Mesh in female pelvic reconstructive surgery

The pelvic floor is a group of muscles and connective tissues. It forms a "hammock" across the bottom of the pelvis. The pelvic floor holds key organs in place. These include the rectum, bladder, vagina, cervix and uterus. A strong pelvic floor helps these organs work well.

If you have a pelvic organ prolapse, certain muscles or other tissues in your pelvis become weak or injured. Pelvic organ prolapse can lead to symptoms that bother you, such as:

• Leaking urine by accident.
• Not being able to control bowel movements.
• Feeling pressure in your pelvis.
• Sexual problems.
• Pain or aches when you do something active.

Treatment can help if you have symptoms that limit what you can do. Surgery is one treatment choice for pelvic organ prolapse. And sometimes surgery involves a material called mesh.

You may have heard about reports of problems that can stem from treatments that use mesh. Learn how surgical mesh is used, the possible problems after surgery and what to watch for.

What is surgical mesh?

Surgical mesh is a medical product that gives weak or damaged tissue extra support. It's used in some surgeries for pelvic organ prolapse. Most surgical mesh is a lab-made material. Some mesh is made from animal tissues. But health care providers often don't suggest using mesh that's made from animal tissues. That's because it doesn't perform as well as lab-made mesh does.

How is surgical mesh used to treat pelvic floor disorders?

Surgical mesh can be used to treat both pelvic organ prolapse and stress urinary incontinence.

Pelvic organ prolapse

There are two ways to fix prolapse with surgery:

• Surgery through the abdomen. A surgeon can implant mesh to reinforce the weakened vaginal wall. You may have surgery through a cut in your stomach or through some smaller cuts. Either of these types of cuts allows the use of surgical mesh.
• Surgery through the vagina. A surgeon can fix the prolapse through a cut in the vagina. But this method doesn't use mesh. The surgeon uses stiches, also called sutures, to repair the damaged tissues instead. Surgery through the vagina using mesh is no longer an option to treat pelvic organ prolapse. You should not have mesh placed through a cut in the vagina, if you have this condition. The mesh might raise your risk of problems after surgery.

Stress urinary incontinence

This condition causes urine to leak when there is pressure on the bladder. That can include coughing, sneezing, running or heavy lifting.

Surgery using mesh may help fix it. Surgeons can implant mesh slings through a cut in the vagina. Or they can do it through two small cuts in the lower stomach just above the pubic bone. The mesh sling supports the tube that carries urine from the body, called the urethra. This operation is known as a midurethral sling or a mesh sling procedure.

What are the safety concerns about use of surgical mesh?

Each use of mesh carries its own risks and benefits.

Use of surgical mesh through the vagina to treat pelvic organ prolapse is linked to higher rates of mesh-related problems. These problems include mesh poking through the vaginal wall, pelvic pain and pain during sex. If you've had this type of surgery, keep up with your routine care. This type of procedure isn't done anymore in the U.S.

When mesh is used for stress urinary incontinence or for prolapse repairs, there's a small chance that other problems could happen. The mesh may stick out through the surgery cut and into the vaginal canal. This is called a mesh exposure or erosion. Most people with erosion don't have symptoms. Those who do get symptoms say they have spotting, discharge or partner discomfort during sex. Serious problems are rare.

If you have mesh-related problems after your surgery, you may need another surgery to remove the mesh. Or you may get better after using a special vaginal cream that your health care provider can give you. A procedure to cut off an exposed piece of mesh also may help you get better.

What should I watch for?

Talk to your health care provider right away if you have symptoms that might be related to surgical mesh, such as:

• Feeling a piece of mesh poking into the vagina.
• Ongoing bleeding or discharge from the vagina.
• Pain in the pelvis or groin.
• Pain during sex for you or your partner.

Even if you don't have any symptoms, it's important to keep up with your routine care. This allows you and your provider to watch for any problems. And it allows for prompt treatment if problems do happen.

What questions should I ask before surgery for a pelvic floor disorder?

Ask your health care provider if use of mesh is planned for your surgery. Ask your provider to explain all of your treatment options, and make sure you understand the possible risks and benefits of each option.