An abdominal adhesion is a band of scar tissue that forms inside the abdomen as part of the normal healing process after surgery, infection, bleeding, or endometriosis involving the abdominal or pelvic cavity.
You can think of an adhesion as you would scar tissue that remains on the skin after a wound heals.
The difference is that an abdominal adhesion tends to form into cord-like structures that can wrap around bowels or other abdominal organs, causing them to stick together, or stick to the abdominal wall itself.
When this happens, an adhesion can cause complications such as:
Abdominal adhesion pain could be so debilitating.
Abdominal adhesion is indeed so common, at it affects about 93% of patients who undergo some form of abdominal surgery, and affecting 1 in 10 patients who have never had any surgery or abdominal procedure.
Abdominal adhesion is more common in patients who have had appendectomy, bowel surgery, hysterectomy or cesarean section.
Adhesion formation following surgery is also referred to as postoperative peritoneal adhesions (PPAs) or post-surgical intra-abdominal adhesion.
It is the most common cause of bowel obstruction in the developed world.
Every abdominal or pelvic surgery carries a 90 to 100% risk of adhesion occurring and it is increasingly necessary for doctors to warn patients of this risk and the subsequent complications of developing adhesions before any such surgery is undertaken. Let's examine a few conditions and procedures that are more associated with the development of adhesion.
An abdominal adhesion is usually the result of any of the following:
The most common specific conditions that leads to abdominal adhesions include:
The risk of adhesion is higher for open abdominal or pelvic surgery than it is for laparoscopic surgery.
If you have had any of the above listed procedure and suffer with chronic abdominal or pelvic pain, speak with your healthcare provider about the possibility of abdominal adhesion as the cause of your pain.
It is possible to have abdominal adhesions and have no symptoms at all.
In fact, only about one-third of people with adhesion eventually develop symptoms. While pelvic adhesions form 4 to 6 weeks after abdominal trauma or surgery, it can take several months to years before symptoms manifest.
Symptoms of pelvic adhesions can include:
Abdominal pain is the most common symptom of pelvic adhesion.
In a recent study, abdominal or pelvic adhesion were found at laparoscopy in more than 25% of women suffering from chronic pelvic pain. Only 10% of women without chronic abdominal or pelvic pain were found to have abdominal adhesion.
The pain in the abdomen occurs because over time, adhesion bands can develop their own nerve fibres and blood vessels, which cause pain when these nerves are stretched by bowel movements or other factors inside the abdominal cavity. This pain can be sharp and intermittent or dull and more persistent.
Bowel or Intestinal Obstruction
The October 2012 issue of Frontiers in Medicine, reports that adhesive small bowel obstruction is a frequent cause of hospital admission. More recent studies show that postoperative abdominal adhesion is the most common cause of bowel obstruction in the Western world.
Adhesions can spread in a spider web-like formation inside the abdominal cavity and restrict the normal movement of the bowels or intestines, trapping and entangling loops of bowel and causing obstruction.
Symptoms of bowel obstruction include colicky abdominal pain, feeling bloated, nausea, vomiting and constipation or inability to empty your bowels. Occasionally, the bowel is able to "free" itself from the grip of adhesions and symptoms may resolve on their own.
Infertility can be the result of abdominal adhesion in those who have had a major abdominal operation, who suffer with endometriosis, or who are known to have had an abdominal or pelvic infection like PID, salpingitis, or peritonitis. The bands form by abdominal adhesions an affect the architecture of the abdomen, interfering with the release of eggs from the ovary, or the migration of a fertilized ovum into the fallopian tubes and womb (uterine adhesions).
Pain During Intercourse
Pain during intercourse, also called dyspareunia is another common symptoms resulting from abdominal adhesions.
There is no definite cure for adhesion.
The best available abdominal adhesion pain relief options that work are:
Because adhesions are multiple scar tissues inside the abdomen or pelvis that pull one surface or organ to another organ or surface, it is difficult to treat.
If your doctor suspects that the cause of your abdominal pain is adhesion, once they have checked that you do not have bowel obstruction or blockade, you are likely to be given some pain killers.
Common painkillers used for adhesion include:
None of these pain medications would provide lasting abdominal adhesion pain relief.
If however any of these can help control your pain at a low dose, it might be best to delay proceeding to seeking surgery in treating your adhesion. You will see why below.
Though not widely available, some experienced physiotherapists are able to provide abdominal adhesion pain relief by focus physiotherapy aimed at gradually stretching the adhesions and weaken the pain-causing grip of adhesion.
Experienced acupuncturists are also able to provide some abdominal adhesion pain relief. Speak to providers in your city to see if this is what they offer.
CBT is a type of "talking therapy" to help you appreciate how your thoughts affects your feelings and such feelings lead to symptoms, and how controlling your thoughts and feelings can help to reduce your pain feedback.
It is aimed at training you to lead an activity-centered life rather than a pain-centered life.
Abdominal adhesion pain could be terrible and chronic. It literally steals the life of thousands of patients around the world. Because there is no definite treatment for this pain, being able to refocus your mind, realising that you may spend the rest of your life with chronic abdominal pain, working to live a "normal life" in spite of the pain is the goal here and it is possible.
Adhesiolysis is done by laparoscopic surgery to break and remove the adhesions.
Though many patients report significant improvement in their overall health, as well as a very low incidence of recurrence, it is not a guaranteed treatment for abdominal adhesion pain.
You should only consider it if all other options have failed.
The following are conditions in patients that would make them more likely to qualify for surgery for removal of postoperative adhesions:
Does any of the above describe you? If so, you can look for doctors who specialise in the removal of postoperative intra-abdominal adhesions for a consultation.
Like any other surgical operation, there are risks with adhesiolysis. The common risks with abdominal adhesion pain relief surgery is that of new adhesion forming a few years after adhesiolysis.
It is possible for patients who have adhesiolysis to need repeated surgery for adhesion in the future - sometimes as often as every two years. This occurs in few than 2 in 10 cases. Some adhesiolysis surgeons will opt to delay the surgery 12 to 24 hours to inject the abdominal cavity with liquids containing carboxymethylcellulose (CMC), hyaluronic acid, or icodextrin ahead of surgery in hopes of reducing the chances of the abdominal adhesions forming after the corrective surgeries.
A recent study finds that taking a fish oil supplement may be an effective adjuvant therapy to reduce the development of postsurgical adhesions related to endometriosis.
This is according to Fertility and sterility, (25 October 2012, 1556-5653).
Unless patients have congenital adhesions, the formation of adhesions can be controlled, or minimized to some extent, if patients are willing to take certain measures before, during, and after a surgical procedure.
Preventative measures you and your surgeon can take to reduce your chances of having adhesion include:
Patients who are preparing for abdominal surgery should discuss these measures with their surgeon.
Last updated on the 28th of December 2019.
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