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Adhesion/Spasm Questions Adhesion/Spasm Questions

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Unread 03-18-2003, 12:24 PM
Adhesion/Spasm Questions

Hi, all! I hope some of you ladies who've dealt with adhesions can help me.

To make a long story short, I went in for a GI consult the other day based on some strange feelings I've had in my abdomen. The doctor thought it was possible that some intestinal and maybe some abdominal nerves were trapped in or irritated by adhesions. Have any of you ladies heard of such a thing? If so, what did you do? The doc gave me a prescription for hyoscyamine (generic for Levsin)--does this sound familiar? Did it work for you?

I'm still working with a physical therapist to try to work on whatever scar tissue/adhesions/muscle spasms/etc are left in there and we've been doing pretty well so far until now. It just seems as if I'm going to a different dr's appt every week since the surgery & it's getting old, fast! I try to be grateful that it's nothing serious, but it's still so :hair: !Any advice is appreciated!
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Unread 03-18-2003, 01:29 PM
Adhesion/Spasm Questions

I'm so sorry your still having problems I suffer from extensive Adhesions that cause me Chronic Pelvic & Abdominal pain, sometimes the pain gets soo bad
A couple of months ago I found this article where a study was done on Adhesions. It concluded that they contained actual Nerve fibers, no wonder they hurt soo is the article:

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]

I have read where nerves from other sources can get wrapped up in scar tissue & cause pain/irritation. Here is some other info on them as well as treatment/prevention:

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.

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.
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.

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.
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.

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

How acupuncture heals nerve damage:

Neuropathy secondary to drugs is a condition in which there is a loss of sensation in a part of the body, associated with the use of a medication that can damage nerves.

Some Tips to Help in Managing Chronic Pain:
Write yourself a contract: Pledge to yourself that you are committed to managing your pain.
Keep your home environment healthful: Remove all items from your home that might lure you into unhealthy habits. Your home should reflect your positive active attitude.
Set goals for pain management: Set specific goals to address your greatest pain problems.
Monitor your progress: Prepare some type visual aid or chart to display your progress.
Accept support: Support of family, friends and physician will help you keep going on track on difficult days.
Team up with your doctor: Your doctor can work with you to overcome obstacles, keep him/her posted on your progress.
Plan each day: Schedule your exercise, relaxation, rest, work. Make a list of things to do in order to accomplish your goals.
Stay positive: Think that you will control the pain. Keep your spirits up, this will help to maintain your ability to overcome and manage pain.
Reward yourself: If you treat yourself to something enjoyable, when you reach a goal, it will reinforce a positive attitude.
Questions You Should Ask About Pain & Pain Treatment:

Pain Management:

Pain Clinics - a personal view:

Women and Pain:

Nerve entrapment:
Physiotherapy Clinic -

Pelvic manipulation:

adhesions in cuff:

Muscle Pain Presenting as Pelvic Pain:

Ilioinguinal Nerve Entrapment:

There were adhesions from the omentum on the posterior wall of the uterus and between the right ovary and the pelvic sidewall. Adhesions and the powder burn were excised. There were adhesions from the omentum on the posterior wall of the uterus and between the right ovary and the pelvic sidewall. Adhesions and the powder burn were excised.

Immediately following the excision, she noted complete resolution of the pain. However, a large area of bruising was evident at the left flank laparoscopy port site which extended to the level of the hip. However, approximately 6 weeks later, she noted increasingly severe, suprapubic, sharp, twisting pain. Examination and urine analysis were unremarkable. The patient was placed on a GnRH agonist.

When seen 4 months postoperatively, her pain had increased in intensity and was now focused in the left lower quadrant, with tenderness localised to her port site. Add-back therapy was started; the patient was placed on gabapentin and received injections of local anaesthetic and methylprednisolone at the port site. Although initial relief was achieved, she experienced fainting spells which were related to gabapentin. The differential diagnosis included ilioinguinal nerve entrapment and port site endometriosis.

At surgery, a large amount of scar tissue was seen at the port site along the line between the anterior superior iliac crest and the pubic tubercle. On dissection, the ilioinguinal nerve was seen exiting through the internal oblique muscle directly into the scar tissue. The nerve tissue was excised and a frozen section confirmed nerve excision.
The patient noted immediate relief in the recovery room. She has been on oral contraceptives postoperatively and has been pain-free.
Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES):

Neurectomy for nerve entrapment:

Severe Neuropathy - Genitofemerol & Ilioinguial nerve entrapment:

Adhesions tug on the nerve during simple movements, causing pain...:

dx~ nerve damage or entrapment?

Adhesions-type of scar tissue that results in the sticking together of some ...
The pain was so bad I dropped to my knees....

I'm sorry for soo much info, once I started looking for some better info on this, the more I kept finding
I hope this helps...good luck & pls leep us posted....((((hugs))))
Unread 03-18-2003, 03:32 PM
Adhesion/Spasm Questions

Sheri, thank you so much! You are such an for looking up all of these sites!

The funny thing is, I initially went to my PCP about an earache because it still hadn't cleared up after two rounds of antibiotics. (Then after 20 days of antibiotics I ended getting Monistat and Difulcan to kill the yeast beast.) I walked out of the PCP's office with nasal spray, a decongestant, Macrobid for a bladder infection and a GI consult! My 36 year or 36,000 mile warranty must be about ready to expire. I'm getting awfully expensive to maintain!

The pain isn't too bad--it's more this too tight seatbelt feeling, plus occassionally there are areas that have that pins-and-needles feeling like when your foot goes to sleep. Once in a while I get a painful surprise if I turn the wrong way too fast. Sitting around in jeans hurts and makes me feel nauseous after a while, too. I had this a little bit pre-hyst, so maybe there is something leftover in there from the C-section almost nine years ago. God knows, I'm good at growing funny lumps!

One more question: do you ever get sharp pains across the crest of your hip bones, kind of like a sharp, paper cut feeling?

Sheri, I hope you are able to find relief from your pain and that you have a good doctor taking care of you! Thanks so much for your help!

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