Why would a doctor use transvaginal mesh?
Vaginal mesh is a synthetic or biologic material permanently implanted in women to repair pelvic organ prolapse (POP) or to support the urethra as a treatment for stress urinary incontinence (SUI), conditions which arise when the vaginal wall and other supporting muscles have been weakened. This weakening often occurs as a consequence of pregnancy and childbirth, and may also arise from other factors, including aging. Transvaginal mesh is inserted through the vagina during pelvic surgery.
What are POP and SUI?
POP happens when the muscles, membranes and structures that support the uterus, bladder and colon/rectum weaken and stretch, allowing pelvic organs to fall and begin pressing downward onto the vagina. Sometimes the organs drop so far they push into the vagina, and in the worst cases can actually protrude through the vaginal opening. The most common symptoms of POP are:
- Pelvic pain
- Pressure within the pelvic region
- Protruding organs, including the bladder or rectum, that push into or past the vaginal opening
- Discomfort during intercourse
SUI is an involuntary (uncontrollable) leakage of urine, often during exercise or sex or when sneezing, coughing, or bending over. SUI is the most common type of incontinence suffered by women. It is most prevalent in older women and women who have given birth. SUI results from weak muscles in the pelvic floor or a weak sphincter muscle at the neck of the bladder. These muscles can be weakened by childbirth, menstruation, menopause, and abdominal surgery. The weakened muscles allow the bladder to drop down into a position that prevents the urethra—the tube through which urine passes from the bladder—from closing completely. Urine leaks into the urethra and when pressure or stress is applied to the bladder by activity, sneezing or bending, the urine is pushed out of the body involuntarily.
Both POP and SUI cause pain and embarrassment for victims, limit the individual’s ability to participate in normal activities, and can dramatically diminish quality of life.
Correcting Pelvic Organ Prolapse
The traditional method of correcting POP is a procedure known as colporrhaphy. An anterior colporrhaphy is performed when the bladder protrudes through the vagina, and a posterior colporrhaphy is performed when the rectum protrudes through the vagina. An incision is made into the skin of the vagina, and the weakness in the fascia (connective tissue that surrounds the muscles) beneath the skin is identified. The fascia is pulled away from the vaginal skin and is then folded over and stitched in place to provide support for the pelvic organs. There are risks to this type of surgery, including damage to other pelvic organs; however, there is only about a 1 percent chance for serious complications. The main concern with colporrhaphy is that there is a 40 percent chance of the pelvic organ prolapse recurring. That is why surgeons turned to surgical mesh, which has long been used to fix hernias.
Transvaginal mesh was heralded as a breakthrough in surgeries to support the pelvic organs, eliminating the discomfort and embarrassment of POP and SUI and, it was believed, lessening the chances that the prolapse would return. For prolapse repair, a sheet of transvaginal mesh is implanted along the vaginal wall to create a permanent structure reinforcing the pelvic floor. This repositions the pelvic organs—bladder, uterus and rectum—to their correct locations and alleviates symptoms.
Correcting Stress Urinary Incontinence
Historically, incontinence treatment options were limited. Patients might be advised to drink less liquid or do Kegel exercises, which are designed to strengthen the pelvic floor muscles. These measures, however, have limited success. Incontinence sufferers are often forced to curtail physical activities and resort to wearing bulky undergarments. There is also a surgical procedure, known as the Burch procedure, which uses the patient’s own connective tissue to support the bladder. The challenge with this procedure is that over time, the repair can weaken and SUI symptoms can recur. This recurrence, in fact, happens nearly half the time.
Transvaginal mesh can offer a permanent fix to the problem. A small piece of mesh— called a bladder sling—is implanted to create a surgical hammock around the bladder neck and urethra to keep them closed during normal activities and prevent urine leakage.
Transvaginal mesh has been widely embraced by physicians. In 2010 alone, about 75,000 women were given transvaginal mesh implants to repair a prolapse, and 208,000 women had mesh implanted to fix incontinence problems.
When successful, a pelvic floor support or bladder sling procedure can change a patient’s life, eliminating painful, embarrassing symptoms and freeing the patient to return to normal activities, all via a fairly mild surgery. Unfortunately, painful complications can arise creating problems worse than the original symptoms the mesh was meant to treat; these complications may even become life-threatening. Read more about these complications on our Complications page.