3 years later

Hi there I had my surgery 3 years ago and have been having trbls with my bowels pretty much ever since, I have had alot of right sided pain aswell, I have been to my doctor many times, and have been told I have cysts on my ovary, aside from that I am wondering if it is scar tissue? or the endo that I had so bad before, I just don`t know, I have been on effexor (antidepressent) for 1 1/2 years, I have been pretty much told that its in my head, I have maybe 2 good days out of a week, sex for the most part is painful. I am at a loss as to what to, I am at a point thet I just hope it gets so bad thet I am addmitted to a hospital and then maybe someone will take me serious and look into what is wrong..

Hi ((((sweetie)))) So sorry you're having these problems

The symptoms you describe are very similar to the issues I've been dealing with since my hyst: I've always had to deal with IBS and the annoying constipation/diarrhea cycle, along with the bloating and endless problems. However, since my hyst, it's been a lot worse.

One of the problems I've had is recurring pain in my lower right abs, right where my ovary is. Since it tends to be cyclic, I was convinced it was my ovary giving me all this grief. However, my ob/gyn and GP have both diagnosed a spastic colon. I've since found out that the menstrual cycle can be a trigger for IBS flare ups.

((((Sweetie)))) I'm sure that your problems are not all in your head Please, do not give up and continue to look for an answer. And, whenever you need to, do not hesitate to come here and vent: your sisters are here for you

((((Dawn))))),
I'm so sorry for all your suffering I am 3.5 yrs Post-Op & have suffered severe pain, since my Hyst, that has only worsened w/time I was DX'd w/ Chronic Pelvic & abdominal pain from extensive Adhesions & Nerve damage. I have been seeing a Pain Dr that has provided me w/ some relief but for me, there are no pat answers or cures..due to the severity of my condition, undergoing further surgery or invasive treatments carry a very high risk of being left w/ worse pain & damage...
For me & many other ((Sisters)) here on The Road, it has become an uphill battle for finding some answers & or relief. All along so very many have watched as our health has worsened

I have done tons of research on Adhesions & their possible complications. From all I've seen, learned & experienced, Adhesions can sometimes become a Chronic, debilitating condition. Surgery to try & relieve them may often worsen the situation. Here is some good info that has helped provide me w/ more insight & knowledge on them:

What are Adhesions?
*Adhesions: Fibrous Bands that Connect Tissue Surfaces that are Normally Separated*

	Quote:
Adhesion 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.3 Postsurgical adhesions are responsible for 20-50% of chronic pelvic pain cases.3 Adhesions also are a leading cause for female infertility, causing 15-20% of cases.3 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. 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. 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. http://www.genzymebiosurgery.com/opa...el=2&opage=268

	Quote:
Intra-abdominal adhesions are usually the result of surgical or gynecologic operations, pelvic inflammatory disease (gonococcal or chlamydial), appendicitis or endometriosis. Adhesions occur after abdominal surgery in more than 60 percent of cases, though less than 30 percent are symptomatic. Adhesions may be responsible for chronic persistent abdominal pain without associated pelvic pathology. Clinically, adhesions present as chronic or acute abdominal or pelvic pain, partial or complete mechanical bowel obstruction, and infertility. Though adhesions probably cause pain by entrapment of expansile viscera, the relationship of adhesions to abdominal pain is still controversial. In contrast, mechanical small bowel obstruction after previous surgery demonstrates unequivocally the most severe effect of adhesions. Patients with chronic or recurrent abdominal pain and a history of numerous abdominal surgical procedures are often denied treatment if they are not obstructed or symptomatic of intermittent bowel obstruction._This may be because, from the surgeon’s viewpoint, adhesiolysis is associated with low reimbursement for long operations with high medicolegal risk. Also, adhesions may recur, and the risk of enterotomy (a hole in the bowel) during surgery is very high. While surgical therapy is withheld, multiple abdominal diagnostic procedures including abdominal CT scan are frequently ordered. The patients are then sent to chronic pain clinics for evaluation. Though few studies exist, a recent report suggests that women with severe, dense vascularized bowel adhesions have a significant reduction in pain after adhesiolysis. http://www.adlap.com/ Chronic pelvic pain and/or associated intestinal disturbance are a major cause of misery for thousands of patients._ Often in constant pain, the patient experiences loneliness, hopelessness, frustration and desperation with thoughts of suicide._ Family and work relationships are strained to the limit._ Although ADHESIONS are often (but not always) the cause of this pain, treatment for adhesions is not performed either because the surgeon does not believe that adhesions can cause the problem, or because lysis of adhesions is considered too difficult or futile.Adhesions are an almost inevitable outcome of surgery, and the problems that they cause are widespread and sometimes severe._ It has been said by some that adhesions are the single most common and costly problem related to surgery, and yet most people have not even heard the term._ This lack of awareness means that, excluding infertility, many doctors are unable or unwilling to tackle the problems of adhesions, many insurance companies are unwilling to pay for treatment and many patients are left in misery. Adhesions and Chronic Pelvic Pain (CPP): ADHESIONS are believed to cause pelvic pain by tethering down organs and tissues, causing traction (pulling) of nerves._ Nerve endings may become entrapped within a developing adhesion._ If the bowel becomes obstructed, distention will cause pain. Some patients in whom chronic pelvic pain has lasted more than six months may develop "Chronic Pelvic Pain Syndrome.”_ In addition to the chronic pain, emotional and behavioral changes appear due to the duration of the pain and its associated stress._ According to the International Pelvic Pain Society: "We have all been taught from infancy to avoid pain. However, when pain is persistent and there seems to be no remedy, it creates tremendous tension. Most of us think of pain as being a symptom of tissue injury. However, in chronic pelvic pain almost always the tissue injury has ceased but the pain continues. This leads to a very important distinction between chronic pelvic pain and episodes of other pain that we might experience during our life: usually pain is a symptom, but in chronic pelvic pain, pain becomes the disease." Chronic pelvic pain is estimated to affect nearly 15% of women between 18 and 50 (Mathias et al., 1996)._ Other estimates arrive at between 200,000 and 2 million women in the United States (Paul, 1998)._ The economic effects are also quite staggering._ In a survey of households, Mathias et al. (1996) estimated that direct medical costs for outpatient visits for chronic pelvic pain for the U.S. population of women aged 18-50 years are $881.5 million per year._ Among 548 employed respondents, 15% reported time lost from paid work and 45% reported reduced work productivity. Not all ADHESIONS cause pain, and not all pain is caused by ADHESIONS. Not all surgeons, particularly general surgeons, agree that ADHESIONS cause pain._ Part of the problem seems to be that it is not easy to observe ADHESIONS non-invasively, for example with MRI or CT scans. However, several studies do describe the relationship between pain and adhesions. According to an early study (Rosenthal et al., 1984) of patients reporting CPP, about 40% have adhesions only, and another 17% have endometriosis (with or without adhesions)._ Kresch et al., (1984) also studied 100 women and found ADHESIONS in 38% of the cases and endometriosis in another 32%._ Overall estimates (Howard, 1993) of the percentage of patients with CPP and ADHESIONS is about 25%, with endometriosis accounting for another 28%._ These figures must be understood in their context, and I recommend highly Howard's article.It is important to recognize that emotional stress contributes greatly to the patient’s perception of pain and her/his ability to deal with the pain._ Rosenthal et al. (1984) found that of the patients in whom a possible physical cause of pain (including ADHESIONS) could be identified, 75% had evidence of psychological influences on the pain. http://www.adhesions.org/pt5cpp.htm

Here are some links I have on all the available products used for preventing these:

http://www.adhesions.org.uk/barriers.html

http://www.obgyn.net/all_advisors/D_Wiseman.htm

http://www.fibroid.com/instruments/adhesion.htm

http://www.allp.com/press/press.exe?@81116

http://members.aol.com/Synechion/patents.htm

http://www.anagen.net/piliel1.htm

http://biz.yahoo.com/prnews/020821/sfw021_1.html

http://www.gliatech.com

http://www.mindbranch.com/page/catal...d32313337.html

http://www.drdaiter.com/hyst_ecto/hyst3.html

2nd look Lap:
http://www.reproductivecenter.com/m...aparoscopy.html

Can Adhesions be prevented?

	Quote:
The only way to treat adhesions is to remove or separate them surgically. This procedure is called adhesiolysis. Studies have shown that patients with pelvic pain and severe adhesions can experience a marked reduction in symptoms after adhesiolysis. However, even following adhesiolysis, adhesions reform more than 70 percent of the time. That’s why adhesion prevention is so important. Meticulous surgical technique – Careful surgical technique can help minimize trauma, minimize the interference with the blood supply, prevent the introduction of foreign bodies, minimize bleeding, lessen the incidence of raw surfaces and decrease the incidence of infection - all of which help reduce adhesion formation. Although adhesions often form after gynecologic surgery, they are not inevitable. And, even if adhesions do form, they usually don’t cause pain or other problems. Although there is no way to eliminate the risk of adhesions completely, there are steps your surgeon can take to reduce the likelihood of adhesion formation. The most effective methods of adhesion prevention involve meticulous surgical technique and the use of a physical barrier to separate tissue surfaces while they heal. Surgeons have developed minimally invasive techniques such as the laparoscopy, that are designed to minimize trauma, blood loss, infection, and the introduction of foreign bodies, all of which can lead to inflammation and adhesion formation. Good surgical technique involves minimizing tissue handling, using delicate instruments, and keeping the tissues moist when they are exposed to the air. While good surgical technique is important, it is often not sufficient to prevent adhesions. There are also other preventive steps that can be taken: Your surgeon may use a lightweight fabric barrier, such as GYNECARE INTERCEED Absorbable Adhesion Barrier, to enhance good surgical technique. This barrier, placed at the site of the surgery, is intended to protect raw tissue surfaces as they heal. Fabric barriers have been shown to be one of the most effective methods of adhesion prevention reduction and prevention. Can Adhesions be prevented: Barriers – Fabric or liquid barriers create a physical separation between raw tissue surfaces while they heal. Thin tissue-like fabric barriers may be used to try to reduce adhesion formation at specific sites, while liquid solution barriers can help prevent adhesions over broad areas of the abdominal and pelvic region. GYNECARE INTERCEED- Barrier is a lightweight, tissue-like “fabric” that can be placed at the surgical site. The fabric protects and separates the surfaces where adhesions are likely to form. The fabric slowly dissolves as the surgical incision heals. Studies demonstrate that GYNECARE INTERCEED Barrier significantly enhances good surgical technique in reducing adhesion formation. GYNECARE INTERGEL -Solution is a liquid that can be poured into the pelvis after surgery to separate and protect organs and tissues as they heal. The solution is easy for the surgeon to use and can be applied directly to the surgical site. Even more important, GYNECARE INTERGEL Solution covers a broad area and provides protection against adhesions. http://www.ethiconinc.com/womens_hea...oduct/faq.html Sulaiman H, Gabella G, Davis MSc C, Mutsaers SE, Boulos P, Laurent GJ, Herrick SE.Presence and distribution of sensory nerve fibers in human Peritoneal adhesions. Ann Surge 2001 Aug; 234(2):256-61 Department of Medicine, University College London, The Rayne Institute, London, UK. OBJECTIVE: To assess the distribution and type of nerve fibers present in human peritoneal adhesions and to relate data on location and size of nerves with estimated age and with clinical parameters such as reports of chronic pelvic pain. SUMMARY BACKGROUND DATA: Peritoneal adhesions are implicated in the cause of chronic abdominopelvic pain, and many patients are relieved of their symptoms after adhesiolysis. Adhesions are thought to cause pain indirectly by restricting organ motion, thus stretching and pulling smooth muscle of adjacent viscera or the abdominal wall. However, in mapping studies using microlaparoscopic techniques, 80% of patients with pelvic adhesions reported tenderness when these structures were probed, an observation suggesting that adhesions themselves are capable of generating pain stimuli. METHODS: Human peritoneal adhesions were collected from 25 patients undergoing laparotomy, 20 of whom reported chronic pelvic pain. Tissue samples were prepared for histologic, immunohistochemical, and ultrastructural analysis. Nerve fibers were characterized using antibodies against several neuronal markers, including those expressed by sensory nerve fibers. In addition, the distribution of nerve fibers, their orientation, and their association with blood vessels were investigated by acetylcholinesterase histo-chemistry and dual immunolocalization. RESULTS: Nerve fibers, identified histologically, ultrastructurally, and immunohistochemically, were present in all the peritoneal adhesions examined. The location of the adhesion, its size, and its estimated age did not influence the type of nerve fibers found. Further, fibers expressing the sensory neuronal markers calcitonin gene-related protein and substance P were present in all adhesions irrespective of reports of chronic abdominopelvic pain. The nerves comprised both myelinated and nonmyelinated axons and were often, but not invariably, associated with blood vessels. CONCLUSIONS: This study provides the first direct evidence for the presence of sensory nerve fibers in human peritoneal adhesions, suggesting that these structures may be capable of conducting pain after appropriate stimulation.

	Quote:
"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 laparoscopy 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."

http://medseek.com/glennbradley/newsdetail.cfm?ref=264

Adhesion Prevention Home Page:
http://www.adhesions.com/welcome_main.html

Proven Adhesion Prevention:
http://www.genzymebiosurgery.com/opa...vel=2&opage=66

Welcome to SPRAYGEL :: Adhesion Barrier: http://www.confluentsurgical.com/spraygel/usa_home.htmA Meta-analysis of Interceed Barrier Safety/Efficacy:
http://www.adhesions.com/clinical_studies.html

Interceed:
http://www.ethiconinc.com/womens_hea...interceed.html

Contemporary Adhesion Prevention:
http://www.centerforendo.com/news/ad.../adhesions.htm

GYNECARE INTERGEL® Adhesion Prevention Solution:
http://www.fda.gov/cdrh/pdf/p990015.html

Seprafilm surgical intestinal adhesion prevention: http://www.gbcrs.org/seprafi.html

ANTI-Adhesion treatment for Gynecologic surgery:
http://www.fda.gov/bbs/topics/ANSWER.../ANS01117.html

Good Luck w/ everything ((Dawn)) Pls know my thots & prayers will be w/ you that you can find some answers & relief to your pain....(((((((((hugs)))))))))))))

((Dawn))

First off, I am so sorry you have found yourself on this road but please know you are not alone. ((SHERI)) and ((Dany)) have both given you great information. I justed wanted to relay my experience: I had my hyst in Sept 0f 2001 and returned with pain to my DR about six months and then 1 yr post hyst. He did an exam to say that I had a cyst on my right ovary(my only one) that we would do the wait and see thing. Within 6 wks I had elected to have surgery, once in there my GYN found no cyst but lots of adhesions. They had encased my ovary and were adhered to my bowels.

JMHO: But maybe it is time to seek a second or even third opinion. My particular pain was not in my head(although sometimes I felt like others thought that) but it took a while to get a dx. I will be honest I am not totally pain free but I am much better than before the adhesiolysis surgery. Again, there is lots of info on this forum with regards to adhesions and other chronic pain issues that might be helpful in your quest for an answer.

https://www.hystersisters.com/vb2/sho...threadid=29378

I, personally, am going to continue to seek medical advice now from a Chronic Pain/GYN specialist.

I hope you will find some resolution soon.

s,
lenee