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Adhesions following Hysterectomy

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Adhesions following hysterectomyI've heard someone mention adhesions as a cause of concern following hysterectomy surgery. What are they? How can I prevent them?

Adhesions are bands of fibrous scar tissue that form on abdominal organs, causing the organs to stick to one another or to the wall of the abdomen. For the most part, they are fairly rare in patients who have never had abdominal surgery, but for people who have had abdominal surgery adhesions are common.

Surgeries, such as those on the appendix, stomach, intestine or uterus (hysterectomy), can produce adhesions as the body heals inside. Surgeons do their best to be gentle with the inside organs, and as a preventative measure, some doctors use a saline solution to fill the abdomen/pelvic area before closing it up. The solution will linger in the abdominal cavity for a few days before it is absorbed, which prevents any major adhering.

There are also mesh-type products, similar to a piece of fabric, which are laid over the organs to protect them from sticking, and there is also a spray gel. However, even with these precautions adhesions still form. Several studies have shown conclusively that microsurgical techniques alone cannot prevent adhesion formation. In six studies from 1982 to 1987, from 55 to 100% of patients had pelvic adhesions at second-look surgery.

Other than surgery there are assorted causes of adhesion formation: perforated ulcers, appendicitis, infections in women's fallopian tubes, and endometriosis. Some, but not all adhesions can be reduced through early recognition and treatment.

It is well worth noting that adhesions are one of top complaints of women who suffer from endometriosis. In these cases women generally have adhesions which were caused by the disease itself but surgery in these patients can often make the problem worse.

How do adhesions form?

Our insides heal differently from our outer skin. A surface cut heals from the outside edges. The spot in the center becomes smaller as the skin regenerates. In the abdomen, areas of regenerated tissues form over the entire surface at once. This means that large internal wounds heal as quickly as small ones..

In layman's terms, our insides are coated with a slippery substance that enables various parts to slide along one another. When one part is disturbed or damaged, as in surgery, the organ forms protective tissue (which can become an adhesion). New Adhesions, or De Novo Adhesions, are filmy and sticky causing them to stick/adhere to other parts. In their early stages they are often described as spider webs. From that stage they can develop into a more vascular type which is denser and not as easily removed. Some can develop nerve endings as well as their own blood supply.

When this new tissue sticks to other healthy tissue, there can be problems and pain.

In most people, abdominal adhesions do not cause any symptoms. However, if adhesions contribute to partial intestinal obstruction you may have intermittent bouts of crampy abdominal pain.

If more significant obstructions develop, you may experience:
  • Severe, crampy abdominal pain

  • Nausea and vomiting

  • Swelling of the abdomen (abdominal distension)

  • Inability to pass gas and absent or infrequent bowel movements

  • Signs of dehydration, including dry skin, dry mouth and tongue, severe thirst, infrequent urination, fast heart rate and low blood pressure

Call your doctor whenever you have severe abdominal pain, especially if you also have a fever, nausea and vomiting, or infrequent bowel movements.

Abdominal adhesions are permanent unless the patient has a surgical procedure, called adhesion lysis, that breaks up adhesions. Unfortunately they can be a recurring problem, because surgery is both the cause and the treatment. To clarify: when surgery is done to remove an intestinal obstruction caused by adhesions, adhesions form again and create a new obstruction in 11 percent to 21 percent of cases.

It seems there is no way for you to prevent adhesions, only minimize the chances. The first step depends on your doctor and the techniques used during surgery.

After surgery too much sudden movement or straining early in your recovery can contribute to adhesion formation because it can result in tiny tears in the healing tissues where they are stitched/stapled/sealed. This straining causes very small blood leaks (maybe only a few drops) into the abdominal cavity. The body may react to that blood by forming adhesions in the area.

So, as recovering hysterectomy patients, we can feel free to move around, but should be very careful about any lifting, jumping, running or quick stretching during the first couple of weeks. Be sure to pay attention to your doctor's restrictions-- remember, you have only one chance to heal properly!

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

08-05-2004 - 01:23 AM


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