Severe menstrual cramps in a young lady

Today it looks like more and more younger women are suffering from endometriosis. It is known to be a disease of affluance and maybe a reflection of our societies increasing affluance and higher living standards in Singapore. Endometriosis some 10 years ago was commoner in those 40 and above but it seems that I am seeing more women in their 20's with this condition. Endometriosis or chocolate/ blood cysts can cause a great deal of damage to a woman's reproductive organs as it is almost as destructive as a cancer. Although not life threatening, it causes the pelvic structures to become `glued' together and obstructs the development and release of eggs and blocks the passage where the egg and sperm meet. I recently encountered a young lady of 29 years with this condition who was diagnosed in 2008 to have an ovarian endometriotic cyst and was supposedly cleared through a laparoscope by another gynaecologist. However when I saw her, both her ovaries were enlarged with endometriotic cysts measuring 3 cms, they were also `glued' to the back of the womb and the pelvic wall. She was having difficulty with conceiving. I did an operation to free all her reproductive structures and removed the cysts in both ovaries. We are now waiting for 3 months before she will try for a pregnancy

Unusual symptom of a tilted womb

I had a patient consult me with the problem of faecal incontinence. She was unable to control her bowel movements and whenever she had the urge to go to the toilet she would leak faeces before she could reach the toilet. Faecal incontinence can occur in those who have had previous normal deliveries and have had tears of the anal sphincter as a result of the delivery. Sometimes a difficult assisted delivery can cause this. However this patient had two previous deliveries by caesarean section some 10 years ago. The only significant finding was a tilted or retroverted but slightly prolapsed womb on pelvic ultrasound scan. Now a retroverted uterus is common and is present in about 20% of women. It is known to cause infertility, dyspareunia or painful intercourse and backache, however it has not been known to cause faecal incontinence. The patient was counselled and was advised that an operation to correct the retroverted uterus may not help her symptoms. However, the patient decided to go ahead with the operation. I have followed the patient up for 6 months after the operation and to my surprise she is free of this debilitating and socially embarrasing condition of faecal incontinence.