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  Frequently Asked Questions  
  What is Pelvic Organ Prolapse?  

The organs within a woman’s pelvis (uterus, bladder and rectum) are normally held in place by ligaments and muscles known as
the pelvic floor. If these support structures are weakened by overstretching, the pelvic organs can bulge (prolapse) from their
natural position into the vagina. When this happens it is known as pelvic organ prolapse. Sometimes a prolapse may be large
enough to protrude outside the vagina.

Being pregnant and giving birth are the most common causes of weakening of the pelvic floor, particularly if your baby was large,
you had an assisted birth (forceps / ventouse) or your labour was prolonged. The more births a woman has, the more likely she is
to develop a prolapse in later life; however, you can still get a prolapse even if you haven’t given birth. Prolapse is more common
as you get older, particularly after the menopause. Being overweight can weaken the pelvic floor. Constipation, persistent
coughing or prolonged heavy lifting can cause a strain to the pelvic floor and can cause pelvic organ prolapse. Following
hysterectomy, the top of the vagina is supported by ligaments and muscles. If these supports weaken, a vault prolapse may occur.
If you have a severe prolapse and other treatments haven’t been effective, some women may have to consider surgery to
strengthen and support the bladder, bowel or uterus.

  I have mesh – should I be worried?  

If you are satisfied with your treatment it is not necessary to take further action. However, it is important for all patients with
a permanent mesh implant to be aware of possible related symptoms. If you are worried or experience any of the following,
please seek medical advice from your GP who can refer you to a specialist if required:

• unexplained vaginal bleeding
• pelvic or vaginal pain
• you can see or feel mesh
• return of incontinence or prolapse
• persistent urinary tract infections (UTIs)
• painful sexual intercourse (dyspareunia) – (for you or your partner)

It is advisable to have an annual check-up for peace of mind and to ensure that complications do not develop in the future.

  Pelvic organ prolapse - Treatment options

Click here to view the NHS website for the treatment options.

  Further information on alternatives  

• Vaginal Hysterectomy for Uterine Prolapse - Download Patient information PDF here

• An operation for Anterior Vaginal Wall Prolapse -
Download Patient information PDF here

• Posterior vaginal Wall Prolapse Repair and Repair of Perineum -
Download Patient information PDF here

• Operations for Prolapse of the Vaginal Apex: Sacrospinous fixation of the
   vaginal vault and  Sacrospinous fixation of the uterus
- Download Patient information PDF here

  Questions to ask my doctor (pre-op)  
• What are the pros and cons of using mesh in my particular case?

• Could my operation be done successfully without mesh?

• What is your experience and success rate of using this particular mesh?

• What experience have your other patients had with this product?

• What is your experience of dealing with complications from this product?

• What should I expect to feel after my operation and for how long?

• Are there any specific side effects that I should let you know about after the surgery?

• What happens if the mesh doesn’t help my problem?

• If I suffer a complication, can the mesh be completely removed and what would the consequences be?

• Is there a patient information leaflet that comes with the product? Can I have a copy please?
  Who can help me? (post-op)  
It is a good idea to write down all your questions, concerns and symptoms. It may be useful to list how you believe the mesh
implant is affecting your quality of life e.g. pain, health and wellbeing, physical, marital, family, work, social etc. We are often
nervous or upset when we speak to doctors and it is easy to become distracted, a good health professional will appreciate the
fact that you have come prepared.

Please contact your GP in the first instance. He/she can assess your situation and can treat any underlying urinary tract
infection (UTI) you may have. He/she can advise and prescribe pain relief. If necessary, he/she will refer you to a specialist:
Gynaecologist, Urologist or Colorectal consultant at your local hospital.

NHS 24:
If it is out with surgery hours you can contact NHS 24 for advice. Your situation will be assessed and you will be advised accordingly. You may find just speaking to someone and listening to their suggestions - helpful and reassuring. You may be advised to contact your GP or if necessary, your local hospital Accident and Emergency department.

Mesh Helpline:
Anyone who has mesh concerns or questions regarding stress urinary incontinence or pelvic organ prolapse issues can can speak to an experienced physiotherapist who has qualifications in holistic care - in complete confidence. The mesh helpline is available on Mondays between 4.30 pm and 6.30 pm and Thursdays from 9 am to 11 am.
The helpline telephone number is: 07824537938.


Your surgeon will take a detailed history and perform an intimate examination if required. If you are in pain beforehand, please
mention this. He/she may suggest further investigations, for example MRI scan, to rule out inflammation or mass or perhaps a
cystoscopy, this is a small camera which is inserted into your bladder to make sure it is working normally and to ensure that no
mesh has eroded (broken through) into your bladder. He/she may suggest a referral to a specialist physiotherapist or pain
management clinic.

If mesh has eroded in your bladder, bowel, urethra or vagina or if the mesh implant is not where it should be or is deemed too
tight, then the surgeon will discuss your options, this is likely to include partial or complete mesh removal. At this point if it is not
offered, it is advisable that you ask to be referred to one of Scotland’s recognised mesh expert multi-disciplinary teams (MDTs)
for an additional opinion. Mesh removal can be challenging and even in experienced hands, there is no guarantee that your
symptoms will be resolved. In some cases symptoms may worsen after mesh removal.

Do your research and ask as many questions as possible. Anything you don’t understand, ask that it is explained in layman’s
terms. Read through patient information leaflets and weigh-up the pros vs cons. Do not feel under pressure to make any
decisions on the day, take time to consider all options and discuss with your family or friends. The next decision you make
could be life-changing and it is important that you are satisfied before consenting.

Questions you may want to consider asking your surgeon before mesh removal

• How many mesh removals have you done and how many have been deemed a success by your patients?

• Is partial or complete removal better in my case?

• Will partial removal need to be repeated in the future?

• Can you remove as much of the mesh implant as is safe to do so in one surgery?

• Will you remove the ends/arms of the device and what are the risks involved?

• What is the risk of nerve damage?

• Is my incontinence/prolapse likely to return and if so, can this be repaired using traditional non-mesh repairs?

• Is it true that ultrasound is the only device that shows mesh clearly?

• Do you use ultrasound to map out the mesh implant before surgery and if not why?

• How can you follow the path of a partially removed mesh implant without ultrasound to guide you?

• Will you use a camera to limit the risk of damage to my bladder or lower bowels?

• How long will my recovery be and what can I expect?

• If mesh remains inside me can I have an annual check-up to ensure that complications do not develop in the future?

• Do you send removed mesh to the lab for testing if there is infection?

• Can you preserve my removed mesh in the lab for legal purposes?

• Will you report my mesh complication/adverse incident to the Medicines and Healthcare Products Regulatory Agency (MHRA)?
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