Transvaginal mesh implants have earned a pretty bad rap, and with good reason. The FDA regards this treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) as doing more harm than good for women in most cases. Both of these conditions occur after the vaginal walls suffer considerable strain, such as after childbirth, during menopause, or even from lifting something too heavy.
Based off a design used to treat hernias, transvaginal mesh is a sling, similar to a tiny hammock, inserted into the vagina to provide extra support for weakened vaginal canals. Unfortunately, it comes with a whole host of side effects, some of which are not only worse than the original problem, but also can be fatal. To top it off, transvaginal mesh often fails to solve the initial condition.
Luckily, it isn’t the only solution anymore. Sometimes POP and SUI can be dealt with through mild physical therapy, like kegel exercises, to strengthen the pelvis. Weight loss may also provide relief to some women. But for those who need a stronger treatment, an in-depth talk with a qualified doctor can help find the right remedy.
Pelvic Organ Prolapse Alternatives
Pelvic organ prolapse occurs when organs no longer stay in their proper place within the abdomen, which can lead to straining and tearing of vaginal tissue. Transvaginal mesh works by boosting the prolapsed organ or organs back up where they belong and providing the support needed to keep them there so the strained tissue can heal. However, other alternatives seem to be providing better options.
- Pessary: Although it is another type of implant, a pessary is a nonsurgical alternative for treating POP. This firm, plastic device is inserted into the vagina and provides support for prolapsed organs. For women who take this route, a pessary is mainly managed at home, with occasional visits to the doctor. Although it can cause mild irritation or infection, this can be corrected easily by using more lubrication or leaving the device out for a little bit.
- POP Surgery: Transvaginal mesh was supposed to be an update for invasive abdominal surgery to correct POP. To perform the original procedure, doctors made incisions in the abdomen, then used preexisting tissue to boost prolapsing organs back up where they belong. Because of the incisions in the abdomen, this was a major surgery; patients had to remain hospitalized for several days and recovery time was extensive. The invention of a laparoscope changed all of that. This device, which is simply a tiny camera on a length of tubing, can be inserted through a much smaller hole. Instruments are also place through similar small incisions, and now POP surgery is an outpatient procedure with a two week recovery time.
Stress Urinary Incontinence Alternatives
Stress urinary incontinence occurs when stress from physical activity, like running, lifting, or even laughing, is placed on the bladder, which leads to the inadvertent release of urine. Transvaginal mesh was intended give the bladder much needed support by strengthening walls and allowing stress to have less impact. However, like with POP, there are several safer alternatives to it.
- Burch Procedure: This treatment is not found to be more effective than transvaginal mesh, but it does alleviate some of the implant issues. Similar to POP surgery, doctors use a laparoscope inserted through an incision in the abdomen or through the vaginal opening. Then, ligaments around the bladder are sutured to provide extra support to the urethra and surrounding tissue.
- Autologous Transobturator Midurethral Sling Procedure: The Mayo Clinic developed this procedure as another alternative to transvaginal mesh implants. Tissue is taken from the abdominal muscles, turned into a sling, and then placed under the urethra for support. Although it is much like the mesh implant, complications are considerably less severe. However, most experts agree that more research is needed about the long-term safety of this procedure.