What’s the Deal with Mesh for Prolapse?
Prolapse Mesh Surgery
“Do I need surgery?” A question frequently asked in my office or consults with women around the globe. While I cannot answer this question from afar, I can say, in my years of practice I have only needed to refer one woman for surgery. While surgery may seem like the “quick fix” many are hoping for, it truly isn’t. From the potential complications of surgery to understanding that habits needed to change for true long term results, it is important to know what you are choosing and why.
Statistics tell us that 33% of women report pelvic floor dysfunction (PFD) classified as pelvic organ prolapse (POP) and/or urinary incontinence (UI); these are only two of several forms of PFD. Based on US Census data, we can expect the number of women currently suffering POP or UI to double by 2053 (1). Behind this stat are thousands of women suffering debilitating symptoms, often experiencing a decrease in quality of life as symptoms increase over time. These women are more than just a number and are desperate for answers.
The goal with mesh surgery is to decrease symptoms of POP and UI by implanting a synthetic mesh to provide support for ligamentous or other tissue damage.
What you need to understand about mesh surgery:
1) No surgery is without side effects. Occasionally the side effects are worse than the original problem and a trial of conservative care should be considered before any surgical procedure (2,3,4,5). As you look for information from your healthcare team, it is crucial to ask questions and gather information. Explore each option and make a decision once you have gathered all necessary information to make an empowered, educated choice.
In 2016, the FDA changed the risk for transvanginal surgery for POP from moderate to high and stated:
“Research has shown that surgical mesh for transvaginal repair of POP can cause complications such as mesh erosion, pain, infection, bleeding, pain during sex, organ perforation and urinary problems. Many of these complications require additional treatment, including surgery.”
2) Pelvic floor dysfunction is more than prolapse and incontinence. PFD spans to pain during intercourse, acute or chronic pelvic pain, constipation or diarrhea, and the latest buzz phrase: diastasis rectus abdominis. If core dysfunction is present before the surgery,surgery alone will not “cure” the dysfunction but rather treat symptoms. Functional core rehabilitation and movement instruction needs to be incorporated into a patient care plan by an appropriate provider, surgery or not.
3) Prevention is key. ACOG recently released new guidelines for healthcare providers asking for more frequent, consistent, and thorough postpartum care. As these changes are implemented, there is potential to see a reduction in PFD over time. Women know they deserve a higher standard in preventative care and while BIRTHFIT has been on a mission for several years to set a higher standard, having ACOG’s statement align is certainly a step in the right direction.
4) Consistency is key. Functional core exercises are crucial in healing yet can be challenging as you learn more about your body. Time and time again consistency proves to be the biggest challenge. Full core function is not a box to be checked but a continuous process needing attention, especially in counteracting habits you have created or will continue to be exposed to. In our BIRTHFIT Programming we use the Functional Progression. It is to movement as vitamins are to nutrition.
5) It’s not all physical. You may be surprised to know that we store a lot of emotion in our pelvic floor and in scar tissue. When life gets physically or mentally stressful, this can impact healing and the function of the pelvic floor. Be sure to find time for emotional self-care as well. Sleep and nutrition also play a role in healing and the links between stress, sleep, nutrition, healing, etc. are being examined more (6,7) .
Support for Prolapse
If you are one of the thousands of women experiencing any obstacles of pelvic floor dysfunction please know you are not alone. Breathe. Journal a bit on where you are in your healing journey and take note of what comes up. Then, start gathering evidence based information and quality support by connecting with a Regional Director local to you and scheduling a Core and Pelvic Floor consult with myself or Lauren Keller, DC. We will also assist you in connecting with a quality Physical Therapist specializing and trained in the pelvic floor therapy, specifically internal work.
Surgery is NOT a quick fix but a last resort and there are several resources to help you not only overcome these obstacles but use them as feedback from your body to help you heal on this journey, long term.
Erica Boland, DC BIRTHFIT Professional Seminar Director BIRTHFIT Wisconsin RD @birthfitwisconsin @emomdc
1) Obstet Gynecol. 2009 Dec;114(6):1278-83. doi: 10.1097/AOG.0b013e3181c2ce96.
2) Int J Urol. 2016 Sep;23(9):797-800. doi: 10.1111/iju.13136. Epub 2016 Jun 2.
3) J Minim Invasive Gynecol. 2017 Jan 1;24(1):67-73. doi: 10.1016/j.jmig.2016.10.001. Epub 2016 Oct 20.
4) Int Urogynecol J. 2017 Aug;28(8):1139-1151. doi: 10.1007/s00192-016-3256-5. Epub 2017 Feb 1.
5) Phys Med Rehabil Clin N Am. 2017 Aug;28(3):603-619. doi: 10.1016/j.pmr.2017.03.010. Epub 2017 May 27.
6) Obstetrics & Gynecology: April 2010 – Volume 115 – Issue 4 – p 795-803