This is a tough one to write, but I feel like I am doing my fellow women (or men) a disservice if this topic is not talked about. Let's play out a scenario. You report that you have urinary incontinence to your doctor (most likely a specialist). The doctor does a vaginal exam and determines you have a grade 1- grade 2 bladder prolapse (bladder is just above or at the vaginal entrance, may depend on the time of day). Maybe the bladder never bothered you and you did not even know you had a prolapse, but the incontinence or leakage has definitely bothered you the last 10 years. Your doctor tells you that a bladder sling (typically used with mesh) will "cure your incontinence" and fix your bladder prolapse. They also tell you that we should take your uterus and ovaries out because you are practically in menopause anyways.
Because this is your doctor, you think, "Okay, well if they think this is best, then it probably is". So you have the surgery. Before surgery, the doctor, nurse, or paperwork lists all the things that can go wrong. This is typically a small percentage of people, though, so you think nothing of it. You trust your doctor because you have seen them for the last 10 years.
Let me also add a disclaimer: All of this scenario to say, I DO NOT think that all doctors have bad intentions when suggesting surgery to their patients. Obviously surgery is ABSOLUTELY necessary in some situations. I am merely suggesting to make sure you have done lots of research and even possibly gotten a second opinion. Reach out to someone if you don't know where to find that research. See scholarly articles below about conservative management of urinary incontinence vs. surgical intervention.
So, you go ahead and have the surgery.
POST SURGICAL SCENARIOS
A. You have the surgery with no complications. It helps your symptoms and you do not have any problems.
B. You have the surgery and it goes fine. You are given a list of things you can never do again so that you avoid hurting the sling, including no lifting over 15-20 lbs, jumping, working out, etc. that you didn't realize you couldn't do post-surgery. You are not educated about pelvic floor strengthening or scar tissue mobility post surgery. The incontinence goes away for 1-2 years, but because you did not change anything about how you were lifting, pooping, sneezing, coughing, or strengthening your core, leakage returns. You are left thinking "what gives".
C. You have the surgery and you wake up in pain. The pain never goes away. The pain is in your butt, shoots down your leg, makes it difficult to sit for any period of time, and leaves you in a chronic state of pain that you have never been in. Health care professionals (at least 6 of them) keep telling you you have "sciatica" (although the pain is not even referring in the sciatic nerve distribution). You are made to believe that you are crazy for feeling this pain. You are told after the bladder sling surgery that "it definitely can't be the sling". So you are left thinking, "What the heck did I do to cause this pain?" All the while thinking "I never had this pain until I had surgery". Oh, and you are still leaking urine. And now you are put into a post menopausal state because they decided to do a total hysterectomy (removal of ovaries and uterus), just to "get everything out of there".
Now C seems pretty dramatic, right? Unfortunately, this situation is VERY real for many women. A true story. We are made to believe surgery is no big deal, but unfortunately studies and story after story of women continue to be presented that vaginal mesh can be extremely disruptive to tissue, cause long term scarring, and cause neurological damage.
In 2019, the FDA banned transvaginal mesh. It took 17 years of women experiencing problems for this to be banned. It is still not banned, however, for abdominal implantation or for stress urinary incontinence (SUI). (The Bleeding Edge on Netflix discusses the problems women have had with Johnson & Johnson mesh products, a $117 million lawsuit. I would argue that this is not enough for the damages done to women's quality of life, problems with intimacy, chronic pain, and subsequently mental and emotional trauma.)
Here's the problem: To this day, some (not all) doctors are refuting the fact that all of these problems could be due to the transvaginal mesh. Even this article from Yale states that abdominal mesh or mesh for SUI are in fact safe, although it is the same mesh and has the same risks. Mesh is not selective to tissue, meaning there is no reason it would be bad for one area of the body and good for another. Many of the side effects are also consistently under-reported. The European Association of Urology has this helpful handout which describes that surgery for prolapse or urinary incontinence should be the absolute last intervention, and that conservative intervention is the gold standard of treatment. Research studies continue to show that stress and mixed urinary incontinence are continually best treated by conservative care by a pelvic floor therapy specialist.
All of this to say, for ANY SURGERY, please try to do your research prior to surgery. If you don't understand what the research means, reach out to me or someone that can direct you to how you can educate yourself. Ask your surgeon questions. If they are not receptive to your questions, do you want them performing surgery on your body? You should feel absolutely comfortable and safe, yet feel empowered to know all of the risks that can occur.
This post is not to scare you, but to empower you that you have ultimate say and control over your own body. Get a second opinion. Know your options. And in most situations, I suggest to attempt conservative care prior to surgery. See flow chart above for the recommended series of events by the European Association of Urology. Typically surgical option is the last option after conservative care is offered.
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This content is created in order for individuals to learn more about the pelvic floor. I am in no way giving medical advice or medically assessing the pelvic floor through this blog. If you ever have any health questions or concerns, please consult with your physician or midwife. If you are ever unsure if you are performing exercises correctly, it may be beneficial for you to get a referral from your physician to a pelvic floor therapist for further evaluation. My blog posts are for educational purposes only! I am not liable or responsible for any damages resulting from or related to your use of this information.