Vaginal mesh complications: symptoms, what the NHS says and where to get help

Vaginal mesh surgery uses a piece of synthetic mesh to support tissues. The NHS explains that for stress incontinence, a strip of synthetic mesh is inserted behind the urethra, the tube that carries urine out of the body, to support it, and this is sometimes called tape surgery. It is usually done as day surgery under anaesthetic, and the mesh stays in the body permanently.

Mesh has also been used to treat pelvic organ prolapse, in which the womb, bladder or bowel bulge into the vagina. NHS England's Mesh Oversight Group report covers vaginal mesh implants used to treat stress urinary incontinence and pelvic organ prolapse in women.

Many people have had these operations without developing any problems afterwards, which the NHS states explicitly, while stressing that a few have had serious complications.

The NHS says that some, but not all, of the complications can also happen after other types of surgery. The problems it lists after mesh surgery are below. People may notice them soon after surgery or years later, and symptoms can overlap with other pelvic conditions, so assessment by a specialist is important.

• Long-lasting pain.

• Permanent nerve damage.

• Incontinence, or a return of leaking.

• Constipation.

• Sexual problems, including pain.

• Mesh exposure through vaginal tissues, and occasionally injury to nearby organs such as the bladder or bowel.

The NHS advice is to speak to a GP or your surgeon if you have had vaginal mesh or tape inserted for incontinence or prolapse and you think you are having complications. If you are not having any complications, there is no need to do anything.

The NHS also says you can report a problem with a medicine or medical device at GOV.UK, which helps regulators monitor the safety of devices.

When you see a doctor, it helps to bring the date and place of the operation, the name of the procedure if known, a description of your symptoms and when they began, and any previous treatment. A hospital operation note may identify the implant used.

The NHS says that surgery to treat pelvic organ prolapse by putting a supportive mesh inside the vagina is no longer done on the NHS unless there is no alternative. For urinary incontinence it says that at the moment it may not be possible to have vaginal mesh surgery on the NHS, but you should have a detailed discussion with a specialist to talk about your options.

The NHS lists alternatives for stress incontinence, including colposuspension, sling surgery using tissue taken from your own body, from a donor or from an animal, urethral bulking agents and an artificial urinary sphincter, each with its own risks. Problems after colposuspension, for instance, include difficulty emptying the bladder completely, recurrent urinary tract infections and discomfort during sex.

Concerns raised by patients led to formal reviews. The Independent Medicines and Medical Devices Safety Review, chaired by Baroness Cumberlege, was asked to look at how the health system responds when patients and their families raise concerns about the safety of treatments, with vaginal mesh, sodium valproate and hormone pregnancy tests as its case studies. It published its report, First Do No Harm, on 8 July 2020 with 9 recommendations.

Earlier, NHS England's Mesh Working Group published an interim report in December 2015 and the Mesh Oversight Group report in July 2017, both about vaginal mesh implants used to treat stress urinary incontinence and pelvic organ prolapse in women.

Long-lasting pain, sexual difficulties and continence problems can affect work, relationships and mental wellbeing. The NHS pages used here do not set out detailed pathways for treating complications, so the options depend on the problem and are decided with a specialist.

The IMMDS review was set up to look at how the health system responds when patients and their families raise concerns. Speaking to your GP about emotional and practical support is reasonable at any stage.

Start with your GP or the surgeon who did the operation. The NHS says a detailed discussion with a specialist is appropriate for those considering treatment for incontinence. Complex mesh problems are generally managed by specialist NHS teams.

Some people seek a private opinion or private surgery, which may be an option for faster assessment. It is sensible to ask any private surgeon about their experience with mesh complications and which NHS team would provide ongoing care.