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 crazy stories about mesh complications?
In this case, you may like to find out more about:
- How to fix a prolapsed bladder without surgery?
- Are there less invasive treatments for bladder prolapse?
- What is bladder prolapse surgery with mesh?
- Are there complications of vaginal mesh repair?
- Is there a possibility of recurrence after surgery?
A prolapse of the bladder, 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.
A 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 to 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 a 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 not aware of it because they have no bothersome symptoms.
2. Are there less invasive treatments for bladder prolapse?
In recent years the doctors are trying to avoid the procedure as long as it is possible. They test other less invasive techniques every day, and some of them 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 which measures and delivers small electrical currents. The probe aims 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 an electrical stimulation with less power which they perform from outside of the body. This treatment magnetically stimulates the pudendal nerve ( the main nerve of the perineum).
In the biofeedback, the doctors are monitoring the vaginal muscle activity of the vagina and the pelvic floor, using a specific sensor. After that, different exercises can be prescribed to straighten these muscles.
But if symptoms of the bladder prolapsed 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 not as 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 being 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 most often, they 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:.
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 pieces of mesh also erode into other tissues. Symptoms range from vaginal pain, discharge, 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, treatment with topical estrogen cream may relieve some of the 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 take often multiple surgeries.
Problems related to shrinking or contracting of synthetic mesh material can occur anytime after the bladder prolapse surgery. Sometimes it begins years later. 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 as well as 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 of their pain once they release the tension.
5. Is there a possibility of recurrence after surgery?
The results of a study carried out by then Radcliff John Hospital in Oxford shows that 10.8 % of women undergoing pelvic organ prolapse surgery have a second or third operation within the next 11 years. The study followed a group of 2099 women that had surgery for POP between 1995 and 2005. Worth mentioning is that of the women that needed repeat surgery, 61,5% needed surgery in a different area than the site of the original operation.
When you decide to have bladder prolapse surgery with mesh repair, be aware of the fact that mesh implants are permanent. That there may be complications affecting your quality of life that may ask for another surgery.
The FDA advice women to closely monitor for complications after this type of surgery, and to report any adverse effects they may have.