10 Jul Pelvic mesh Safety Review
“She suggested that it was such an easy fix, that it was almost unthinkable that I would have any other options.”
This is one of the statements from a woman who gave evidence to The Independent Medicines and Medical Devices safety Review (IMMDS) with respect to the pelvic mesh surgery she underwent. The IMMDS is Chaired by Baroness Julia Cumberlege CBE DL and was set up in the UK in 2018 after reports from patients about harmful side effects from medicines and medical devices. The Review was set up to look into 3 areas. 1. The use of the hormone pregnancy test Primodos, 2. Anti-epileptic drug sodium valproate and 3. Pelvic Mesh. The Reviews report is named ‘First do no harm’ and was published on the 8th July 2020.
For 2 years the board listened carefully to the women who were affected.Travelling across the UK the board met over 700 women and their families. The Review heard of lives that had been damaged, families under immense strain, relationships destroyed, careers broken, and as a result financial ruin, with no income, many lost their homes, and faced their children being taken into care. The Review Board were told not only about the most intimate details of these women’s lives but about their bodies.
Mesh surgery no longer gold standard
The idea that this mesh surgery was a one size fits all solution to every woman’s problem seems ridiculous now and if there is one thing I’ve learned since EVB Sport began it’s that nothing about pelvic dysfunction is easy? It takes time, patience and perseverance to understand the issue and improve it. It was stated in the review that, ‘we expect that the number of pelvic mesh procedures in the future will be tiny. Gone are the days when women in their tens of thousands had mesh implanted and were told it was the gold standard.’ It is now generally accepted that the gold standard therapy for pelvic dysfunction is physiotherapy with a trained pelvic health physiotherapist. We hear on a daily basis how women who have tried physio many years ago and didn’t adhere to the therapy for one reason or another think physio didn’t work for them. So much has changed over the years. In the latest edition of Nursing in General Practise Senior physiotherapist in Women’s Health in the Lourdes Hospital in Drogheda, Miriam Gamble talks about the role of a specialist physiotherapist.
A physiotherapist will look at the spine, hips, feet, diaphragm, ribcage, breathing pattern, scar tissue on the abdomen or perineum, bowel habit, muscle function of abdominals, gluteals, adductors. A vaginal assessment will determine pelvic floor function. A large percentage of women have an overactive pelvic floor, one that doesn’t relax properly, which needs to “downtrain” before work on strengthening/ improving function can begin. But SUI is not usually a brute-force issue. Specificity, co-ordination and timing all need to be addressed. 25% of women will do a Valsalva manoeuvre when asked to turn their pelvic floor on. And only half of women will do PFEs correctly based on verbal instruction: the best technique is to ask her to pretend to hold in flatulence.
The longterm implication of not getting a handle on your pelvic health is too enormous not to be taken seriously. The longterm implications to surgical interventions are unknown.
During the press conference on Tuesday Baronesss Cumberlege stated that
‘ Women with mesh complications have suffered terribly. We were so appalled by this suffering that in July 2018 we said that mesh for the treatment of Stress Urinary Incontinence must be halted immediately. We set conditions that had to be met before these operations could continue. Today, two years later, they have not been met. Twenty years after mesh started to be used in the pelvis we still don’t know its long-term risks or complication rate. The same is true for mesh removals’.
Take back control
The report made 9 recommendations and Annex J of the Review page 14 lists the personal testimonials from women who underwent mesh surgery and who so courageously gave their stories. I urge you to read these accounts and think about your own pelvic health. Think about how you can keep it in check. Nobody knows Your body better. Take back control now. Reach out to a pelvic health physio and learn how to do the most important core exercise you will ever need to do. For the majority of women the solution is within their control. The following are some of the testimonials we have taken from the report.
If I had known of any risks then I most certainly would not have gone ahead with the surgery and my symptoms were not that severe.”
“It’s heart breaking, as I was told that the Mesh was the best thing for my prolapse, and that the quality of my life would be much improved in having it done, and NEVER told of any possible complications, and I trusted fully all I was told. Instead it has ruined my life in every way
Little did I know it would rob me of future health and happiness.”
We will follow up in the next few weeks with a more comprehensive summary of the report. If you would like to find a pelvic health physio in your locality please reach out to me here email@example.com.