You may have heard that transvaginal mesh (TVM) can cause terrifying and painful complications, but what if you have stress urinary incontinence (SUI)? This condition can be embarrassing and may make it difficult to go to work or have a carefree evening with friends. Fortunately, there are alternative ways to help manage SUI.
First of all, discuss your unique situation your doctor. Your individual condition may dictate which option may work best for you. Additionally, every medical decision comes with a certain amount pros and cons. It’s important to fully educate yourself on the benefits versus risks to determine which path is best for you.
Your first line of defense should be the safest which means trying certain exercises. Kegel exercises, which involve repeatedly contracting and relaxing the pelvic floor muscles, may help with incontinence. A physical therapist may have additional exercises that can help you to strengthen, tighten, and lengthen these weakened muscles.
Some doctors recommend “timed voiding” which means using the restroom every hour and not only when you feel the urge. “Now instead of the bladder being in control, the individual is,” says Alan Y. Sadah, MD, urogynecologist at West Suburban Medical Center. “Bladders can be retrained. It just takes a plan and some time.”
Pessaries are silicon rings, disks, cubes, or U-shaped devices that help support organs for SUI. This removable device is inserted in the vagina and comes in different sizes, so it may take a few tries to get the perfect fit (too small and it could fall out, too large and the added pressure will feel uncomfortable). If you have a pessary that you can remove (like the ring version), you’ll have to carefully clean it once a week. If it’s a disk-type, then you’ll have to visit your doctor every one to three months to have him remove it to clean it. The cons with this device is that you will need to remove it to clean it and there is a chance that it could cause vaginal irritation or infection. Larger pessaries will also prevent you from having sexual intercourse with it in.
Depending on your issues, there are different types of surgeries that can help to support your organs. Fascial or natural tissue repair uses your own tissues to support the weakened muscles. Animal-derived mesh which consists of animal tissue - such as intestine or skin that have been processed and disinfected to be suitable for use - may also be used. The problems with this type of procedure is that this solution involves absorbable mesh and will degrade and lose strength over time. This means that additional surgeries may be needed in the future.
Clearly finding the right sized pessary and cleaning it monthly or having repeat surgeries for native tissue repairs is not ideal, which is why TVM was considered to be “the gold standard” for a long term solution for SUI. The problems associated with mesh is that it can break apart and the sharp edges can cut tissue and organs causing immense pain and complications. It is also difficult and sometimes impossible to remove when tissue grows in and around it. These debilitating injuries have harmed tens of thousands of women worldwide and TVM is currently banned in New Zealand and Australia and is paused in the UK and Ireland. While these alternative options may not be the most convenient, they pose much less risk than TVM.