Were you told a bladder sling is an “easy” solution to a leaky, overactive bladder or pelvic organ prolapse? Easy for the surgeon, maybe, but not so easy for millions of women. Today’s story about mesh trouble is about vaginal scarring, which can make sexual intercourse difficult, even impossible, cause deformities and increase pain.
Scar tissue, made of collagen, a fibrous tissue that replaces normal tissue after any injury and can adhere to skin, muscle, or connective tissue. It pulls on the surrounding tissue, making it taut and restricting blood flow. It causes pain when it impinges on nerves or restricts the flow of blood carrying oxygen to an area. Merely cutting the vagina open and sewing it shut in order to implant mesh leaves scarring—adding polypropylene mesh separates the healthy tissues, causing it to struggle to heal and leaving more damage behind.
Anatomy of a vaginal scar: Even though plastic mesh has been implanted since 1998, scientists really don’t know what they are doing to your body, R.Laing, et al wrote in 2013: “Meshes are widely used in prolapse surgeries to improve anatomical outcomes with little knowledge of the impact on the vagina. Like all organs in the body, the vagina is comprised of several protective layers: adventitia, subepithelium, and smooth muscle layers. Disrupting those important tissues causes scarring. The tissue surrounding the vaginal consists of key structural proteins: collagen, elastin and smooth muscle myosin.” These help the vagina to move, stretch and maintain support for its own structure. The introduction of surgical mesh to those proteins has the potential to send them into chaos. The more pliable the mesh, the less disorganization occurs in the protective layers. Softer meshes have been recently introduced but they continue to elicit a foreign body response (rejection activity) and encourage thinning of the protective environment which can lead to vaginal erosion. The 2013 study reported: “Possible mechanisms include the innate immune response and chronic microinjury from mesh micromotion.”
Treatment: Some doctors tell patients that if there is no pain, no dehiscence, no erosion, there will be no treatment. For women who have endured many surgeries trying to relieve mesh complications, scarring is an enormous issue.
There are a number of treatments available. If the scar is due to infection, antibiotics can reduce infection and inflammation. Estrogen cream and pessaries can improve blood flow and nerve supply to your vagina and promote healthy healing.
The scar can be taken out and the area sewn closed again with newer and smaller sutures—like those used in plastic surgery. Lasers can be used in small areas to dissolve the abnormal tissue and some surgeons combine both modalities.
Physical therapy (PT) can make the tissue more flexible by massaging it or applying ultrasound. Scar tissue massage can be extremely painful and re-traumatizing. Some women cannot tolerate it. For those who can, many report that after months, they find it helps lessen scars.
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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