'Hundreds of women' left waiting for incontinence treatment amid pause on mesh implants
Consultant obstetrician urogynaecologist at CUMH Suzanne O' Sullivan Picture: Larry Cummins
"I want to run with my kids. I want to coach them in GAA and go down a waterslide with them on holidays. But that is all impossible now. Nobody wants to talk about incontinence, it’s embarrassing."
That is according to one Cork mother of three who is dealing with incontinence. Physiotherapy, expensive pessaries, nothing has worked, leaving the 46-year-old former camogie player wearing continence pads daily.
She has spoken out in frustration because a pause put in place six years ago on a surgical treatment option — use of vaginal mesh — still continues in Ireland. The pause had been in reaction to serious life-long complications arising for some women.
It is now also 14 months since new HSE guidelines were published for stress incontinence treatment, including mesh as an option. “My life has also been put on pause,” she said.
“I’ve a treadmill here at home because I don’t want to go out walking because you are going to be wet, you are going to be soaked.”
She is very aware of the negative experiences women had before. However, she said: “The mid-urethral sling would work for me, it’s the gold standard treatment for this problem throughout the world.”
Many non-surgical options have not helped, and she said: “I’m literally at my wits end.” Describing the incontinence as a birth-related injury, she said:
Dr Suzanne O’ Sullivan, obstetrician urogynaecologist at Cork University Maternity Hospital, said recommendations made in 2018 for safer mesh use have been addressed.
“We have hundreds of women in Cork waiting,” she said. “Most of our patients want to wait because they know the people who it worked so well on, and I’m with them on that.”
Also lead for the Cork mesh complications service, she said: “We’ve been looking after women who have genuine severe problems for years, but the number has been less than we expected.”
She called for the pause to be lifted.
“It is not perfect or the best operation for all women, but compared to the other operations out there, the figures are pretty clear,” she said.
"There is no perfect operation, there is nothing that is going to offer a success rate that is really higher than 85%.
"The bottom line is that the best operation there has ever been for stress incontinence with the highest success rate and the lowest complication rate is a mid-urethral sling made from vaginal mesh."
She also said a higher risk of complications is seen among women having mesh procedures for pelvic organ prolapse.
“Vaginal mesh for recurrent prolapse was an option for women unsuitable for major abdominal surgery or instead of closing the vagina off and leaving them unable to have intercourse again,” she said.
Ireland and the UK are the only countries where mesh use is paused, she said.
However Terri Martin, co-ordinator of Mesh Survivors Ireland and who has significant health issues since a mesh procedure seven years ago, still has major reservations.
“The people who were injured are not sorted out yet,” she said. “They need to rectify the first lot before they think about lifting the pause.”
Her main concerns are consent and whether doctors could remove the mesh should things go wrong.
Plain English forms laying out all risks are needed, she said, adding: “To tell you the truth, I didn’t even know I was having an implant.”
"Everybody to their own, and everybody should be given the option but given the option with fully informed consent.”
She welcomed recent improvements in care for their over 600 members, but said more remains to be done.
A HSE National Vaginal Mesh Implant Oversight Group was set up last year to assess the 2018 recommendations and whether it is appropriate to lift the pause.
A draft final report from the group is with the Department of Health.
