Bladder slings, the installation of
June 22, 2020 11:13 AM   Subscribe

After some symptoms took me to the gynecologist (previously I'd been getting checks from my family practitioner), it looks like I have some issues that will result in a hysterectomy. But the question of a bladder sling has come up, so I'm hoping to get advice. Medical stuff about innards to follow.

I just turned 45. After some symptoms including stress incontinence (I've been wearing pads for about a year+ now), some pain, some potential hormonal mood stuff, and just being in my mid-forties, I decided I should go to a gyno instead of relying on my regular doctor. After the exam and a sonogram, I've been diagnosed with multiple large fibroids (my uterus is apparently three times the size it should be) and I have a baseball-sized complex cyst on one ovary. She would like to remove the ovary and the uterus, and check the other ovary. If it's good, it can stay. There is the possibility of endometriosis since it runs in my family, but if it's there, it hasn't caused me any trouble.

The doctor thinks that much of the problem with my bladder is that I have a lot of weight from the cyst and the uterus sitting on top of it. But during the exam she also noticed that there was movement at the bladder neck when I coughed. She's speculating that years of my chronic cough (I have a lot of allergies, and especially during the fall and spring, I can experience pretty violent coughing fits) and/or the weight on my bladder may have caused some of the supports for that neck to fail. The options are: get a bladder sling when they go in and do the rest of the surgery, or wait, see if the surgery fixes it, get PT, and if things are better, no surgery needed.

I'd like to go the more conservative route but the idea of having to go back in within the year or so to put the sling in makes me pause a bit. I also know that there have been some issues with mesh, and that the bad stuff has been discontinued. I'm just a little unsure of how to make my decision here.

Additional info: I'm fat, and I'm a type II diabetic.

Any thoughts on how I parse these options?
posted by PussKillian to Health & Fitness (11 answers total)
 
I would wait. To me, avoiding possibly complications and a longer surgery would be worth possibly having to do an additional surgery two years later.

It may be that both things are in play -- weight on your bladder and some other issue -- such that removing the weight on your bladder will bring the incontinence into a tolerable level. I have some stress incontinence and it varies from "eh, whatever, a little bit once a week is not a problem" to "lol why me" depending on what else is going on down there. It never has 100% abated, but when it's better, I would never consider a sling or anything like that, it just wouldn't be worth the risks for something that is so easy to manage and has such a minimal effect on my life.
posted by Rock 'em Sock 'em at 11:18 AM on June 22 [3 favorites]


I would also see if you can get a consult with your doctor specifically on this point. Sometimes they do the "oh yeah also a bladder sling ok bye" kind of thing but I think it's worth asking them to talk you through it as though it were a separate surgery that you are separately consenting to.

Just in terms of what consulting with the Dr. more might help -- in terms of doing multiple surgeries/procedures at once, there are factors on both sides. However, I personally would err on the side of spending a shorter time under anesthesia and having less going on to think about if you have issues after surgery.

For example, if you have pain after surgery, you might end up not knowing if it's the bladder sling, a surgery side effect, a PT issue, or ? To me, that would complicate things in a way that I wouldn't be interested in while also dealing with figuring out the hysterectomy surgery.

But! I don't know if that's a serious issue with bladder sling surgery -- I don't know if there tend to need to be corrective surgeries or whatever other issues there might be, so I think your best bet is to get answers on those questions.
posted by Rock 'em Sock 'em at 11:28 AM on June 22 [1 favorite]


There have been thousands of lawsuits alleging that bladder slings, also called transvaginal mesh, have caused life-altering damage. I would at least discuss this issue with your surgeon before deciding. Of course, it's easy to sue and not all cases have merit, but I wanted to add that there is some controversy on the issue.
posted by citygirl at 11:44 AM on June 22 [4 favorites]


For me bladder issues resolved entirely after myectomy and fixing my immune system (coughing was related to winter-long colds triggering asthmatic episodes). The PT can also do magic, and there's also medication like solifenacin. I'd probably err towards seeing if the narrower surgery helps, then explore noninvasive treatment.
posted by I claim sanctuary at 11:48 AM on June 22 [2 favorites]


This may not be an issue for you, though no risk to test, but I've learned that even mild constipation can cause/ exacerbate urinary incontinence in women, men, children.
posted by theora55 at 12:17 PM on June 22 [2 favorites]


I had a nearly decade-long fight with fibroids, which eventually caused some stress incontinence. In 2010 I had a myomectomy, which helped, followed by losing a fairly significant amount of weight, which also helped. The fibroids came back, because fibroids are jerks, and due to their size and weight led to some stress incontinence due to how my big ol' uterus was sitting on my bladder. I also felt like I had to pee pretty much all the time.

I eventually had a hysterectomy at the end of 2018, which resolved the constant feeling of bladder fullness. I still have a bit of stress incontinence if I cough or sneeze suddenly with a full bladder, but it is MUCH less frequent than pre-hysterectomy.

TL;DR - I would wait and see if it gets better after the hysterectomy.
posted by bedhead at 12:30 PM on June 22


One more vote for waiting and seeing after the hysterectomy. Fibroids and cysts can impact you in lots of ways, and with that much going on in there, I'd say you might find that you're considerably better off without them. Especially if you have pelvic floor physical therapy, which is what I'm hoping you're referring to. It didn't do a ton for me (with very different circumstances from yours), but I know people with incontinence and birth-related injuries whose lives it's changed.
posted by fiercecupcake at 1:24 PM on June 22


These implants are apparently easy to install and insanely difficult to remove if something goes wrong. CBC.ca has run a series of articles (search for "pelvic mesh") about women being gaslit for years about the problems caused by failed implants being not real and then long waiting lists or expensive out-of-country surgery to remove the implants and try to reconstruct the damaged anatomy. It sounds really horrifying to be honest. This is mostly an old kind of mesh, so YMMV.
posted by heatherlogan at 6:27 PM on June 22


Have you ever seen a pelvic floor physical therapist?

I wouldn’t ever touch surgical mesh with a thousand foot pole, personally. Especially not before doing PT.
posted by Crystalinne at 7:03 PM on June 22 [1 favorite]


Thanks, everyone. I was leaning away from the bladder sling and I think you guys have helped me clarify my thinking that I don't really want to mess with it. I'm hoping that when they get the big cyst and my giant uterus out of there, the bowling-ball-in-the-gut feeling will go. I'm scheduled for July 1. This has all happened really quickly, but I've been getting more and more uncomfortable and I've been having painful days get more frequent as well. The prospect of surgery is kind of a relief.
posted by PussKillian at 3:26 PM on June 23 [2 favorites]


I've known a couple of people who had fibroids removed and their quality of life went way, way up. Here's hoping that happens for you, too! Good luck.
posted by Rock 'em Sock 'em at 4:26 PM on June 23 [2 favorites]


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