Pelvic organ prolapse is a condition that is not too uncommon in women, especially older women who have given birth. The condition occurs when the pelvic floor muscles and tissues, those that support the organs of the pelvic region, weaken and can no longer fully hold up those organs. The pelvic floor acts like a sling or hammock to hold the bladder, uterus, and bowels in place.
When the pelvic floor weakens like this it can cause all kinds of disruptive symptoms including difficulty urinating and urinary incontinence. Surgery can be done to repair the weakened tissues, but it is invasive. In recent years, medical device manufacturers developed a new procedure using bladder slings or transvaginal mesh that could be inserted vaginally in an outpatient procedure rather than surgically. While it was supposed to provide a better option, instead it has caused thousands of women more pain.
The Pelvic Floor and Organ Prolapse
The pelvic floor is a sling of tissue and muscle that holds up the uterus, cervix, bladder, intestines, urethra, and rectum. It can become weak, or relaxed as it is sometimes termed, causing these organs to drop down. This is called pelvic organ prolapse and it can actually cause these organs to protrude into the vagina and in severe cases, all the way outside of the body. For a long time this was an issue that was little talked about, but now women’s health care providers push to educate patients about it and to make sure it is a problem that is no longer ignored.
The cause of pelvic organ prolapse is the weakening of the pelvic floor muscles, but what causes that may vary depending on the individual. The risk for this weakening of the tissues increases with age, as the muscles weaken over time. A woman who has had multiple vaginal births is also at an elevated risk. Other risk factors include obesity and having had surgery previously in the pelvic region.
Symptoms and Complications
Pelvic organ prolapse is not something that should be ignored or left untreated because it causes symptoms and complications that are chronic, uncomfortable, painful, and that reduce quality of life. The most common symptoms are pain and pressure from the dropping organs. This may be felt in the vagina and likely worsens when having a bowel movement and at the end of the day.
Other symptoms and complications may include difficulty urinating, painful urination, urinary incontinence, urinary tract infections, and constipation. There are also likely to be sexual function problems, including pain during intercourse. Women with pelvic organ prolapse may also suffer from stress and anxiety, feelings of shame and embarrassment, and are likely to withdraw from social activities.
Prevention and Non-Surgical Treatment
Women can take steps to try to prevent developing pelvic organ prolapse, and it makes sense to do so, especially for women who have given birth. To reduce the risk of weakening the pelvic floor it is important to maintain a healthy weight, to avoid smoking, to prevent constipation with a good diet, get exercise, and get checkups regularly.
Women who have prolapse, but only mildly and with symptoms that are not disruptive can benefit from non-surgical treatments that prevent the condition from worsening. One important strategy is to do pelvic floor exercises to help strengthen the muscles. These are called Kegel exercises, and a doctor can explain to a patient how to do them and how many to do per day. Another non-surgical option is to have a pessary, a cap, placed inside the vagina to provide added support.
For women with moderate to severe cases of pelvic organ prolapse, the preventative measures and non-surgical treatments may not be enough. When the prolapse is severe enough to cause discomfort and symptoms like incontinence, surgery may be done to correct the problem. Traditional surgery for this condition involves repositioning organs and holding them in place with stitches or with a graft.
Surgery is not always a perfect solution to pelvic organ prolapse. It is invasive, although now the procedure may be performed laparoscopically with small abdominal incisions. Surgery requires a long recovery time and it may cause complications, like infections, incontinence, bleeding, or in some cases even additional damage to the tissues in the pelvic region.
Surgical mesh is a synthetic material that can be used to support organs in the body. For instance, it is often used to treat a hernia by adding support to the abdominal wall at a weak spot. At one time, pelvic organ prolapse was only treated with surgery, but a new method was developed, using surgical mesh inserted vaginally. This was supposed to limit the risks associated with surgery, the need for surgical incisions, and recovery time. Instead of surgery with general anesthesia and days of recovery, a woman’s gynecologist could insert the mesh and use it to support pelvic organs in a procedure that takes about ten minutes.
Complications of Transvaginal Mesh
Manufacturers of surgical mesh realized there was a market for this use of mesh and began packaging mesh in kits that could be used by gynecologists in their offices. Since this practice became popular, though, there have been thousands of reports of complications and adverse events. Some of these include erosion, the movement of the mesh through surrounding tissues, infections, pain, bleeding, perforation of organs by the mesh, and incontinence. Many women were so badly injured by the mesh that they required revision surgery.
The U.S. Food and Drug Administration (FDA) collect adverse event reports and then decide to take action or not. In the case of transvaginal mesh the FDA has not recalled the product, but it has issued warnings and in 2016 updated the classification for transvaginal mesh from a moderate- to high-risk medical device. The agency continues to investigate the safety of the device and reasons for the complications it causes. One suggestion is that it is the way the mesh is inserted, by doctors in an office setting rather than by a surgeon in a sterile operating room, that causes the majority of problems.
Transvaginal Mesh Lawsuits
Women have suffered in the thousands because of transvaginal mesh, whatever the real cause of the complications is. Multidistrict litigation against companies C.R. Bard and American Medical Systems have resulted in multimillion dollar awards to those women who suffered terrible and painful complications. Other companies have been implicated as well and accused by plaintiffs of failing to adequately test their products for safety, of not communicating risks to doctors and patients, and of even hiding the risks associated with transvaginal mesh.
Women who have already suffered the symptoms and complications of pelvic organ prolapse should not have to suffer more from the treatment. Now labeled as a high-risk device, transvaginal mesh is used far less often than it used to be and many women have been given the compensation they were owed.