What Causes Vaginal Prolapse?
What happens in prolapse is that a pelvic organ falls in location, thanks to a weakening or abnormal stretching of the anterior vaginal wall. This can be a highly uncomfortable feeling and sometimes a very painful one. There is no sure way of knowing if and when the body will recover. In many cases, the problem does not go away and the only option women have is to pursue surgery.
This will depend on the type of prolapse that has occurred, but the most common reason for damage is childbirth or complications from surgery (usually a hysterectomy). In general, organs of the pelvis (which reach up all the way to the stomach) are kept in place by muscles and lower stomach tissues. Childbirth is a traumatic experience and involves major tearing and stretching.
Ordinarily, a woman’s body will heal to a sufficient extent after childbirth. However, this does not always occur and this is why pelvic organs weaken and fall from their place. There are also other factors, and they all involve an abnormal level of pressure being placed on the stomach and pelvis area; these include obesity, hard coughing, long lasting and recurring constipation and tumors in the pelvis. There is some evidence to suggest genetic disposition may also be a contributing factor.
Symptoms for Vaginal Prolapse and Vaginal Erosion
The symptoms of pelvis prolapse include a strong feeling of pressure, as if something is pressing against a woman’s vaginal wall. Other symptoms may include a feeling of fullness, a “pulled” sensation in the genitals or the lower back, incontinence, excessive urination, constipation and other bowel problems, and dyspareunia, or painful sexual intercourse.
The most common treatment for this problem is a mesh; the prolapse symptoms are not as painful or discomforting when using a vaginal mesh. However, there is a slight risk of vaginal erosion occurring when using these “medically safe” meshes. There have been many cases of vaginal erosion since 2008, and common symptoms include vaginal pains and bleeding, vaginal discharge, vaginal infections and extrusion of the vaginal surgical mesh.
On the other hand, a vaginal mesh product can help with relieving pain and pressure. It is a device that functions similarly to a female contraceptive, as it is removable. This medical product can keep the pelvis organs in their proper places. Many individuals find this treatment preferable to spending thousands of dollars on colporrhaphy surgery—a procedure that comes with many risks. This treatment is conservative when compared to other solutions, and yet is a relief to women who are feeling pain or discomfort, or who feel as if this is not a major medical issue.
However, the risks associated with meshes should be seriously considered. Talk to your doctor about vaginal erosion solutions or alternatives to prolapse treatments as soon as possible.
Did you have surgery to treat stress urinary incontinence? Are you experiencing vaginal pain and bleeding, or discharge? Your vaginal mesh may have eroded increasing your risk of serious infection and injury.
Signs and Symptoms of Problems with Your Vaginal Surgical Mesh
• vaginal pains and bleeding
• vaginal discharge
• vaginal infections resulting from impaired healing
• extrusion of the vaginal surgical mesh (the mesh is “coming out” of the vagina),
• pain during intercourse, and
• urinary tract erosion
Vaginal mesh, vaginal slings, vaginal tape?
There is a lot of confusion as to what is the proper name of the type of surgical mesh used in the treatment of stress urinary incontinence. This is because there are many different types of products in the market place. As a result of the different variations of the product many women do not know which type of surgical mesh was implanted.
Some of the popular names of the surgical mesh are as follows: vaginal mesh, vaginal slings, vaginal tape. Whatever it is that your doctor calls it, the simple fact is that all the products are made our of some sort of surgical mesh. As to whether the product is considered vaginal mesh, vaginal slings or vaginal tape really depends on the type of surgical mesh used and the place where the the mesh is implanted.
What is urinary incontinence?
Stress Urinary Incontinence (SUI) is a condition which affects approximately 13 million people in the United States, predominantly women. This highly prevalent medical condition remains underdiagnosed and underreported due to its embarrassing nature and social stigma. Female stress urinary incontinence occurs when the pelvic muscles which support the bladder and urethra are weakened; resulting in loss of bladder control. Typically, patients complain of involuntary urine loss during coughing, laughing, and sneezing and their incontinence becomes worse during high impact sports activities.
It is estimated that 50-70% of females with urinary incontinence fail to seek medical evaluation and treatment. Of individuals with urinary incontinence, only 5% in the general community and 2% in nursing homes receive appropriate medical evaluation and treatment. Patients with urinary incontinence often endure this condition for 6-9 years before seeking medical therapy.
For those women who have the resolve to overcome the embarrassment of seeking treatment for this condition, help is available in the form of a â€œvaginal meshâ€, like the Bard Avaulta surgical mesh, which is inserted into the urethra via a medical procedure. Stress urinary incontinence has emerged as such a highly prevalent medical condition that a large and competitive marketplace for commercially viable solutions has emerged. From this demand vaginal surgical mesh like the “Bard Avaulta” mesh was born.
What is vaginal surgical mesh?
Vaginal surgical mesh is manufactured to surgically treat female urinary incontinence. The mesh, like the Bard Avaulta surgical mesh, is an artificial structure that is designed to replace eroded or weakened muscles in the urethra. When implanted, women were supposed to experience relief from their condition, what many received instead was an alarming, violent reaction to the device that lead to a plethora of medical issues.
Vaginal surgical mesh linked to erosion, infections
There are an estimated 35,000 women who suffered through bladder control problems brought on by aging, child birth, and a variety of other causes. The lives of those who had adverse reactions to Bard Avaulta mesh were literally ruined as many experienced crippling pain and permanent scarring damage from the procedures involved in the insertion and necessary removal of the vaginal tape.
Many women experienced debilitating pain as their bodies rejected the vaginal mesh, eventually these women were forced to undergo multiple surgeries to address the complications of their condition and sustained permanent injury. Ultimately, vaginal tape failed to cure their female urinary stress incontinence and caused additional medical complications.
Users of vaginal mesh, like Bard Avaulta surgical mesh, presented to their physicians with extreme vaginal pains and bleeding, vaginal discharge, and infections resulting from impaired healing, vaginal extrusion of the mesh and urinary tract erosion.
Surgical vaginal mesh erosion
Vaginal mesh, like the Bard Avaulta surgical mesh, can erode either into the vagina, or worse, into the urethra or bladder. When this happens surgery is a must because it can cause a lot of problems including chronic infections or a cut off of circulation.
Signs and symptoms of vaginal surgical mesh erosion
If you have any of the following symptoms of mesh erosion you need to go see your surgeon to have another evaluation and possible removal: malodorous vaginal discharge, vaginal pains and bleeding, pain with intercourse, recurrent bladder infections, or generalized pain.
Help for victims of vaginal mesh erosion, organ damage or infections
If you or someone you love are among the tens of thousands of women who had a vaginal surgical mesh, like the Bard Avaulta surgical mesh, implanted contact Law Offices of Sadaka Associates for a free evaluation today!
FDA Issues Warning to Doctors in October 2008
Dear Healthcare Provider:
This is to alert you to complications associated with transvaginal placement of surgical mesh to treat Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). Although rare, these complications can have serious consequences. Following is information regarding the adverse events that have been reported to the FDA and recommendations to reduce the risks.
Nature of the Problem
Over the past three years, FDA has received over 1,000 reports from nine surgical mesh manufacturers of complications that were associated with surgical mesh devices used to repair POP and SUI. These mesh devices are usually placed transvaginally utilizing tools for minimally invasive placement.
The most frequent complications included erosion through vaginal epithelium, infection, pain, urinary problems, and recurrence of prolapse and/or incontinence. There were also reports of bowel, bladder, and blood vessel perforation during insertion. In some cases, vaginal scarring and mesh erosion led to a significant decrease in patient quality of life due to discomfort and pain, including dyspareunia.
Treatment of the various types of complications included additional surgical procedures (some of them to remove the mesh), IV therapy, blood transfusions, and drainage of hematomas or abscesses.
Specific characteristics of patients at increased risk for complications have not been determined. Contributing factors may include the overall health of the patient, the mesh material, the size and shape of the mesh, the surgical technique used, concomitant procedures undertaken (e.g. hysterectomy), and possibly estrogen status.
• Obtain specialized training for each mesh placement technique, and be aware of its risks.
• Be vigilant for potential adverse events from the mesh, especially erosion and infection.
• Watch for complications associated with the tools used in transvaginal placement, especially bowel, bladder and blood vessel perforations.
• Inform patients that implantation of surgical mesh is permanent, and that some complications associated with the implanted mesh may require additional surgery that may or may not correct the complication.
• Inform patients about the potential for serious complications and their effect on quality of life, including pain during sexual intercourse, scarring, and narrowing of the vaginal wall (in POP repair).
• Provide patients with a written copy of the patient labeling from the surgical mesh manufacturer, if available.
Additional patient information can be found on the following FDA Consumer website at http://www.fda.gov/cdrh/consumer/surgicalmesh-popsui.html.
Reporting Adverse Events to FDA
FDA requires hospitals and other user facilities to report deaths and serious injuries associated with the use of medical devices. If you suspect that a reportable adverse event was related to the use of surgical mesh, you should follow the reporting procedure established by your facility.
We also encourage you to report adverse events related to surgical mesh that do not meet the requirements for mandatory reporting. You can report directly to MedWatch, the FDA Safety Information and Adverse Event Reporting program online at www.fda.gov/MedWatch/report.htm, by phone at 1-800-FDA-1088, or obtain the fillable form online at www.fda.gov/MedWatch/getforms.htm, print it out and fax to 1-800-FDA-0178 or mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787.
Getting More Information
If you have questions about this notification, please contact the Office of Surveillance and Biometrics (HFZ-510), 1350 Piccard Drive, Rockville, Maryland, 20850, Fax at 240-276-3356, or by e-mail at firstname.lastname@example.org. You may also leave a voice mail message at 240-276-3357 and we will return your call as soon as possible.
FDA medical device Public Health Notifications are available on the Internet at http://www.fda.gov/cdrh/safety.html. You can also be notified through e-mail each time a new Public Health Notification is added to our web page. To subscribe to this service, visit: http://service.govdelivery.com/service/subscribe.html?code=USFDA_39 .
Daniel G. Schultz, MD
Center for Devices and Radiological Health
Food and Drug Administration
Looking Into Problems With Transvaginal Surgical Mesh
By Nasrin Mirsaidi, RN, CNOR, MSN
(Article reprinted from July Nursing2009, Volume 39, Issue 7)
A PATIENT, 67, had a transvaginal repair with synthetic mesh for pelvic organ prolapse. Four weeks later, she reported spotting, discomfort, and vaginal irritation. The surgeon found that the surgical mesh had eroded into her vagina and prescribed estrogen cream for a month, but it wasn’t effective. The patient needed more surgery for resection of the exposed mesh and closure of eroded tissue.
Pelvic organ prolapse and stress urinary incontinence are pelvic disorders affecting millions of women in the United States.1 They occur when pelvic floor muscles lose strength, allowing pelvic organs, including the bladder and uterus, to descend from their normal location and bulge through the vaginal wall (pelvic organ prolapse), or diminishing bladder control (stress urinary incontinence).1,2
Treatment options for pelvic organ prolapse or stress urinary incontinence include several surgical and nonsurgical approaches. Transvaginal placement of mesh has become increasingly popular in recent years.3
What’s the problem?
In the last 3 years, the FDA has received over 1,000 adverse event reports about mesh used in transvaginal surgical repair of pelvic organ prolapse and stress urinary incontinence. These reports include problems such as pain, infection, mesh erosion (into vagina, bowel, and bladder), and recurrence of prolapse or incontinence. Some reports involved rare but serious intraoperative injuries such as bowel, bladder, or blood vessel perforation. Most patients described in the adverse event reports needed medical or surgical intervention, and some required hospitalization.4
Although the exact cause of these adverse events hasn’t been identified, they’re likely to be the result of multiple factors. Further investigation is needed.
What precautions can you take?
Although treatment with mesh may have helped many women, in others it’s caused complications affecting quality of life.3,4 A literature review demonstrates conflicting information on success rates for transvaginal mesh placement, but everyone agrees on the need for controlled trials.5 If you care for a patient undergoing a transvaginal mesh placement procedure, consider this advice:
Become familiar with the types of mesh and procedures used for the repair of pelvic organ prolapse and treatment of stress urinary incontinence.
Ensure that your patient has given her informed consent. Make sure she’s received appropriate information about her choice of treatment, the type of procedure she’s undergoing, and possible adverse events.
During preoperative teaching sessions, tell your patient about possible adverse reactions, the signs and symptoms of infection, and when to notify her healthcare provider.
If you’re an OR nurse, follow your facility’s policies and procedures for recording information about implanted materials. Record the name of the mesh used and its catalog number, lot number, and size in the patient’s medical record.
Provide your patient with a written copy of the patient labeling from the surgical mesh manufacturer, if it’s available.
If your patient has surgery to remove mesh, follow your facility’s policies and procedures for properly handling the explanted mesh. Additionally, follow your facility’s policies and procedures for reporting adverse events.
For further information, refer your patient to this FDA Web site.
1. Weber AM, Richter HE. Pelvic organ prolapse. Obstet Gynecol. 2005;106(3):615-634.
2. Fultz NH, Burgio K, Diokno AC, Kinchen KS, Obenchain R, Bump RC. Burden of stress urinary incontinence for community-dwelling women. Obstet Gynecol. 2003;189(5):1275-1282.
3. Mistrangelo E, Mancuso S, Nadalini C, Lijoi D, Costantini S. Rising use of synthetic mesh in transvaginal pelvic reconstructive surgery: a review of the risk of vaginal erosion. J Minim Invasive Gynecol. 2007;14(5):564-569.
4. FDA Public Health Notification: Serious complications associated with transvaginal placement of surgical mesh in repair of pelvic organ prolapse and stress urinary incontinence. October 20, 2008.
5. Slack A, Jackson S. Advances in the surgical management of prolapse. Menopause Int. 2007;13(1): 38-43.
Although you need to support your healthcare facility’s adverse eventâ€”reporting policy, you may voluntarily report a medical device that doesn’t perform as intended by contacting MedWatch at 1-800-FDA-1088 (fax: 1-800-FDA-0178) or online.
Diane Dwyer, RN, BSN, who coordinates Device Safety, is a nurse consultant at the Center for Devices and Radiological Health at the FDA in Rockville, Md.
Nasrin Mirsaidi is a nurse consultant for general and plastic surgery devices at the Center for Devices and Radiological Health.