Among the new words mesh-affected folks must learn is “fistula.” Before mesh implant surgery most people have never heard of it, yet fistula is one of the most devastating mesh injuries. Fistula is a connection between two organs that are not normally connected. For example, between the rectum and the vagina. The fistula gets there because something happened to the normally healthy tissue that separates the two organs—a sharp injury (such as a surgical cut), blunt force injury (such as childbirth or violent rape), inflammation or infection. Other known causes are inflammation due to Crohn’s disease, cancer, radiation treatment, diverticulitis or ulcerative colitis.
Mesh-related fistulas are caused by a surgical mistakes (e.g. puncturing an organ with a trocar or a scalpel), erosion of the mesh into one or more organs, inflammation or infections.
When fistulas develop in the vagina, they create an abnormal opening between the vagina and bladder or rectum. Fistula is an grave emotional injury as well—imagine how it would feel to sit on the potty and urine or stool is passing through your vagina. Vaginal fistulas play on a woman’s feeling of shame, a situation that surgeons often ignore. A women harbors primitive and deep feelings about her vagina that should be honored. She places special emotional, spiritual, and tribal values on her most private and sacred organ and, while her surgeon can label those feelings as “embarrassing,” her feelings go much deeper than that. Surgeons should be aware of the effect of the callous treatment women say they experience, both in the examining room and in the operating room. Pelvic surgeons need to take a long, hard look at their own behavior and remember why they became a doctor in the first place.
Types of vaginal fistulae:
• Vesicovaginal fistula—Vagina and the urinary tract • Enterovaginal fistula—Vagina and the small bowel • Rectovaginal fistula—Vagina and the rectum • Colovaginal fistula—Vagina and the colon
Complications, or mesh troubles, with fistulas:
Fistulas can lead to serious medical conditions like an infection in the genital area, and unusual discharge, urinary incontinence and pain in the vagina.
Treatment of vaginal fistulas: How you decide to have your fistula treated, is your decision once you know more about the size and placement of your fistula and take into consideration your overall health and your financial and emotional support system. Treatment often requires surgery to close the unwanted opening but attempts to use a transvaginal mesh patch to keep the organs separated ignore recent research about foreign body reactions and infections common to vaginal mesh. There are other ways to regain strength in the surrounding muscles that might help a woman avoid a(nother) dangerous and defective implant.
Peggy Day is working on a book to combine all these stories. This is an excerpt from Pelvis in Flames: Your Pelvic Mesh Owner’s Guide. Your input is welcome to help make Pelvis in Flames the book you need to read.
If you’d like to join an online support group and learn about erosion, partial removals, surgeons, or just find out that you are not alone, join my group, Surgical Mesh or check the list of support groups here.
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