The treatment of a prolapse depends on various factors, including the severity of the prolapse, the patient’s symptoms, and overall health. While vaginal mesh has been used to treat prolapse, concerns, and mesh complications have led to regulatory changes and a shift toward alternative treatment options. So, can you fix a prolapse without mesh?
Non-surgical and surgical treatment options for managing pelvic organ prolapse (POP) without mesh are available. Here are some of the approaches:
- Pelvic Floor Physical Therapy: This is often the first-line treatment for mild to moderate cases of POP. A physical therapist can teach kegel exercises and techniques to strengthen the pelvic floor muscles, improve support, and alleviate symptoms.
- Lifestyle Modifications: Lifestyle changes such as weight loss, avoiding heavy lifting, and managing chronic constipation (which can strain pelvic muscles) can help prevent or alleviate prolapse symptoms.
- Vaginal Pessaries: A pessary is a device you insert into the vagina to support your pelvic organs and alleviate symptoms. It’s an option that doesn’t need pelvic reconstructive surgery and can be effective for some women.
- Surgical Repair: Surgical procedures [Colporrhaphy] do not involve surgical mesh considerations. These surgeries typically involve repairing and reinforcing the vaginal walls and supporting structures using native tissue repair or other materials.
- Hormone Therapy: In some cases, hormone therapy may be recommended to improve the strength and elasticity of the pelvic tissues, especially in postmenopausal women.
- Minimally Invasive Surgery: Some surgeons perform minimally invasive procedures using laparoscopic or robotic-assisted techniques to repair prolapse without using mesh. These procedures often involve the repositioning and reinforcement of pelvic organs.
- Hysterectomy: In some cases, a hysterectomy (removal of the uterus) may be recommended to address prolapse, but this is not always necessary, and other surgical techniques can be used to preserve the uterus.
It’s essential to consult a healthcare provider specializing in surgery for pelvic organ and floor disorders to determine the most appropriate treatment option for your situation. The treatment choice should consider the severity of the pelvic organ prolapse, your overall health, your preferences, and the potential risks and benefits of each option. Mesh surgery is not always required or recommended to treat pelvic organ prolapse; alternative approaches can be practical in many cases.
What is surgical mesh?
Surgical mesh is a medical device used to reinforce and mend injured or weaker tissues. Stress urinary incontinence, vaginal/bowel prolapse, uterine/bladder prolapse, and bladder prolapse are created using mesh, as can hernia repairs.
Most surgical mesh is a synthetic material created in a lab. Some types of mesh are fabricated using animal tissue. However, medical professionals seldom advocate for using mesh derived from animal tissues.
This is due to its inferior performance compared to that of laboratory-created mesh. These synthetic plastic medical implant devices are intended for long-term use. They may or may not allow for complete removal, so keep that in mind. This is an important factor to consider when weighing your surgery options.
Transvaginal Surgical Mesh for Pelvic Organ Prolapse Surgery
Pelvic organ prolapse may be treated by transvaginal insertion of surgical mesh to reinforce weak or damaged tissue. Excellent surgical results in the treatment of abdominal wall hernia (since the 1950s), abdominal POP surgery (since the 1970s), and urinary stress incontinence (since the late 1990s) provide the basis for transvaginal mesh repair.
Transvaginal mesh is intended to prolong the effectiveness of repairs and surgical treatments for pelvic organ prolapse.
How is surgical mesh used to treat pelvic floor disorders?
Surgical mesh is sometimes used to treat pelvic floor disorders, particularly pelvic organ prolapse (POP) and stress urinary incontinence (SUI). However, it’s important to note that the use of surgical mesh for these conditions has been a topic of controversy and regulatory scrutiny due to safety concerns.
- Pelvic Organ Prolapse (POP): Pelvic organ prolapse occurs when the pelvic organs, such as the bladder, uterus, or rectum, bulge or protrude into the vaginal wall. Surgical mesh can be used to provide support to the weakened or stretched pelvic tissues, helping to hold the organs in their normal positions. This can help alleviate symptoms like pressure, discomfort, and urinary incontinence.
- Stress Urinary Incontinence (SUI): Stress urinary incontinence is the unintentional leakage of urine during activities that pressure the bladder, such as sneezing, coughing, or exercising. Mesh slings can be implanted to support the urethra and bladder neck, preventing urine leakage during these activities.
What are the safety concerns about the use of surgical mesh?
Surgical mesh is either synthetic mesh or biological material that reinforces the vaginal wall and supports the prolapsed organs. The idea was to provide additional structural support to correct pelvis floor disorders.
The use of transvaginal surgical mesh became controversial due to several issues: Many patients reported severe complications after transvaginal mesh surgery, such as pelvic pain, infection, mesh erosion through vaginal tissue, painful sexual intercourse, mesh exposure, organ perforation, and recurrent prolapse.
In 2011 and 2019, the U.S. Food and Drug Administration (FDA) warned about the potential transvaginal mesh complications used in POP repair pelvic surgery. In 2016, the FDA reclassified transvaginal mesh as a high-risk device.
Thousands of lawsuits were filed against manufacturers of transvaginal mesh products by women who experienced complications and injuries.
Due to the safety concerns and adverse events associated with transvaginal mesh, regulatory agencies in various countries took action to restrict or ban its use. In some cases, manufacturers voluntarily withdrew their products from the market.
Due to the controversy, alternative treatments for POP, including traditional surgical techniques and non-surgical approaches like pelvic floor physical therapy, have gained prominence. These treatments address pelvic organ prolapse while minimizing mesh complications compared to transvaginal mesh.
Differences between abdominal hernia and pelvic floor repairs
Abdominal hernia repair and pelvic floor repair are surgical procedures that address specific issues in the abdominal and pelvic regions. Here are the key differences between these two types of surgeries:
Abdominal hernia repair surgical procedure addresses a protrusion of the abdominal sac through a weak area in the abdominal wall, such as the inguinal region, umbilicus (belly button), or surgical scar.
Pelvic floor repair focuses on restoring or strengthening the muscles, ligaments, and connective tissues that support the pelvic organs (e.g., bladder, uterus, rectum) when they become weakened or damaged, often due to childbirth, certain medical conditions, or old age.
Abdominal hernia repair can be done using an open approach (traditional surgery with an abdominal incision) or minimally invasive techniques such as laparoscopic or robotic-assisted surgery.
Pelvic organ prolapse repair is typically performed through the vagina (transvaginal) or through the abdomen (abdominal approach) using surgical techniques to lift and support the pelvic organs.