(646) 355-8777

Herman & Wallace Blog

A Mesh of Continued Controversy

Allison Ariail

This post was written by H&W instructor Lila Abbate PT, DPT, MS, OCS. Lila will be instructing Pelvic Floor Level 3 with Institute founder Holly Herman in San Diego at the end of this month! Sign up for the few remaining seats left in this popular course!

When treating your patient who has undergone a pelvic reconstruction in the not-so-distant past, does the mesh controversy come to your mind?Is the effect of the mesh causing your patient this dysfunction and is she complaining of urinary urgency, urinary frequency, or pelvic pain? Understanding pelvic muscle dysfunction, as pelvic rehabilitation providers do, can put us in a good position to help our patients, as well as to help our physicians with this oftentimes litigious issue.

Urogynecologists, gynecologists, urologists, or any surgeon who deals in the business of female sexual medicine and pelvic reconstruction seems to have been put in a position to defend their stance on the use of mesh when working with patients who present with any degree of pelvic organ prolapse (POP), be it complicated or simple.The decision to utilize mesh is now made with greater emphasis on education for the patient who is undergoing the procedure.

The Food and Drug Adminstration (FDA) has released a proposal on April 29, 2014 in order to address the potential reclassification of surgical mesh for transvaginal POP from a class II (moderate risk) to a class III (high risk) device and would “require manufacturers to submit a premarket approval (PMA) application for the agency to evaluate safety and effectiveness.” 1 A similar proposal was put in place with breast implants in 1992 in order to create more awareness of safety concerns with the use of breast implants. 2

While older mesh kits (demonstrated to be more likely to cause complications) have been pulled from the market, any mesh surgery can create complications. As the body heals, scar tissue forms and contracts which is part of the normal healing process, and for some patients, this process can wreak havoc as the tissues and the mesh shrink. Muscles are bypassed, pressed upon, and ligaments are used as supportive measures for the mesh arms, and this can set up the pelvic floor muscles for edema, weakness, or even muscle over-activity. We know that different patients heal in different ways; just as a patient who has had a total hip replacement experiences muscle swelling, soreness, weakness, and scarring, a mesh surgery will necessarily create temporary dysfunction. However, physical therapists are skilled and well-versed in palpating and treating muscle dysfunction, scar tissue and adhesions, and we can educate our patients on the symptoms of mesh complication that may in fact be a muscle problem. Not every patient who has had mesh placement is suffering from mesh erosion, and physical therapists can help patients improve or resolve their symptoms over time through treatment.

Pelvic Floor Level 3 is an advanced course offered by the Institute that covers surgical procedures, pharmacology including hormone replacement, and other medical interventions that address pelvic muscle over-activity, tissue dysfunction, and surgical complications. Lab activities include manual techniques to downtrain (decrease muscle over-activity) such as Strain-Counterstrain of the pelvic floor muscles.

1.http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm395192.htm. Accessed on May 5, 2014.

2. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm064461.htm. Accessed on May 5, 2014.

Nonoperative Management of Hip Labral Tears in You...
Is Pelvic Muscle Tenderness "Normal"?

Upcoming Continuing Education Courses

Mobilization of the Myofascial Layer - Medford, OR Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Asante Rogue Valley Medical Center

Nutrition Perspectives for the Pelvic Rehab Therapist - Seattle, WA (POSTPONED)

Nov 6, 2020 - Nov 8, 2020
Location: MTI Physical Therapy

Mobilization of the Myofascial layer: Pelvis and Lower Extremity- Greenville, SC (Postponed)

Nov 6, 2020 - Nov 8, 2020
Location: Bon Secours St. Francis Health System

Mobilization of the Myofascial Layer Satellite Lab Course

Nov 6, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Mobilization of the Myofascial Layer - Athens, GA Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Thrive Integrated Medicine

Mobilization of the Myofascial Layer - Greenville, SC Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Bon Secours St. Francis Health System

Mobilization of Myofascial - Self-Hosted

Nov 6, 2020 - Nov 8, 2020
Location: Self-Hosted Course

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Athletes & Pelvic Rehabilitation - San Diego, CA (Postponed)

Nov 7, 2020 - Nov 8, 2020
Location: Comprehensive Therapy Services

Pelvic Floor Level 2B - Somerset, NJ Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Sports Medicine Institute

Pelvic Floor Level 2A - Grand Rapids, MI (SOLD OUT)

Nov 7, 2020 - Nov 8, 2020
Location: Mary Free Bed Rehabilitation Hospital

Pregnancy Rehabilitation - Washington, DC (Postponed)

Nov 7, 2020 - Nov 8, 2020
Location: GWUH Outpatient Rehabilitation Center

Bowel Pathology and Function -Middletown, CT (Postponed)

Nov 7, 2020 - Nov 8, 2020
Location: Middlesex Hospital

Bowel Pathology and Function - Remote Course (SOLD OUT)

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2B - Satellite Lab Course

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2B - Marietta, GA Satellite Location (SOLD OUT)

Nov 7, 2020 - Nov 8, 2020
Location: Southern Pelvic Health

Pelvic Floor Level 2B - East Norriton, PA Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 2B - Cranford, NJ Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2B - Manchester, IA Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Physical Therapy Solutions

Pelvic Floor Level 2B - Richmond, VA Satellite Course

Nov 7, 2020 - Nov 8, 2020
Location: Pivot Physical Therapy

Athletes & Pelvic Rehabilitation - Remote Course

Nov 7, 2020 - Nov 8, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2B - Self-Hosted

Nov 7, 2020 - Nov 8, 2020
Location: Self-Hosted Course

Pelvic Floor Level 2A - Bay Shore, NY (Postponed)

Nov 8, 2020 - Nov 9, 2020
Location: Touro College: Bayshore

Mobilization of Visceral Fascia: The Gastrointestinal System - Jackson, WY Satellite Location

Nov 13, 2020 - Nov 15, 2020
Location: Four Pines Physical Therapy

Mobilization of Visceral Fascia: The Gastrointestinal System - Fairlawn, NJ (Postponed)

Nov 13, 2020 - Nov 15, 2020
Location: Bella Physical Therapy

Mobilization of Visceral Fascia: The Gastrointestinal System - Self-Hosted

Nov 13, 2020 - Nov 15, 2020
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Gastrointestinal System - Fargo, ND Satellite Location

Nov 13, 2020 - Nov 15, 2020
Location: Apex Physical Therapy & Wellness Center