Female pelvic mesh

Symptoms related to pelvic mesh implants include:

• pain or spasms at the site of the mesh implant, including vaginal, groin, pelvic area, lower abdominal, lower back, buttock, and referred pain down one or both legs
• urinary tract (bladder) infections
• vaginal discharge
• difficulty urinating
• excessive vaginal or urinary bleeding - this can be normal
• pain during sex or painful sex experienced by the partner when they feel the mesh during sexual intercourse
• abscess or swelling at the mesh insertion or exit sites
• increased anxiety.

Some people have pelvic mesh implants with no complications and good outcomes — but this is not true for everyone. Some people suffer complications which lead to injuries that can be minor to serious, severe and life-changing.

Harm from pelvic mesh can cause symptoms immediately following surgery. Or it can be years down the track before any symptoms start. This is because pelvic mesh hardens over time and as it hardens it can begin to push into and damage surrounding tissues, organs and nerves. It can also move inside your body or become infected or inflamed.

If you have had pelvic mesh implanted and begin experiencing symptoms, talk to your doctor or specialist.

These are some of the possible pelvic mesh-related complications.

Erosion

Erosion is where mesh pushes against and into the surrounding tissue, nerves and organs. Erosion can occur years after surgery with the most common being erosion into the vagina.

Extrusion

Extrusion is where mesh pushes through or perforates surrounding tissue, nerves and organs including the bladder, urethra or bowel.

Infection

Infection of damaged tissues, with recurrent urinary tract (bladder) infections being the most common.

Inflammation

Inflammation caused because the mesh is a foreign body that activates an immune response.

You can get help from the New Zealand Female Pelvic Mesh Service if:

• you are eligible for publicly funded health and disability services in Aotearoa New Zealand
• your doctor or specialist believe your mesh complications may be covered by ACC as Treatment Injury ACC.

You will also have had to have any of the following pelvic mesh procedures.

• All pelvic mesh inserted for pelvic organ prolapse (POP).
• All pelvic mesh inserted for stress urinary incontinence (SUI).
• Pelvic mesh inserted for rectal prolapse (rectopexy) if another type of pelvic mesh for either POP or SUI was also inserted. If only rectopexy mesh was inserted you will be referred to a colorectal specialist instead.

Mesh used for hernia repair in the pelvic region is not currently included in this service.

For more information see pelvic mesh injury on the ACC website.

Pelvic mesh injury - ACC (external link)↗

If ACC cover is approved

If cover is approved, you will be appointed a recovery team member who will help coordinate your entitlements on a case-by-case basis. This can include costs associated with:

• diagnostics, investigations and assessments
• treatments (both surgical and non-surgical)
• weekly compensation
• transport and accommodation
• home and community support
• equipment and consumables
• rongōa services.

Talk to your doctor or specialist about your symptoms and let them know that you have a pelvic mesh implant. They will refer you to the New Zealand Female Pelvic Mesh Service if appropriate.

In some cases they may begin to manage your symptoms - such as pain or anxiety - while waiting for your referral to be accepted.

The referral process

Once your referral is received it will be assessed. The more information your doctor or specialist can provide to support your referral the better.

This may mean asking for surgical notes if your operation was not recent. It may also involve your doctor or specialist asking some questions which may be personal and uncomfortable for you. These questions are important to help identify if your symptoms are from surgical mesh.

If your referral is declined

Your options will depend on the reason your referral was declined.

Sometimes, after the pelvic mesh service staff have gathered all of the required information, it is found that mesh was not inserted or it is not the reason for your symptoms. If they determine that mesh has not been inserted:

• they will let your doctor or specialist know
• make recommendations to support you further, if appropriate.

Some referrals received by the pelvic mesh service may be for women who have had mesh inserted, but not in the pelvis, for example mesh used to repair a hernia. If this is the case, you should see your doctor or Specialist regarding management of this, which may include referral to a surgeon.

If your referral is accepted

If your referral is accepted you will be contacted by a member of the team. This may be to set up appointments to meet the Health Navigator, Nurse Specialist or doctor. Or it may be to ask some questions that help the team plan any investigations that might be needed.

Share your experiences

We understand that it can be frustrating and traumatic to constantly be asked to repeat your journey with every new health person.

You will be offered the opportunity to share your journey and experiences since surgical mesh was implanted. Choosing not to share it in this way will not impact your care.

Capturing your experience helps the team:

• understand your needs and experiences
• guide them on potential ways to help you
• understand what matters to you.

If you decide to share your experience a Health Navigator will:

• contact you to explain the process
• give you options on how to do it
• tell what happens when they document it for the health team
• explain how it happens.

Once it is written up you will be asked to read it and make any corrections or additions. It will be entered into your medical records so:

• people involved in your treatment will be familiar with it
• you do have to keep retelling it.

The Health Navigators role is to support you every step of the way as you journey through this service. Our navigators are based in Christchurch and Auckland, and work with women from all over the country.

The doctor or specialist who has referred you will have sent through any relevant medical records with your referral. It may be determined that some additional investigations are needed to be able to help prioritise the care that you need. If this is the case, these will be discussed with you and booked as appropriate. If any travel or accommodation is required, these will be organised by the service for yourself and a support person.

You are encouraged to have a support person with you for all appointments, including phone and video appointments. If you cannot bring someone with you, the Health Navigator can support you if you wish.

Ensuring you have access to cultural, spiritual or language support throughout your journey with the service is important. If at any time you would like us to arrange a person to support you with this, ask the Health Navigator.

Treatment and care options will be discussed with you. The service will work with you to develop your individual treatment and care plan. Treatment will only be provided if you agree.

Your treatment team may include:

• credentialled surgeons
• specialist nurses
• pain specialists
• physiotherapists
• social workers
• psychology services
• occupational therapists.

Tier 3 credentialled surgeons - Health New Zealand (external link)↗

They will work through treatment options that may suit your situation and work on a treatment, care and support plan, to discuss with you.

Surgery, to remove the mesh or repair damaged tissue, may be discussed with you as part of your treatment plan. But for some people surgery may not be the best option. The service will work with you to develop your individual treatment and care plan, and treatment will only be provided if you agree.

Care and support options include:

• continence care
• pain management
• physiotherapy
• psychologists
• surgery
• cultural and language support
• spiritual support.

You will continue to be looked after by the New Zealand Female Pelvic Mesh Service until you and the clinical team agree that the treatment goals you and the surgeon agreed for you have been met.

If you have complications related to pelvic surgical mesh, you can access this service from anywhere in Aotearoa New Zealand.

The New Zealand Female Pelvic Mesh Service is based in:

• Ōtautahi Christchurch
• Tāmaki Makaurau Auckland

Treatment may also be provided at other locations where team members are based.

Not all appointments or assessments will need to be held in these physical locations. Phone or video consults will be available as appropriate. If you need to attend an appointment or assessment in person, travel and accommodation expenses may be covered for yourself and a support person.

The Health Navigator will help connect you with the National Travel Scheme to assess your eligibility, or if you may be eligible for travel assistance as part of having an ACC claim accepted.

Surgical mesh is a medical device used to repair and provide support to parts of your body that have become weakened. Pelvic mesh is a type of surgical mesh. It is a synthetic implant that is made from a plastic (non-absorbable polypropylene) material. It is known by multiple names including:

• tape
• sling
• TVT
• patch
• ribbon
• graft
• hammock.

A mesh implant is used to support your urethra and hold your weakened organs in place. It will stay in your body permanently as it is non-absorbable.

These devices are designed to be a permanent implant. The most common procedure involving mesh is known as a mid-urethral sling (MUS) procedure, used to treat stress urinary incontinence.

Pelvic mesh is also used to treat pelvic organ prolapse. It is used to treat rectal and bowel prolapse in a procedure called a rectopexy.

For the purposes of this service the word female refers to individuals born with these female pelvic organs:

• vagina
• uterus
• ovaries.

It does not make any judgement about whether individuals identify as male, female or non-binary.