She walked with womb outside body for a month
Six years after doctors removed womb, her bladder also started to drop out
April 22, 2007
IT was sliding out of her body, but Mrs Jean Margaret Peris had no idea it was her womb.
When she finally went to see a doctor, they had to remove it - and her ovaries too.
Then last year, her bladder started to drop as well.
Mrs Peris, 55, is not the only one with this condition.
A medical expert says that in Singapore, one in two women suffer from some form of uterovaginal prolapse where internal organs 'fall out'.
Fortunately, there is a new technique called the Prolift operation to the rescue.
And surgeons here have been using this technique for the past 20 months.
A mesh is inserted through the vagina and is held in place by threading it through the thighs and pelvis. It acts as a new pelvic floor to hold the affected organ in.
The new treatment has helped to improve the cure rate from 75 to 95 per cent.
But when Mrs Peris' womb fell out six years ago, all doctors could do then was to remove it.
Mrs Peris, a housewife, said: 'When my womb first fell out, I didn't really know what it was. It happened gradually.'
Over a month, her womb prolapsed until much of it was hanging outside.
It became increasingly uncomfortable for her.
'BALL' BETWEEN LEGS
'I could not walk or stand or sit,' Mrs Peris recalled. 'It was like trying to move around with a ball between my legs.'
The mother of three grown-up daughters did not feel any pain and her dropped womb did not bleed. So she delayed going to the doctor.
One day, her eldest daughter saw how uncomfortable she was and asked her to get it checked.
'By then, the womb was almost all out,' Mrs Peris said. 'I could hardly move around to do my housework.'
That was when she consulted a polyclinic doctor, who took one look and referred her to KK Women's and Children's Hospital (KKH).
At the time, because her condition was so serious, doctors could not push her womb back. The part that was hanging out looked like a ball with a 10cm diameter.
They had to operate to remove her womb and ovaries.
Dr Han How Chuan, who is the head and senior consultant of the urogynaecological unit at KKH, said: 'Six years ago, there was nothing much we could do except to either push the womb back and sew it up - which is not ideal because it could drop again - or we perform a hysterectomy and remove the womb and ovaries.'
But even a hysterectomy is not ideal because 25 per cent of women who have had their wombs and ovaries removed will experience a collapse of their vaginal skin.
Or as in Mrs Peris' case, another internal organ, such as the bladder, will start falling out.
The main reason women have this problem is because of pregnancy and natural childbirth.
Dr Han said: 'Even though the pelvic floor heals, it does not return to its original strength.'
The Prolift technique first surfaced in Europe in 2004.
'I was quite excited by it,' Dr Han said. 'I saw it as a good way to help many women here.'
He went to France in May 2005 to learn how to do the procedure and started offering it to his patients in July 2005.
So far, he has operated on 120 women.
When Mrs Peris' bladder started to descend some time last year, Dr Han offered her the Prolift option.
She had the operation last August.
After the mesh was threaded, the excess mesh is cut off and nothing is seen on the outside of her thighs.
The non-absorbable mesh (see graphic above) then stays put in the area and integrates with the body's tissue to form new collagen.
Mrs Peris said: 'I feel much more comfortable now. I can walk around without fear and carry things without thinking, 'Oh, will something start coming down?'
Dr Han said that of the women who suffer uterovaginal prolapse, 10 per cent will suffer the severe form. With Prolift, these women now do not need to have their wombs and ovaries surgically removed.
However, one of the complications of Prolift is that the mesh may come out of the vaginal skin. But this can be fixed quite easily by the surgeon.
A more serious complication is post-surgical infection. But, so far, none of Dr Han's patients has had this problem.
After the operation, one in 10 women are unable to pass urine. This usually resolves itself within a week. In the meantime, doctors will insert a catheter.
The operation costs $6,000 for non-subsidised patients, and about $2,300 for subsidised patients.
In one year, Dr Han sees about 2,000 new patients aged 45 to 65.
'There is a misconception that this is part of the ageing process and no treatment is needed,' he said.
'I would like to tell women that they can seek treatment early to improve their quality of life.'
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PUBLIC FORUM
KKH is holding a public forum today, 22 Apr, on Treatment for Incontinence and Uterovaginal Prolapse.
It will be held from 1pm to 4pm at the Auditorium (Training Centre), Level 1, Women's Tower. Call 6398 3096 for details or log on to www.kkh.com.sg
