Pain or complications after Surgery using Mesh

Information for women suffering mesh-related symptoms

Due to the large increase in members  of the Australian Pelvic Mesh Support Facebook Group over the past few months, we have become increasingly concerned about not meeting women’s needs through the Facebook page. To be able to provide up to date information in relation to mesh recovery, we have dedicated this webpage for women and families to access.

What is Trans-Vaginal Mesh?

Transvaginal mesh is an implant used to treat pelvic organ prolapse and stress urinary incontinence in women.

Mesh products have been used for over 20 years in the human body to help support weak tissue. Transvaginal mesh has been used in Australia since about 2000. 

The product design and implantation techniques appear to be responsible for serious, life-altering complications in some women. It is estimated that there may be as many as 100,000 women with the implant, and of these, the proportion of women suffering complications has been estimated to be anywhere between 1% and 30%.

If you are suffering symptoms of prolapse and are considering surgery please read this information sheet developed by the Health Issues Centre

On 15 February 2017, a senate inquiry was launched into the number of women in Australia with transvaginal mesh implants and related matters. A report and recommendations from the Committee is expected in February 2018.

WHRIA is taking a pro-active approach while the Senate gathers information. 

What are the symptoms of trans-vaginal mesh complications?

Some women will have no symptoms at all. Other women have severe and debilitating symptoms. The first step is to discuss your symptoms with your GP. There may be simple solutions for relief. 

Some complications can include:

The main symptom is often pain, which can be highly variable. You might feel burning, electric shock, shooting, aching, itch or a raw feeling in your clitoris, labia, vagina, urethra, perineum, anus or rectum. You might find it difficult to sit or walk because of your pain. 

You may also experience bladder and bowel irritation or leakage. Sometimes you can feel this irritation without feeling much pain. Occasionally there is a full sensation in vagina or rectum. There may be pain with sex or arousal. Other times the area can feel numb.

Sometimes pain can be felt into the buttocks, hips, legs and feet. This is because the skin there is supplied by the same level of your spinal cord and your brain ‘perceives’ the pain in the skin of your buttocks, legs and feet.

A full list of symptoms reported to the Therapeutic Goods Administration (TGA) can be seen here.

Steps to see Professor Vancaillie, Dr Yasmin Tan & the team at WHRIA

There are many women who may require mesh removal and we are doing our very best to ensure everyone is seen.

If you would like to to see Prof Vancaillie or Dr Yasmin Tan and the team at WHRIA in relation to pain and complications after mesh surgery please follow the steps below.

First step:

Email the following information to mere.seniloli@whria.com.au

1. Name and DOB
2. Referral from your GP/specialist (even if a phone consult is required) and referral to WHRIA Diagnostics for your ultrasound
3. Procedure (type of surgery)
4. Implant log (type of mesh/hardware etc)
5. Number of surgeries/revisions (removal/partial removal etc)
6. Has your mesh been removed completely?
7. Complete this quick survey for your file

Next step

Your file will be reviewed by our team.

Mere will telephone you to book an appointment with Prof Vancaillie or Dr Yasmin Tan, 3D ultrasound and Pain Education with Liz Howard after your doctor’s appointment. Plan for approximately 2-3 hours at the clinic.

Information for assisted travel from interstate:

• South Australia 
• Victoria
• Western Australia
• New South Wales
• Northern Territory
• Tasmania
• Queensland

Physical Examination 

We’ll conduct a gentle internal examination and other external clinical examinations. These include neurological and musculoskeletal tests of your legs, pelvis and perineum. Your doctor will assess your history, and the information from your physical examination and tests to come to a diagnosis – or to work out if your symptoms are caused by another problem. Then, they’ll discuss the best treatment plan with you.

Do I need a 3D Trans-labial Ultrasound? 

A 3D Ultrasound, is best way to provide visualize mesh pre-surgery, and provide more information to help you make a decision. Our gynaecological sonographer, Kathleen Sweeney will conduct the scan with Dr Yasmin Tan or Prof Vancaillie. A seperate referral is required from your GP or specialist for the scan.

Appointments for 3D Ultrasound are scheduled on Monday afternoon or Thursdays. 

Management of mesh-related complications

Mesh-related pain, like any pain condition, is managed through adapting your everyday life. We’ll suggest adjustments to your work and home life, and your leisure activities. Your doctor may also suggest medical interventions.

The crucial element in the process is that you are the driver of your management plan. Your physical, work, home and social goals are the main focus. We help you work towards your goals.

With tailored management, we will help you regain as much functionality in your life as possible.

Liz Howard can provide pain education and will usually be available to discuss your plan after your appointment with your doctor.

Conservative Management

Depending on the factors involved in your mesh implant and resulting pain or symptoms, your management plan might involve several different specialists, as well as your own self-management. If you require surgery, it is important to reduce your pain levels before surgery to reduce the likelihood of persistent pain after surgery. You can read more at IASP Global Year Against Pain After Surgery 2017

The aim is to reduce the irritability of your nervous system and reduce your pain. As with any nerve irritability in the body, the nerve needs time to settle, even after you’ve made changes in your lifestyle.

Research shows that understanding how pain works can reduce your pain. We recommend Explain Pain and the Protectometer Handbook by the NOI Group. These are available from most libraries and the Protectometer is an excellent App for iPad that incorporates the latest neuroscience in day to day steps to reduce pain. It works!

Common lifestyle changes include:

• Bowel and bladder management strategies: Try not to strain when emptying your bowels or passing urine, as this stretches the nerve. Avoid stimulant laxatives. Physiotherapy can help you develop a plan for good bladder and bowel habits that suit you.

• Sitting modification: Avoiding contact of your perineum (the area inside your ‘sit bones’) with the seat helps to reduce nerve irritability. You can buy special coccyx-cut-out memory foam cushions and modify them to remove the section under your perineum. Decreasing your sitting can also help – try standing at your desk for part of the day using a laptop on a box or a portable desk raiser.

• Avoiding physical activities that irritate the nerve: The biggest ones are horse or bike-riding and rowing machines. Other activities to minimise are trampoline jumping, and excessive ‘core muscle’ exercises. Osteopathy and physiotherapy can help you identify movements specific that may need to be minimised for a period of time.

• Adapting your sex life: Some people find sex can flare their pain. There are many options to keep your sex life going while avoiding pain. Your clinician can help you with this.

  Please see our website page Pudendal Neuralgia for more information about treatments available.

  For more information on what you can do and how this affects your nervous system to help reduce your pain, see the poster below

Psychotherapy

Having good mental health is extremely important in coping with chronic pain, especially perineal pain, which involves three vital functions – urinary, intestinal and sexual. Read more about Psychology & Hypnotherapy available at WHRIA, or ask your doctor for advice.

Medication

Daily medication – like topical creams and oral medications – can help calm your nervous system. Your nervous tissue is very sensitive. If you have had pain for a while, your nervous system can become even more sensitive, and cause your pain to flare with seemingly small activities or emotional stresses. Your doctor may prescribe you medication to help you to manage your pain, with fewer flare-ups. For more information about medicines see our health information sheet Medications for Pelvic Pain – General Instructions. Prof Vancaillie has helped develop a topical cream to reduce nerve pain and improve the vaginal skin, in conjunction with Stenlake Compounding Chemist.

Pain Education & Support Group

As one of the world’s leading specialty centers for the holistic care of pelvic pain, we host education and support group evenings. The group provides the opportunity to meet others and learn from guest speakers, from our own team as well as our broader professional network.

We publish regular e-newsletters that summarise the meetings to help keep our out of town members in touch. Topics focus on self-management techniques and new advances in pain management in relation to pain, such as understanding persistent pain and discussing advances in neuromodulation.

Yoga for pelvic pain. If you are interested in the next yoga series at WHRIA, please email Rebecca from Akasha Yoga via rebecca@akashayoga.net

Join our mailing list below for newsletters and more details about our support group.

Click here to see a list of our previous newsletters.

Interventional management options including surgical removal.

After a full clinical investigation, we will discuss the specific options for mesh removal for you. Not all women will choose to have their mesh removed, as the risks may outweigh the benefits. It will be an individual decision each woman will make.

The mesh material, after removal, is sent to the laboratory (Laverty Pathology) for examination: the mesh pieces are measured and samples are taken to look for the presence of specific infection or other pathology.  Any requests for the specimen after removal will need to conducted through Laverty Pathology, and must comply with biological hazard guidelines.

A combination of treatments may provide symptom relief in preparation for, or as an alternative to mesh removal surgery. Read more about interventional treatment options, such as surgery and injections, by downloading our Health Information sheets:

• Cortisone injections: near a nerve, into a joint, tendon or tender point
• Hyaluronic acid injections near the nerve to help with healing (often added to the diagnostic pudendal nerve block injection)
• Botox / Botulinum toxin Type A injections: for overly tight pelvic floor muscles
• Activated platelet extract injections (PRP platelet-rich plasma): to activate healing
• Neuro-modulation with implantable electrodes

Further information