Pelvic mesh is a synthetic netting surgically implanted to treat Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). POP happens when pelvic organs like the bladder or uterus lose support and create a bulge in the vagina, while SUI is urine leakage during activities like coughing. The mesh is designed to reinforce weakened tissues.
While many have had successful outcomes, a notable number have experienced significant complications, leading to revised clinical recommendations. These issues have prompted the establishment of specialized clinics to assist those affected.
Types of Pelvic Mesh Complications
One of the most frequently reported issues is mesh erosion, where the synthetic material wears through the vaginal tissues and becomes exposed. The mesh can also migrate and perforate nearby organs, such as the bladder and bowel. Organ perforation is a serious event where the mesh creates a hole in an adjacent organ.
A significant portion of individuals with mesh complications report experiencing chronic pain. This discomfort can be located in the pelvis, groin, and lower back. A specific type of pain is dyspareunia, which is pain experienced during sexual intercourse. This pain is often neuropathic, resulting from nerve damage caused by the mesh.
The presence of a foreign material can also create a site for persistent infections. The mesh’s structure can harbor bacteria, making it difficult for antibiotics to fully eradicate an infection. This can lead to chronic urinary tract infections (UTIs) and localized inflammation.
Symptoms and Early Warning Signs
A primary indicator of mesh erosion is abnormal vaginal bleeding or a persistent, unusual discharge. A partner may also feel the exposed mesh during intercourse, which can cause discomfort for both individuals.
Changes in urinary function can also signal a problem with the implant. Some individuals may experience a recurrence of incontinence, difficulty urinating, or a feeling that the bladder is not emptying completely. Recurrent UTIs can also be a sign that the mesh is irritating or has perforated the bladder.
Persistent pain is another common warning sign, often localized in the pelvic region, groin, or radiating down the legs. It can range from a dull, constant ache to sharp sensations that interfere with daily activities. The onset of this pain may not be immediate and can develop months or even years after the initial surgery.
Pain during sexual intercourse, or dyspareunia, is a specific symptom that can result from mesh erosion or from the implant causing tissues to become stiff. The discomfort can be severe enough to make intercourse impossible, placing a substantial strain on personal relationships.
How Complications Are Diagnosed
Diagnosis begins with a thorough physical examination, including a pelvic exam to check for tenderness or visible signs of mesh erosion. A provider will also consider the patient’s medical history and a detailed description of their symptoms.
To visualize the mesh and its interaction with pelvic structures, imaging tests are used. A transvaginal ultrasound can reveal the mesh’s position and identify issues like fluid collection, while a magnetic resonance imaging (MRI) scan provides clearer pictures of the soft tissues and the implant.
In cases where bladder-related symptoms are prominent, a cystoscopy may be performed. This involves inserting a thin tube with a camera into the urethra to inspect the inside of the bladder. This allows a specialist to see if the mesh has perforated or is eroding into the urinary tract.
Corrective Procedures and Management
For many individuals experiencing complications, surgery is the primary course of action to remove the mesh, either partially or completely. Complete mesh removal is a complex procedure that requires a surgeon with specialized expertise due to the risk of damaging nerves and surrounding organs.
Removal surgeries can be extensive, and sometimes multiple operations are needed. The mesh is designed to integrate with the body’s tissues, making its removal difficult, similar to removing rebar from concrete. The success of surgery varies, and some patients may experience issues even after the mesh is out.
Beyond surgery, non-surgical options are available to manage symptoms. Pelvic floor physical therapy can be beneficial for addressing muscle spasms and managing pain. This therapy is tailored to the individual’s condition to help improve function and reduce discomfort.
Pain management is another aspect of non-surgical care, involving medications for nerve pain or trigger point injections. For some, a pessary—a removable device placed in the vagina to support pelvic organs—can provide relief from prolapse symptoms without further surgery.