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What causes...??? What causes...???

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  #11  
Unread 03-10-2003, 07:59 PM
Thursday is a go..

Hi Everyone...

Saw the GYN for pre-op today. Talked to her about the odd sensation in the vagina - she really didn't have an idea about it, but she will take a look while she's in there. She said this is primarily a "fact finding" proceedure and if there are adhesions, she'll take care of them. She also said she would be surprised if there were any. because with an LAVH there are minimal possibilities of them occuring.

She knows I've done everything I can to reduce the pain ,etc...PT, chiro, massage, meds, etc. and, that is why she is doing it. She said if she was absolutely certain there were not adhesions, then she'd try to talk me out of it. If this doesn't show adhesions, then it must be my bladder and I'll have to consult with the Uro again.

If these are bladder spasms, I'm having some pretty severe ones

Very stressful day today at work...I'm looking forward to Yoga tonight.

's

Lori
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  #12  
Unread 03-11-2003, 03:01 AM
Just some reading I thot might be intersting to you ((Lori))

  Quote:
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.This paper describes adhesions, their treatment and their relationship to pain and bowel obstruction. In addition, stories from patients are featured to illustrate how adhesions (or suspected adhesions) affect their daily lives and how they cope with a sometimes-insurmountable problem.

A key lesson and source of comfort for patients with this problem is that they are not alone and the importance of mutual support among patients cannot be underestimated.

http://www.adhesions.org/FAQs/index.htm
  Quote:
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: www.pelvicpain.com


"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.

The problem with adhesiolysis is that ADHESIONS almost always reform, and so the procedure is sometimes self-defeating. This is one of the main reasons why surgeons are reluctant to perform adhesiolysis, particularly in severe cases. In addition, the presence of adhesions makes surgery more hazardous, because of the risk of injury to the bowel, bladder, blood vessels and ureters. As we have seen, some patients may have periods of relief from and/or bowel obstruction for several months, only to have the problem recur

Adhesions are a common occurrence after pelvic or abdominal surgery. Adhesions are also common in women who suffer from pelvic inflammatory disease (PID), endometriosis, or sexually transmitted diseases.

The likelihood of adhesion formation and the seriousness of their consequences vary based on multiple factors (e.g., type of surgery, number of previous surgeries, surgical technique, and the predisposition of individual patients). However, studies have consistently shown that a majority of women who have gynecologic surgery will experience some degree of adhesion formation.
www.Adhesions.org
  Quote:
All of the abdominal and pelvic organs except the ovaries are at least partially wrapped in a clear membrane called the peritoneum. When this membrane is traumatized during surgery, the site of the trauma becomes inflamed. Inflammation is normal and in fact is part of the healing process, but it also contributes to adhesion formation by encouraging the development of fibrous bands of scar tissue.

Normally, these fibrin bands eventually dissolve through a biochemical process called “fibrinolysis,” and the traumatized site continues to heal. But sometimes the nature of the surgery results in decreased blood flow to these areas (ischemia). This ischemic condition can suppress the fibrinolysis. If the fibrin bands do not dissolve, they may develop into adhesions that connect pelvic organs or tissues that normally are separate.


Pelvic Pain: Adhesions are commonly associated with pelvic pain. Adhesions cause pelvic pain because they bind normally separate organs and tissues together - essentially “tying them down” - so that the stretching and pulling of everyday movements can irritate the nerves involved. Adhesions can also cause pain during intercourse.


Bowel Obstruction: Adhesion formation involving the bowel is particularly common following a hysterectomy. While these adhesions don’t normally result in any problems, there is one serious problem that can develop. It is called intestinal or bowel obstruction, and it can occur a few days or many years after surgery. Symptoms of bowel obstruction may include pain, nausea, and vomiting.

Ovarian Surgery: The ovaries are one of the most common sites where adhesions form. Adhesion formation after ovarian surgery can lead to pelvic pain and infertility.

Surgical Treatment of Endometriosis: Endometriosis is a condition in which patches of cells similar to the ones in the uterine lining become implanted outside the uterus – usually on the ovaries, bladder or fallopian tubes. This condition can be associated with severe inflammation and dense adhesions, and can potentially contribute to infertility. Endometriosis itself can lead to adhesions, and when those adhesions are surgically removed, new adhesions can re-form.

Myomectomy: Myomectomy is surgery to remove fibroid tumors from the uterus. Adhesions may form at the incision line on the uterus. These adhesions can also involve the ovaries and fallopian tubes, potentially causing infertility and pelvic pain.

Reconstructive Tubal Surgery: The repair of blocked fallopian tubes is a delicate procedure that often includes the removal of existing adhesions. Unfortunately, the surgery itself can also lead to the formation of new adhesions and associated complications such as pelvic pain and infertility.

Hysterectomy: Hysterectomy is a procedure in which the uterus is removed. Removal of one or both ovaries (oophorectomy) is sometimes performed at the same time. Adhesions that form after this procedure may attach to the small intestine, causing pelvic pain, constipation, and sometimes a more serious complication –bowel obstruction (blockage of the intestine). Bowel obstruction may occur shortly after surgery or may may occur years after surgery.

Cesarean Section: These adhesions typically do not cause pain. They can sometimes make subsequent cesarean sections more difficult, however, because the physician must cut through these adhesions to reach the uterus and the baby. This can increase the length of the procedure and the amount of time the mother and baby are under anesthesia. There is also a risk of damaging surrounding organs such as the bladder.

To determine whether adhesions are the cause of pelvic pain or fertility problems, your doctor may perform a laparoscopy, an exploratory procedure using a laparoscope (a narrow lighted telescope inserted through a small incision in the “belly button”) to inspect the abdominal cavity and pelvic structures.

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.
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
www.Adhesions.com
Good Luck on Thurs
(((((hugs))))
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