safety warning advising that the use of mesh was a serious concern. (Told ya it’s not for the faint-hearted!)

 

Mesh for pelvic organ prolapse versus mesh for stress urinary incontinence

Emerging evidence shows that the complications depend on the types of procedures performed. Mesh use appears to be safe when used for stress urinary incontinence but not for pelvic organ prolapse.

  • Stress urinary incontinence
    • Recent studies have shown that surgery involving use of mesh is as effective as other types of surgical methods for stress incontinence. Further, there are fewer short- and long-term complications compared with other surgical treatments (some good news hey!).
  • Pelvic organ prolapse
    • Unfortunately, the risk of serious complications following use of mesh for pelvic organ prolapse remains high. Many countries have issued warnings regarding use of mesh in repair of pelvic organ prolapse while some countries have taken to ban the products altogether. For example, in November 2017, the Australian Government Therapeutic Goods Administration decided to ban the use of the transvaginal mesh implants which are solely used in the treatment of pelvic organ prolapse.

 

How is this related to you?

  • If you leak urine or feel there is ‘something’ protruding from your vagina, consult your doctor today!
  • Early diagnosis means you are less likely to have severe incontinence or prolapse, and therefore more likely to have good treatment outcome.
  • Early diagnosis also means that there is a higher possibility that non-surgical treatment will work for you.

 

What can I do if I’ve had a mesh inserted?

  • This article is only intended to create awareness about the possible complications following mesh implant. Many women do not experience any side effects, so do not worry!
  • If you have had a mesh implanted and do not experience any adverse events, this means you have good surgical outcome. That’s great!
  • If you are currently experience adverse events, please consult your doctor immediately.

 

Finally, please spread the word! Creating awareness and removing the stigma associated with stress urinary incontinence and pelvic organ prolapse can help women who currently suffer in silence.

 

 

References

1. Australian Government Department of Health Therapeutic Goods Administration (2017) TGA actions after review into urogynaecological surgical mesh implants. https://www.tga.gov.au/alert/tga-actions-after-review-urogynaecological-surgical-mesh-implants. Accessed 12 December 2017

2. U.S. Food and Drug Administration (2017) Urogynecologic Surgical Mesh Implants. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/UroGynSurgicalMesh/default.htm. Accessed 12 December 2017

3. Morling JR, McAllister DA, Agur W, et al. Adverse events after first, single, mesh and non-mesh surgical procedures for stress urinary incontinence and pelvic organ prolapse in Scotland, 1997-2016: a population-based cohort study. Lancet, 2017. 389(10069): p. 629-640.

4. Chughtai B, Barber MD, Mao J, et al. Association Between the Amount of Vaginal Mesh Used With Mesh Erosions and Repeated Surgery After Repairing Pelvic Organ Prolapse and Stress Urinary Incontinence. JAMA Surg. 2017 Mar 1;152(3):257-263.

 

Renly Lim
Renly Lim

MPharm, PhD, RPh

Research fellow in Adelaide -partly because of my love for science but mainly because I adore koalas and kangaroos. Planning to engage the public with science over a glass of wine.

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