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Adhesions???? Adhesions????

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Unread 05-09-2003, 07:52 PM

My surgery was in March 2002, I've noticed if I lift anything heavy my insides hurt for a while and I seem to swell. Does anyone else have this problem? I feel pretty good except for this. The only other thing is I am still numb on both sides between my navel and my hip - which look like swollen places. I had been going to massage therapy and the person told me it looked like my ab muscles didn't reconnect in the center, another doctor said adhesions stuck to my intestines to my abdomen wall, then we have possible hernia's? I'm confused.
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Unread 05-09-2003, 10:04 PM

Hi Gracie

I'm so sorry you're still dealing with pain, this long after your surgery I do not have any personal experience with adhesions, but I know that others do and I'm sure they'll be along very soon.

In the meantime, here are some links to websites that might prove most useful:,00.html

Adhesions pelvic causes symptoms diagnosis treatments

I hope this helps shed a bit of on the issue.
Unread 05-10-2003, 07:16 PM

I'm so sorry your experincing this pain & problems..Adhesions are unfoutunately a very common outcome of this surgery Depending on their location & the amount you may have, the pain & possible complications they can cause may be severe..I suffer with an extensive amount that have been a great deal of pain & problems since my Hyst in Jan 2000. I've never suffered a Hernia but there are several others here who have..hopefully, they'll stop by soon & share their experiences/advice with their dx & treatment Here is some excellent info I hsve on both of these dx's that will hopefully help you in getting a better understanding of them:

What are Adhesions?
Adhesions: Fibrous Bands that Connect Tissue Surfaces that are Normally Separated...
dhesion formation is a natural consequence of surgery, resulting when tissue repairs itself following incision, cauterization, suturing or other means of trauma. Even the most careful and skilled surgeon will inevitably effect tissues inside the abdomen during a surgical procedure. At the places where a surgeon has had to cut, handle, or otherwise manage parts inside the body, tissues which normally should remain separate will sometimes become "stuck" together by scar tissue, defined as adhesions. This process begins immediately and continues for up to 7 days following surgery.

The Problem of Adhesions:

The incidence of adhesions is overwhelming. Adhesions develop in 93% of patients following abdominal and pelvic surgery.

Following surgery, adhesions may form, for example, between the incision in the abdominal wall and the small bowel, often causing small bowel obstruction. This obstruction can lead to vomiting and debilitating pain. In extreme cases, the bowel may rupture, necessitating emergency surgery for the patient.

How Adhesions Effect a Patient:

Adhesions can lead to serious complications including small bowel obstruction, female infertility, chronic debilitating pain and difficulty with future operations.

The consequences of adhesions can be substantial. Postsurgical adhesions cause up to 74% of bowel obstructions. Postsurgical adhesions are responsible for 20-50% of chronic pelvic pain cases. Adhesions also are a leading cause for female infertility, causing 15-20% of cases.
Quality of life is also potentially impaired.
Quite often a patient will undergo surgery to lyse (cut) adhesions, only to have them re-form. Once a patient has undergone a colorectal procedure, the incidence of re-operation within two years is high - up to 20% of patients will have a subsequent colorectal procedure in that time.4 Many of these surgeries are to remove adhesions. Between 2.3 and 5% of patients will have to undergo adhesiolysis for bowel obstruction within two years of colorectal surgery.

Re-operations are also complicated by adhesions. Surgeons have to spend a considerable amount of time, anywhere from 10 minutes to several hours, lysing adhesions before the new procedure can begin. This can prolong the patient's recovery time and increase the risk, cost and complexity of the surgery.

Seprafilm Adhesion Barrier: Proven Adhesion Prevention:

Adhesions can range from filmy to dense, with dense adhesions proving to be the most difficult for a surgeon to treat. The use of a physical barrier to separate the traumatized tissue from other tissues will decrease the risk of all adhesion formation.
Burden of Adhesive Disease:

"Adhesive Disease is a consequence of abdominal surgery. The process begins immediately following the operation." Marvin L. Corman, M.D., University of California, Los Angeles.

Adhesion formation occurs during the natural and normal tissue repair process, when tissue surfaces that usually are separated adhere to each other. The body's cavities and internal organs are covered by membranes. In the abdomen and pelvis, this membrane is known as the peritoneum. The peritoneum protects and lubricates the external surface of the organs they cover. When the peritoneum is damaged, for example during surgery, a protein called fibrin can accumulate on the injured surface, making it sticky. This sticky surface can then adhere to other areas of peritoneum. These sticky bands are called adhesions.
Under normal circumstances, fibrin present at the site of mesothelial damage is broken down by plasmin. Plasmin is derived from plasminogen, a protein found in the blood. Tissue plasminogen activators (released from mesothelial cells) convert plasminogen into plasmin. Through a process called fibrinolysis, the plasmin then breaks down the fibrin into a substance that is absorbed by the peritoneum. Permanent adhesions form when fibrinolysis does not occur following the formation of the fibrin matrix. In the setting of ischemia or inflammation, plasminogen is not activated and plasmin does not form. Consequently, the fibrin cannot be broken down and a permanent adhesion forms.

Adhesions can cause tissues or organs to adhere to each other, often limiting the mobility of organs and inducing pain. Adhesions are associated with chronic abdominal and pelvic pain, intestinal obstruction, female infertility and can make future operations much more difficult.

  • Adhesive Disease accounts for 49-74% of small bowel obstructions.

    Adhesive Disease accounts for 15-20% of infertility cases.

    Adhesive Disease accounts for 20-50% of chronic pelvic pain cases.

    Adhesive Disease increases risk, complexity and complications during subsequent surgery:

One study showed a 19% rate of adhesion-related bowel perforation during subsequent/secondary operations.
Bowel perforations occur even more frequently (33%) during surgery for SBO.
Patients with adhesion-related perforations had significantly higher postoperative complications (leaks, wound infections, hemorrhages and length of stay).

A recent Medicare Database (HCFA) study on 18, 912 patients showed that nearly one in six patients were readmitted with an intestinal obstruction within two years
Adhesive complications in the Medicare population:
Two-Year Medicare Study

A recent analysis of claims data from the Federal Medicare program highlights the potential impact of postsurgical adhesions.1 Medicare provides health care coverage to nearly 40 million senior and disabled Americans. Medicare claims data are excellent sources for health outcomes analysis. A recent analysis of claims data from the Federal Medicare program highlights the potential impact of postsurgical adhesions.1 Medicare provides health care coverage to nearly 40 million senior and disabled Americans. Medicare claims data are excellent sources for health outcomes analysis.

This analysis examined a randomly-selected 5% of the Medicare population and identified 18,912 patients who had colorectal surgery in 1993. The study tracked two-year outcomes for these patients after their initial surgery. The study revealed that a substantial percentage of patients were re-hospitalized for additional colorectal surgery or to treat bowel obstructions within two years of the initial procedures. These repeat hospitalizations likely were either directly caused, or complicated by adhesions formed after the initial surgery.
Intestinal Adhesions:
Adhesions in the abdomen are basically bands of scar tissue that form after a surgical procedure is performed in the abdomen or pelvis. Most commonly they form after gynecologic surgery or a procedure involving the colon (such as colectomy or appendectomy). Factors that increase the likelihood that adhesions will form include abdominal infection, poor blood flow in the abdominal vessels and use of certain suture material.
Although these bands may involve any organ in the abdomen, the type of adhesions most likely to cause problems are those affecting the small intestine. Adhesions can cause an external obstruction of the small intestine by crossing over a loop of intestine and preventing intestinal contents from passing through. In fact, the most common cause of obstruction of the small intestines is adhesion formation. Patients who develop obstruction complain of a crampy, abdominal pain, often accompanied by nausea, vomiting and abdominal distention. An X-ray of the abdomen provides information to make the diagnosis.Patients with obstruction often improve spontaneously after treatment in the hospital with IV fluids and nutrition. However, in some cases, the obstruction is complete or persistent, resulting in "strangulation" of the bowel. These cases may require emergency surgery to remove the adhesions. Some patients may also suffer repeated, frequent episodes of obstruction. In these cases, elective removal of the adhesions is often recommended. This operation, typically done via laparoscopy, involves finding the adhesions and then cutting the bands to release the bowel loops they encircle.
Pelvic adhesions cause many problems for millions of women. From obstructed tubes associated with infertility, to pelvic tenderness, and painful intercourse, to chronic pelvic pain. Curiously, adhesions can be very extensive, yet relatively silent. They may remain silent indefinitely, or long after the causative event, become symptomatic. The causes of adhesions are multiple but basically the tissue irritation that produces the adhesive process arises from an inflammatory event, or from trauma (i.e. post surgical).

Examples of an inflammatory event would be a tubal infection from a sexually transmitted disease (e.g. Gonorrhea), a post surgery infection, or appendicitis. Chronic "irritation" of the pelvic tissues from a common disease process such as endometriosis, may also incite adhesions. A very significant proportion of symptomatic pelvic adhesive disease arises from previous necessary pelvic surgery (removal of an ovarian cyst would be a good example).

What are "pelvic adhesions" anyway??
In the process of trying to repair injured tissue, a series of normal healing events may cause some structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal healthy pelvis (or the whole abdominal cavity for that matter) this large space is lined with a tissue called peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In a non-injured or irritated state, the peritoneum can be likened to slippery cellophane wrap the organs and structures lying immediately adjacent to each other just slip off each other and do not become bonded together. Given a tissue injury, the healing process initiates a sequence of events that can result in a certain tissue becoming "stuck" to its neighbor, and when this happens certain undesirable results occur.

The ovary for example is a very sensitive structure, much like the testis. If as a consequence of an ovarian cystectomy, (the removal of the cyst from the ovary) the ovary becomes "attached' to the pelvic sidewall, or the top of the vagina, the patient may experience persistent pelvic pain and/or painful intercourse. The diagnosis is suspected by a history of ovarian surgery, and subsequent persistent pain or tenderness unrelated to her menstrual cycle.

After a large abdominal incision (e.g. a hysterectomy for large fibroids) the bowel or an associated fatty structure called the omentum may become adherent to the abdominal wall. Adhesions begin to develop within hours of surgery. If by chance it is a loop of bowel, the patient may experience intermittent bouts of crampy pain, perhaps associated with some nausea, bloating, or even vomiting. The intestinal symptoms are related to some degree of bowel obstruction that inhibits the passage of the bowel contents or gas through the partially obstructed area. When the obstruction is severe then the patient will be very ill with nausea, distention and vomiting, and may not be passing any gas rectally. X-ray studies may confirm the severe obstruction, and treatment may require decompression of the bowel by means of a tube passed through the stomach to the intestine, or even exploratory surgery.

More often in my experience, the symptoms are troublesome and annoying, and the obstruction is not severe enough to make any of the X-ray tests informative. Often the patient will be sent to the gastroenterologist, and endoscopoic evaluation of both the upper and lower bowel will be performed. Frequently, the diagnosis is "irritable bowel syndrome". It should be remembered that intra-abdominal and pelvic adhesions rarely if ever show up on X-ray or ultrasound. Unfortunately, every time an abdominal incision is performed, the risk is present for recurrent Adhesion problems. The good news is however that most patients will not develop serious post-operative adhesions causing further problems. Those unfortunate to do so may ultimately undergo repeated surgeries, always hoping that "this will do it!!"

Does everybody develop adhesions??
No they do not, but it is not understood why one person develops very extensive adhesions, and the next individual none at all. The nature of the traumatic tissue event, the duration of the inflammatory insult, the nature of the preceding surgery, the operative technique of the surgeon, and the unknown healing characteristics of a given individual all interplay in the final outcome.

What can be done to minimize pelvic adhesions from forming?

Early treatment of an infectious process if identified, utilization of safe sex practices to minimize the transmission of sexually transmitted disease, meticulous surgical technique to minimize unnecessary tissue trauma, and perhaps using barrier products where appropriate. The latter may be helpful in reducing the extent or severity of the postoperative Adhesion development.

**What to do if symptomatic adhesions develop, what are the patients options?
The first option in any situation is don't do anything. Pain is a relative experience, and the degree of severity will vary from individual to individual. Minor, or even moderately severe discomfort can often be lived with, or controlled by medication, acupuncture, or medical hypnosis. Not infrequently pelvic pain is not helped by conventional treatment such as hormones, pain medicine, or even surgery. In those circumstances, non-conventional treatment with acupuncture or hypnosis can sometimes be very helpful.

Given significant symptomatic pelvic adhesions being suspected from the history and physical exam, a thorough workup is indicated, which may include special x-ray studies and ultrasound. Ultimately, laproscopy may be utilized to allow visual inspection of the intra-abdominal organs. What to do surgically depends on the findings. If an ovary is bound down with adhesions from previous surgery, the extent of the adhesive process may indicate a simple cutting of the adhesions or if necessary, removal of the ovary. If the patient has completed her fertility requirements, and if the pelvic adhesive process is very extensive, a complete hysterectomy with removal of both tubes and ovaries may be indicated. Obviously, the patient and her gynecologist need to have had a very comprehensive and detailed discussion about what might be encountered, and what options might be exercised.

What about abdominal wall adhesions resulting from prior abdominal surgery?
These can usually be taken down laproscopically, thus minimizing tissue injury, as opposed to a conventional large incision. Multiple tiny incisions may be necessary in order for the surgeon to see well, and from different angles the area of dense adhesions. Nonetheless, several tiny 1/2 inch incisions are far less uncomfortable than a conventional laparotomy incision.

If the adhesions are extensive, and the patient has undergone previous Adhesion surgery that failed, I have taken an unorthodox approach to such individuals. Because adhesions begin to form almost immediately, along with the healing process involving the raw anterior abdominal wall, I have in special situations recommended a repeat laproscopy in one week. At this point, the "new" adhesions are flimsy, soft, do not contain a blood supply, and can be swept away with minimal tissue injury, compared to a conventional adhesiolysis (freeing the adhesions surgically) of old adhesions that are dense, very adherent, and bloody. This is performed in an outpatient setting, and usually takes but a few minutes, compared to the time involved dealing with extensive, dense old adhesions.

It is important that patients inquire about their surgeon's experience with extensive adhesions, because what might be viewed as "not possible laproscopically" by one gynecologist, may be very familiar territory for another. Because bowel may be intimately involved with the adhesive process the patient has to be aware that the worst case scenario may require bowel surgery, and a conventional laparotomy incision.

Pelvic adhesions can be a serious detrimental quality of life issue. Some patients are total pelvic cripples because of this problem. Once formed, they do not disappear with time. If you are suffering from some of the medical complaints outlined earlier, do consider a consultation with an experienced laproscopic gynecologist and hopefully your adhesive problems can be solved.

"An adhesion is an abnormal fibrous band between adjacent parts or structures of the body. Within the abdominal cavity, adhesions commonly occur between loops of intestine or between the intestine and pelvic organs and the area of the appendix or the gallbladder. They may form following abdominal surgery such as an appendectomy, hysterectomy, and removal of the gallbladder or of a bowel tumor. They also may occur in response to an infection such as appendicitis or inflamed gallbladder that did not lead to surgery.

"Most adhesions do not cause symptoms unless they entrap a section of the intestine. Such a complication may obstruct the normal flow of intestinal contents (bowel obstruction) or even impair blood supply to the bowel. Then the symptoms may include cramping abdominal pain, vomiting, inability to pass gas rectally, and bloating. Although intestinal obstruction due to an adhesion may resolve with conservative treatment, if the obstruction does not resolve, or if there is damage to the bowel wall, surgical removal of the involved segment may be required."
Abdominal adhesions are the result of internal scar tissue that can develop after abdominal or pelvic surgery and are a frequent cause of chronic abdominal pain in people who have had such operations. Although adhesions are quite common and are the leading cause of obstruction in the small bowel, we still Abdominal adhesions are the result of internal scar tissue that can develop after abdominal or pelvic surgery and are a frequent cause of chronic abdominal pain in people who have had such operations. Although adhesions are quite common and are the leading cause of obstruction in the small bowel, we still
don't know how to prevent or treat them. You might try abdominal manipulation, done by an osteopathic physician or a chiropractor who has experience in this area. Guided imagery may also be helpful. If you're having problems with constipation because of adhesions, you should probably take the bowel regulator Triphala, an Ayurvedic remedy that is available in capsules at health food stores. This combination of three fruits is a much better bowel regulator than laxatives. Follow the dosage recommendations on the label.

No one can predict which patients will develop adhesions, or which types of surgery are most likely to cause them, but a recent study from Scotland found that nearly six percent of hospital readmissions could be blamed on them. They also found that nearly 35 percent of all the patients who had abdominal or pelvic surgery were readmitted -- on an average of twice in a 10-year period -- because of adhesions. Another study found the link between adhesions and bowel obstruction a bigger problem than previously believed: Of the 18,912 Medicare patients who had some type of abdominal surgery at the Ochsner Clinic in New Orleans, about 46 percent developed obstructions requiring treatment, which usually led to more surgery.

Scientific studies have shown that you're less likely to develop adhesions following laparoscopic surgery, which requires only a very small incision and uses a tiny "scope" for doctors to see what they're doing. However, even this type of operation doesn't eliminate the risk. To make matters worse, problems related to internal scarring can develop years after an otherwise successful surgery.

If you do get another adhesion, you will need more surgery -- and unfortunately, any kind of abdominal surgery increases your risk of developing more troublesome scarring. So you can find yourself caught in a vicious circle of requiring surgery to eliminate adhesions but risking more adhesions with each additional procedure. If you're lucky it's not a lot of adhesion and it's not around something important--then it causes
no pain. Apparently the more skilled your surgeon, the less they handle things, the less inflammation (rest rest rest) the better off you are. Other than that, they don't know a lot. So, the lap I think has like a 50/50 chance of working from what I've read. But if there's a lot of pain, those might sound like good odds.

trish tah/bso 7/12/99, cancer of the stroma
Adhesions Explained{

Adhesions-type of scar tissue that results in the sticking together of some ..

Rate of adhesion formation:
Surgery Pain & Adhesions:

A Patient's Guide to Adhesions & Related Pain:

Inguinal Hernia -

Hernia: What You Should Know -

What Is a Hernia?
A hernia occurs when an organ or tissue squeezes through a hole or a weak spot in a surrounding muscle or connective tissue called fascia. The most common types are inguinal, incisional, femoral, umbilical, and hiatal.

What Causes Hernias?
Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia: The pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth; more often, it occurs later in life. Poor nutrition, smoking, and overexertion all can weaken muscles and make hernias more likely. Anything that causes an increase in pressure in the abdomen can then cause a hernia, including obesity, lifting heavy objects, diarrhea or constipation, or persistent coughing or sneezing.

What Are the Symptoms?
For inguinal, femoral, umbilical, and incisional hernia:
An obvious swelling beneath the skin of the abdomen or the groin; it may disappear when you lie down and may be tender.
A heavy feeling in the abdomen that is sometimes accompanied by constipation or blood in the stool.
Discomfort in the abdomen or groin when lifting or bending over.

How Do I Know If I Have It?
A doctor's physical examination is often enough to diagnose a hernia. Sometimes hernia swelling is visible when you stand upright; usually, the hernia can be felt if you place your hand directly over it and then bear down. Ultrasound may be used to see a femoral hernia, and abdominal X-rays may be ordered to identify a bowel obstruction.

What Are the Treatments?

The standard treatment is conventional hernia-repair surgery (called herniorrhaphy). It is possible to simply live with a hernia and monitor it. The main risk of this approach is that the protruding organ may become strangulated (have its blood supply cut off), and infection and tissue death may occur as a result. A strangulated intestinal hernia may result in intestinal obstruction, causing the abdomen to swell. The strangulation can also lead to infection, gangrene, intestinal perforation, shock, or even death. Conventional Medicine Your doctor may manually press your hernia back into place and advise you to wear a special belt, known as a truss, that holds a hernia in place until surgery. Over-the-counter analgesics can help ease discomfort. Hernia surgery is performed under either local or general anesthesia. The surgeon repositions the herniated tissue and, if strangulation has occurred, removes the oxygen-starved part of the organ. The damaged muscle wall will then be repaired. Increasingly, inguinal herniorrhaphy is performed using a laparoscope, a thin, telescope-like instrument that requires smaller incisions and involves a shorter recovery period. Patients often walk around the day after hernia surgery. There are usually no dietary restrictions, and work and regular activity may be resumed in a week. Complete recovery takes three to four weeks, with no heavy lifting for at least three months. Hernias often return after surgery, so preventive measures are especially important to avoid a recurrence.
Good Luck ((Gracie)) I hope you are able to find some answers & relief to your pain & problems soon..pls keep us posted....((hugs))

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