5 Burning Questions About Bladder Prolapse Surgery With Mesh Repair

Are you apprehensive because your doctor says bladder prolapse surgery is the best solution for your fallen bladder?

Do you try to make sense of all the shocking stories about mesh complications?

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A bladder prolapse, or cystocele, occurs when the pelvic floor muscles and ligaments become weaker or even stretched. Often they call it a fallen bladder as it is causing the bladder to fall against or into the vagina.

When a prolapsed bladder is severe, it may feel as if your bladder is dropping out of your vagina. You may feel ashamed because of your increasing incontinence, and intercourse may be painful when your partner pushes against the bladder.

Bladder prolapse is more likely to occur after a hysterectomy as this surgery affects the ligaments, muscles, and other support structures of the pelvic floor.

1. How do you fix a prolapsed bladder without surgery?

Kegel exercises, special exercises that strengthen the pelvic floor muscles, can help control urine leakage. Estrogen replacement therapy can also help improve muscle strength. In some cases, inserting a pessary may be enough to support the bladder.

According to the American Urological Association Foundation, the stress on the area during childbirth is a significant cause of women getting bladder prolapse.

They estimate that one out of three women who gave birth vaginally have a stage 2 pelvic organ prolapse. Stage 2 is when the bladder pushes the vaginal wall within 1 cm of the vaginal opening. Surprisingly, many of these women are unaware of it because they have no bothersome symptoms.

2. Are there less invasive treatments for bladder prolapse?

In recent years, doctors have been trying to avoid the procedure as long as it is possible. They test other less invasive techniques daily, and some show great results.

Electrical stimulation and a procedure called biofeedback can help to straighten the pelvic muscles.

For electrical stimulation, they attach a probe to another medical device that measures and delivers small electrical currents.  The probe aims at the muscles group within the area of the vagina and makes contractions. The result is that these muscles become stronger.

Another less intrusive stimulation is electrical stimulation with less power, which they perform outside the body. This treatment magnetically stimulates the pudendal nerve ( the main nerve of the perineum).

In biofeedback, doctors use a specific sensor to monitor the vaginal muscle activity of the vagina and the pelvic floor. After that, different exercises can be prescribed to straighten these muscles.

But if symptoms of bladder prolapse start interfering with a woman’s life or if she is not responding correctly to a treatment, bladder support surgery might be the only solution.

3. What is bladder prolapse surgery with mesh?

Bladder prolapse surgery (anterior vaginal repair) is most commonly performed through the vaginal entrance. They can also do it abdominal, but doctors prefer transvaginal as it is easier, faster, and less invasive. What they aim to do is to settle the bladder in its original position and mobilize it. For this, they use a surgical mesh that is made of synthetic material or animal tissue.

To reinforce the vaginal wall, the surgeon will insert a mesh through an incision in the anterior wall of the vagina. The vaginal wall is straightened, and the bladder is then supported.

Depending on a woman’s condition and the complexity of the procedure, they do bladder lift surgery with regional or local anesthesia or, if necessary, under general anesthesia.

A good thing to know about this surgery is that they often release women from the hospital the same day after the surgery.

4. Are there complications associated with vaginal mesh repair?

Sometimes, a woman’s problems don’t end there. Complications of bladder lift surgery are frighteningly common. Failures from transvaginal repair of a bladder prolapse remain a great concern for the FDA. Most of the time, complications are from the mesh material itself like:

Mesh erosion

Erosion is a serious complication. What happens is that the mesh implant gradually erodes through the vaginal wall. It becomes a major health issue when mesh pieces also erode into other tissues. Symptoms range from vaginal pain, discharge, and odor to bleeding. Sex can become painful for both men and women. A man can scratch his penis on the exposed mesh material during intercourse.

When they discover mesh erosion early, topical estrogen cream treatment may relieve some symptoms but will rarely cure the problem. When problems are severe, surgery is often the best option. However, they often find that tissue has grown into and around the mesh, making the removal of mesh from the surrounding tissues and organs a complex procedure.  When the bladder, bowel, and urethra are involved, this will often take multiple surgeries.

 Mesh contraction

 Problems related to shrinking or contracting synthetic mesh material can occur anytime after the bladder prolapse surgery. Sometimes, it begins years later. The contracting mesh may pull nerves, tissues, and organs out of their normal position. This may produce a range of symptoms, including:

• Severe vaginal pain
• Pain during intercourse
• Pelvic floor spasm
• Rectal pain
• Painful bowel movements
• Pain that radiates through the leg

 Women suffering painful symptoms of mesh contraction may find relief through pelvic floor therapy, vaginal trigger point or epidural injections, and pain medications. Women may also opt for surgery, where they make a cut into the mesh to release the tightness. Most women find immediate relief from their pain once they release the tension.

5. Is there a possibility of recurrence after surgery?

Following women for five years following two popular prolapse surgeries, a Duke-led study that was just published in the Journal of the American Medical Association found that both treatments had failure rates of over 60%. Surveys of the study’s nearly 300 female participants revealed that, even for patients whose surgical adjustments resulted in relapses or new or worsening symptoms, more than half still stated that, five years after surgery, their quality of life was significantly better than before, and only a small number of women pursued retreatment. (Source)

Conclusion

When you decide to have bladder prolapse surgery with mesh repair, be aware of the fact that mesh implants are permanent. There may be complications affecting your quality of life that may require another surgery.

The FDA advises women to monitor for complications after this type of surgery closely and to report any adverse effects they may have.

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• How to do pelvic floor exercises after hysterectomy?
• Can you fix light bladder leakage after hysterectomy?
• 5 Burning Questions About Bladder Prolapse Surgery With Mesh Repair
• Why do I keep getting UTIs after hysterectomy?
• Interesting Facts About Prolapse after Hysterectomy I Bet You Never Knew