November 20, 2007

The Operation That Gives Women Their Lives Back


MORE than half of women suffer a pelvic prolapse as a complication of childbirth. Wendy Bougen, 45, a health spa manager from Cheltenham, had a graft of pig tissue to repair the problem. She talks to ANGELA EPSTEIN about her experience, and her surgeon explains the procedure..


AS A child, I sometimes wet myself when I laughed, coughed or sneezed. Although it bothered me, I was so embarrassed I could not face talking to anyone about it. But when I had children Aimie, now 16, and Zachary, 13 the symptoms got worse.

By the time my son was a toddler, I had to stop myself getting the giggles because of the embarrassing leakage it would cause.

I felt terribly self-conscious, and whenever I was out I always had to make sure I knew if there was a toilet nearby. And though I worked in a spa, I wouldn't use the gym for fear of leaking.

What's more, I began to experience a dull pain in my back passage and inside my vagina most of the time, and sex could be uncomfortable because of this.

But still I tried to ignore it: I was busy with family and my job, and embarrassment stopped me going to GP. My husband David wanted me to get it sorted out, but I felt it was a problem I had to live with.

Then, last August, I was called for a routine smear test. The practice nurse had difficulty locating my cervix, and said this was because I appeared to have a prolapse a weakening of the supportive muscles which meant my womb was pushing down, causing incontinence problems.

My GP referred me to urogynaecologist David Holmes. After ignoring my problems for so long, I suddenly felt immense relief that at last something would be done.

Mr Holmes confirmed I had a prolapsed uterus, but also two prolapses of the passageway that leads from the uterus and through which urine passes.

As a result, the bladder was pushing into the front of the vaginal wall and the rectum was pressing into the back of it.

I couldn't believe the extent of my problems, so was terribly disappointed when Mr Holmes suggested Iunderwent four months of pelvic floor exercises instead of surgery. The idea was that the special exercises would strengthen the muscles and push the prolapse back.

They didn't work and in the end I needed to have surgery. The procedure involved a hysterectomy (removal of the uterus and cervix) as well as stitching the sagging muscles together with an artificial graft.

I was surprised when Mr Holmes explained he could correct the prolapse at the back by using a graft taken from pig intestine. But it didn't bother me I just wanted to get on with my life.

As for the hysterectomy, we'd already decided we didn't want any more children my husband had a vasectomy a few years ago so it wasn't a huge deal.

When I came round from the operation, I wasn't in pain. I did notice that the little extra roll of flesh around my middle seemed a bit higher up than before because my sagging internal organs had been pushed back into place.

What I didn't expect was the emotional fallout of having a hysterectomy, though I had been warned that your hormones can go awry. Suddenly I felt tearful whenever I saw a baby on TV. This passed after a few weeks.

Physically, I felt weak and could not manage even a short walk for a fortnight. I was off work for two months.

Since the operation, I'm able to do things I'd avoided in the past for fear of a leakage. I go jogging and use the gym at work. It's wonderful to have such freedom and I'm only sorry that embarrassment stopped me having something done about it years ago..


DAVID HOLMES, a consultant urogynaecologist at Cheltenham General Hospital, says:

WHEN Wendy was referred to me, she was in extreme discomfort. It was clear that without some form of intervention she would find it almost impossible to enjoy a normal lifestyle.

An examination confirmed a prolapse around her bladder, rectum and womb. As a result, all these organs had slipped from their normal position and were pushing into the vagina and triggering her symptoms.

Prolapse is a common problem, but some women won't seek help because the symptoms, which include urinary problems, pain during sex and constipation, are awkward to discuss.

Though surgery is an option, it's best to see if it can be avoided..

However, pelvic floor exercises had no effect and Wendy felt certain she wanted an operation.

All three prolapses can be treated at the same time. The most effective way to deal with a prolapsed womb is to remove it, if the patient does not want more children.

However, I decided to leave Wendy's ovaries intact, since these were normal and removing them would have triggered a premature menopause.

To repair the prolapse at the front of the vagina, I made a small incision in the front wall and pushed the prolapse back. To stop it bulging down again, I stitched together the supportive tissue beneath it from either side of the incision.

While treatment for a prolapse in the bladder and uterus are standard, the surgery to correct the prolapse of the back wall is revolutionary. It involves grafting a patch of collagen from pig intestine, rather than using a synthetic material that can cause more discomfort.

COLLAGEN encourages other tissues to grow into it and over the bulge in the vagina, pushing it upwards and away from where it was creating pressure on the rectum.

The graft is like a trellis over which climbing plants grow.

This material, known as Surgisis Biodesign, is a parchment-thin sheet of collagen which can be grafted on to the pelvic floor.

When the tissue healing is complete, the graft dissolves and is absorbed by the body.

First, I made a 7cm incision around the prolapse and pushed the bulge back up. Then I took the collagen graft 5cm by 7cm and, using dissolvable stitches, secured it to hold the tissue in place, rather like putting an elbow patch on a sweater.

To press this skin against the graft to help it heal, I placed a roll of cotton gauze in the vagina (this was removed the following day).

The benefit of this new material is that it does not reduce the size of the vagina. Synthetic prolene meshes can leave the vaginal wall rigid and there is a significant chance of eroding, which causes immense discomfort.

Eight months on, Wendy can enjoy a full and active lifestyle.

THE operation is available on the NHS. The cost privately would be around Pounds 4,200..

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