What are adhesions and how do they develop after C-sections. How can adhesions impact a woman’s health and quality of life. What treatment options are available for managing adhesion-related complications.

What Are Adhesions and How Do They Form After C-Sections?

Adhesions are bands of scar tissue that form between internal body surfaces that are not typically connected. They develop as part of the body’s natural healing process following surgery, infection, injury, or inflammation. After a C-section, adhesions commonly form in the abdominal and pelvic regions as the body works to repair the surgical incision.

The formation of adhesions after C-sections is remarkably common. Studies indicate that up to 93% of individuals who undergo abdominal surgery, including C-sections, develop adhesions. These fibrous bands can range from thin, plastic wrap-like sheets to thick, rope-like structures.

Why are adhesions so prevalent after C-sections?

C-sections involve creating an incision through multiple layers of tissue, including the abdominal wall and uterus. This extensive surgical trauma triggers an intense healing response, leading to a higher likelihood of adhesion formation. Additionally, the peritoneum (the membrane lining the abdominal cavity) is particularly prone to adhesion development when disrupted during surgery.

Common Symptoms and Complications of C-Section Adhesions

While many adhesions remain asymptomatic, they can cause a range of issues for some women. Understanding these potential complications is crucial for early detection and management.

• Chronic pelvic pain
• Infertility
• Bowel obstruction
• Painful intercourse (dyspareunia)
• Urinary bladder dysfunction
• Difficulty with certain movements or positions

In some cases, adhesions can lead to a complex set of symptoms known as Adhesion-Related Disorder (ARD). ARD can significantly impact a woman’s quality of life and may be challenging to diagnose due to its varied and often vague symptoms.

How do adhesions cause these symptoms?

Adhesions can restrict the normal movement and function of organs in the abdominal and pelvic cavities. For example, they may cause the bowel to kink or twist, leading to obstruction. In the reproductive system, adhesions can distort the anatomy of the fallopian tubes or ovaries, potentially affecting fertility. The pulling and stretching of adhesions during movement or organ function can also result in chronic pain.

Diagnosing Adhesions: Challenges and Techniques

Diagnosing adhesions, particularly when they cause chronic pain, can be challenging. Many common diagnostic tools are ineffective in directly visualizing adhesions.

• Blood tests, X-rays, CT scans, MRIs, and ultrasounds cannot definitively diagnose adhesions
• Hysterosalpingography may help identify adhesions within the uterus or fallopian tubes
• Diagnostic laparoscopy is the only definitive method to confirm the presence of adhesions

Due to the difficulty in directly imaging adhesions, diagnosis often involves ruling out other potential causes of symptoms. This process may be frustrating for patients, as symptoms can mimic other conditions such as endometriosis, irritable bowel syndrome, or chronic fatigue syndrome.

What should you expect during the diagnostic process?

If you’re experiencing symptoms that may be related to adhesions, your healthcare provider will likely start with a thorough medical history and physical examination. They may order various tests to rule out other conditions before considering a diagnostic laparoscopy. It’s important to be patient and communicate clearly about your symptoms throughout this process.

Treatment Options for C-Section Adhesions

Managing adhesions often requires a multifaceted approach, depending on the severity of symptoms and the extent of adhesion formation. Treatment options range from conservative management to surgical intervention.

Conservative Management

For mild symptoms or in cases where surgery is not immediately necessary, conservative approaches may be recommended:

• Physical therapy and exercises to improve mobility and reduce pain
• Pain management techniques, including medication and alternative therapies
• Dietary modifications to manage bowel-related symptoms

Surgical Treatment: Adhesiolysis

When adhesions cause significant complications or persistent symptoms, surgical intervention may be necessary. The primary surgical treatment for adhesions is adhesiolysis, which can be performed through open surgery or laparoscopically.

Laparoscopic adhesiolysis is generally preferred when possible, as it involves smaller incisions and potentially fewer complications. During this procedure, a surgeon uses specialized instruments to cut or separate the adhesions, freeing the affected organs or tissues.

What are the risks and considerations of adhesiolysis?

While adhesiolysis can provide relief from symptoms, it’s important to understand that the surgery itself can lead to the formation of new adhesions. Studies suggest that in approximately 70% of cases, adhesions may reform after the initial removal. This risk underscores the importance of carefully weighing the potential benefits against the risks when considering surgical intervention.

Preventing Adhesions: Strategies for Future C-Sections

Given the high prevalence of adhesions following C-sections, prevention strategies are a crucial area of focus in obstetric care. While it may not be possible to completely prevent adhesion formation, certain techniques and approaches can help minimize their occurrence and severity.

Surgical Techniques

• Minimally invasive approaches when possible
• Careful handling of tissues to minimize trauma
• Thorough irrigation of the surgical site
• Use of specialized suturing techniques

Adhesion Barriers

Adhesion barriers are products designed to separate healing tissues during the critical period of adhesion formation. These can include:

• Synthetic mesh barriers
• Gel-based products
• Liquid solutions applied during surgery

While these barriers show promise in reducing adhesion formation, their effectiveness can vary, and they may not be suitable in all cases.

How can patients contribute to adhesion prevention?

While many aspects of adhesion prevention are in the hands of medical professionals, patients can play a role in minimizing their risk:

• Follow post-operative care instructions closely
• Engage in gentle movement and exercises as advised by your healthcare provider
• Maintain a healthy lifestyle to support overall healing
• Discuss concerns about adhesions with your healthcare team before any planned surgeries

Living with Adhesions: Coping Strategies and Support

For many women, living with adhesions after a C-section can be challenging, particularly if they cause ongoing symptoms. Developing effective coping strategies and seeking appropriate support are crucial for maintaining quality of life.

Pain Management

Chronic pain from adhesions can be managed through various approaches:

• Medications, including over-the-counter pain relievers and prescription options
• Physical therapy and targeted exercises
• Alternative therapies such as acupuncture or massage
• Mindfulness and relaxation techniques

Emotional Support

The impact of adhesions can extend beyond physical symptoms, affecting emotional well-being and mental health. Seeking support through the following channels can be beneficial:

• Support groups for individuals with chronic pain or adhesion-related issues
• Professional counseling or therapy
• Open communication with family and friends about the challenges faced

Lifestyle Adaptations

Making certain lifestyle changes can help manage symptoms and improve overall well-being:

• Dietary modifications to manage bowel-related symptoms
• Gentle exercise routines tailored to individual capabilities
• Stress reduction techniques
• Ergonomic adjustments at home and work to minimize discomfort

How can partners and family members support someone living with adhesions?

Supporting a loved one with adhesion-related complications involves:

• Educating yourself about adhesions and their impact
• Offering emotional support and understanding
• Assisting with daily tasks when needed
• Encouraging and participating in healthy lifestyle choices
• Accompanying them to medical appointments for additional support

Future Directions in Adhesion Research and Management

The field of adhesion prevention and treatment is continually evolving, with ongoing research aimed at improving outcomes for patients. Several promising areas of study may shape the future of adhesion management:

Advanced Imaging Techniques

Researchers are exploring new imaging modalities that could potentially visualize adhesions non-invasively. These advancements could revolutionize the diagnosis and monitoring of adhesions, allowing for earlier intervention and more targeted treatments.

Novel Adhesion Barriers

The development of more effective and biocompatible adhesion barriers is an active area of research. Scientists are investigating materials that can provide longer-lasting separation between healing tissues while being safely absorbed by the body.

Pharmacological Interventions

Studies are underway to identify medications that could prevent or reduce adhesion formation without interfering with normal wound healing. These could potentially be administered during surgery or as part of post-operative care.

Minimally Invasive Surgical Techniques

Advancements in surgical technology continue to push the boundaries of minimally invasive procedures. These techniques aim to reduce tissue trauma and, consequently, the risk of adhesion formation.

What potential breakthroughs might we see in adhesion management?

While it’s difficult to predict specific breakthroughs, several exciting possibilities are on the horizon:

• Gene therapy approaches to modulate the adhesion formation process
• Nanotechnology-based treatments for targeted adhesion prevention
• Artificial intelligence algorithms to predict adhesion risk and guide personalized prevention strategies
• Regenerative medicine techniques to promote adhesion-free healing

As research progresses, these and other innovations may significantly improve the prevention, diagnosis, and treatment of adhesions, offering hope for better outcomes for women who have undergone C-sections and other abdominal surgeries.

Navigating Healthcare: Advocating for Adhesion Awareness

Given the prevalence and potential impact of adhesions following C-sections, it’s crucial for patients to be informed advocates for their health. Understanding how to navigate the healthcare system and communicate effectively with medical professionals can lead to better outcomes and more comprehensive care.

Educating Yourself

Knowledge is power when it comes to managing your health. Take proactive steps to learn about adhesions:

• Research reputable medical sources for information on adhesions
• Stay informed about the latest developments in adhesion prevention and treatment
• Prepare a list of questions before medical appointments

Communicating with Healthcare Providers

Effective communication with your healthcare team is essential:

• Be clear and specific when describing symptoms
• Keep a symptom diary to track patterns and triggers
• Don’t hesitate to seek second opinions if you feel your concerns aren’t being adequately addressed
• Discuss the potential for adhesions before any planned surgeries

Seeking Specialized Care

In some cases, seeking care from specialists experienced in treating adhesion-related issues may be beneficial:

• Gynecological surgeons specializing in minimally invasive techniques
• Pain management specialists
• Fertility specialists if adhesions are impacting reproductive health

How can patients effectively advocate for adhesion awareness in healthcare settings?

Patients can play a crucial role in raising awareness about adhesions:

• Share your experiences with healthcare providers to increase their understanding of the patient perspective
• Participate in patient advocacy groups or support organizations focused on adhesion-related issues
• Consider participating in clinical trials or research studies on adhesions, if appropriate and available
• Encourage open discussions about adhesions with other women who have undergone or are planning C-sections

By actively engaging in your healthcare and advocating for adhesion awareness, you can contribute to improved care not only for yourself but potentially for other women facing similar challenges.

Adhesions – Better Health Channel

An adhesion is a band of scar tissue that joins two internal body surfaces that are not usually connected. Organs or tissues within the body stick (adhere) to other internal surfaces.

Adhesions develop as the body attempts to repair itself. This normal response can occur after surgery, infection, injury (trauma) or radiation. Adhesions may appear as thin sheets of tissue similar to plastic wrap, or as thick fibrous bands.

Adhesions can affect the female reproductive organs (ovaries, fallopian tubes), the bowel, the area around the heart, the spine and the hand. They can cause a range of problems including infertility, dyspareunia (painful intercourse), pelvic pain and bowel obstruction or blockage. Adhesions can also lead to a complex set of problems called adhesion-related disorder (ARD).

Adhesions are a widespread problem. Up to 93 per cent of people who have abdominal surgery go on to develop adhesions. Abdominal adhesions also occur in 10 per cent of people who have never had surgery.

Risks of adhesions

Adhesions may:

• develop after any kind of pelvic or abdominal surgery – people who have major or multiple procedures are even more at risk
• cause significantly higher post-operative complications (leaks, wound infections, haemorrhages) in people with adhesion-related perforations. This may also lead to a longer stay in hospital
• lead to other risks and complications, including small bowel obstructions, infertility and chronic pelvic pain
• cause increased risk, complexity and complications during subsequent surgery.

The incidence of adhesions has increased with the rise in gynaecological procedures. Up to 90 per cent of women suffer post-operative adhesions following major gynaecological surgery.

Development of adhesions

Adhesions develop as the body attempts to repair itself. This is the body’s normal response after:

• surgery, particularly abdominal surgery
• infection
• endometriosis
• injury (trauma)
• radiation treatment.

Adhesions can also form after inflammation in the abdomen or pelvis.

Symptoms of adhesions

Although most adhesions are painless and do not cause complications, adhesions cause 60 to 70 per cent of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain.

Adhesion-related disorder (ARD) is a group of symptoms that may occur as a result of adhesions. A person with ARD will usually experience chronic abdominal pain.

Typical adhesions form within the first few days after surgery, but symptoms can last for months or even years. Symptoms may be mostly in one area of the abdomen, but are often generalised, vague, ‘crampy’ and difficult to define. This means ARD can be difficult to diagnose.

Symptoms of ARD may include:

• chronic pain
• infertility
• bowel obstruction and an inability to pass gas
• urinary bladder dysfunction
• pain and difficulty having a bowel movement
• pain on movement such as walking, sitting or lying in certain positions
• emotional disorders such as depression, thoughts of suicide or hopelessness.

Other intestinal problems may include constipation, obstruction, or alternating constipation with diarrhoea from partial obstruction.

Women may experience gynaecological problems, which can add to the anxiety and self-esteem problems that may already be experienced by women who suffer with this disorder.

Symptoms of ARD can be mistaken as a sign of another condition. These can include a whole host of other possible diagnoses such as chronic fatigue syndrome, endometriosis, irritable bowel syndrome, fibromyalgia, depression and anxiety.

Diagnosis of adhesions

It is very difficult to diagnose the chronic pain of adhesions correctly. Diagnostic tests such as blood tests, x-ray procedures, CT scans, MRIs and ultrasound will not diagnose adhesions. Hysterosalpingography (an x-ray that views the inside of the uterus and fallopian tubes) may help diagnose adhesions inside the uterus or fallopian tubes.

According to your symptoms, your doctor will order the appropriate diagnostic tests to rule out other medical conditions that may have similar symptoms.

If the results of these tests are normal or negative for abnormal pathology, a diagnostic laparoscopy may be appropriate. This is the only test that can confirm the presence of adhesions. If adhesions are found, you doctor can usually release them during the same surgery.

Treatment of adhesions

Adhesions can be treated either with open or laparoscopic (keyhole) surgery, known as adhesiolysis. The adhesions are cut by scalpel or electrical current.

Open adhesiolysis

As adhesions are likely to form after certain surgical procedures, open adhesiolysis may not be worthwhile, except to remedy serious problems such as bowel obstruction.

In around 70 per cent of cases, the operation to remove the original adhesions will cause more adhesions to develop. Discuss the risks, benefits and alternatives to surgery thoroughly with your doctor before you make a decision.

Laparoscopic adhesiolysis

People with symptoms of adhesions may consider laparoscopic surgery. The advantage of this procedure is that only a small incision (cut) is required, which is why it is also known as ‘keyhole surgery’. Laparoscopy is the preferred method for performing infertility surgery as there is a decreased risk of new adhesions forming.

Laparoscopic adhesiolysis can significantly improve quality of life among women with chronic pelvic pain due to adhesions. This procedure shows similar results to more invasive forms of surgery when it comes to managing extensive adhesions. However, it can be time-consuming (the procedure may take two to four hours), technically difficult and involves some risk. Adhesion barriers (commercially made) that are placed at the time of surgery may reduce adhesion formations.

Adjuvant treatment (using commercially available product such as intercoat) after adhesiolysis is beneficial in preventing the development of intrauterine adhesions.

Most women who choose to have laparoscopic adhesiolysis:

• are discharged on the same day of the procedure
• don’t need to have major abdominal cuts (incisions)
• experience minimal complications
• return to full activity within one week of the procedure.

Non-surgical treatments for adhesions

Alternatives to surgery include:

• medication – this is often the first treatment choice for acute pain and forms part of the treatment for chronic pain
• exercise
• physical therapy
• lifestyle changes
• soft tissue mobilisation (Wasserman et al 2019)

Although they can be helpful, medications are not a cure-all. They can cause side effects or may be ineffective, and are often costly. A pain specialist can advise you on the non-surgical treatment options most suited to your situation.

Where to get help

• Your GP (doctor)
• Nurse-on-Call Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

How To Tell If You Have Adhesions After C-Section ( C-Section Scar Tissue)

chronic pain caused by adhesions

Table of Contents

C-sections are one of the most common surgeries in the U.S. For many women a c-section isn’t a choice — it is the only safe way to deliver the baby. Most c-section are routine and go as planned. However, many women are unaware of the post-surgical complications that can occur months or even years after a C-section. When the body heals from the procedure, it forms bands of internal scar tissue called adhesions. Adhesions can cause a host of problems if left untreated, including chronic pain, female infertility and life-threatening bowel obstructions. Unfortunately, they are often misdiagnosed because adhesions and pelvic adhesions do not appear on diagnostic tests such as x-rays. Many of us know about the scar that is left after c-section, but you may be surprised to learn that the way your scar looks can be an indication of your internal healing. Research now suggests that there is a strong correlation between the physical characteristics of an external c-section scar and the adhesions underneath it. Women can use researchers’ findings to help determine whether they have adhesions after a c-section.

What are adhesions?

C-section scar tissue is strands of collagen that form in the body after a surgery, trauma, infection or inflammation. Unfortunately, they are rarely discussed and many patients have never heard the term ‘adhesions.’ Because they are part of the body’s natural healing process, there is no way to prevent adhesions from forming and the surgeries designed to remove them cause more to form. Adhesions can look like spider webs covering the organs or like filmy, white strands of nylon rope constricting structures inside the body. These powerful strands of collagen wrap around structures at the healing site and can restrict blood flow or reduce the function of internal organs. They can bind tissues and organs, resulting in mild to excruciating pain.

Symptoms of Post C-Section Adhesions and Scar Tissue

When we talk to patients, they often have an ‘aha moment.’ We begin describing what someone with post-surgical adhesions typically experiences and the common response is “Wow, you’re describing me!” Women who have had c-section often know something is wrong – they can feel it, whether is a specific pain or a tightness that they have trouble describing. Unfortunately, many physicians will tell them that pain after c-section is common and that there is nothing to be done about it. The following are common symptoms of adhesions after a c-section. If these describe you, you may have adhesions.

• Non-diagnosable abdominal pain (sometimes years after your c-section)
• Trouble standing up straight
• Swollen/bloated abdomen
• Pain during intercourse
• Painful bowel movements
• Secondary infertility
• Chronic pelvic pain
• Increased menstrual pain (since c-section)
• Pain/tenderness at the location of your scar
• Swelling after c-section
• c-section scar pain

Now that you are familiar with the symptoms of post c-section adhesions, we will look at the different visual characteristics of a c-section scar and what it can tell you about the presence of adhesions.

How to Tell if You Have C-Section Scar Tissue

Lay flat on your back and examine your c-section scar. Women with flat, small scars without significant pigment changes (changes in skin color) are less likely to have adhesions in their pelvis. However, a scar that pulls towards the back (indented) or one that is raised and thick — with or without changes in the color of the skin in that area — suggests the presence of dense adhesions. Additionally, women with scars that are darker in color than the rest of their skin are are much more likely to have adhesions, regardless of whether the scar indents, lays flat or protrudes out. If your scar looks like the example above — indented without any changes to the pigment — there is a high probability that you have adhesions. Because the skin is indented, women with this type of scar are more likely to have dense adhesions than those whose scar looks similar but is flat, without indentation. If you have c-section scar pain you most likely also have c-section scar tissue. If you scar looks similar to this second image above (raised with pigment change), you also likely have adhesions. Women with this type of scar are most likely to have dense adhesions, which cause pain and dysfunction, because the scar exhibits characteristics from both risk categories — raised and different pigmentation than the surrounding skin.

What to Do if You Think You Have Adhesions

If your symptoms match those described in this article and your scar resembles the examples provided, there is a high probability that you have adhesions. Few options exist for women with abdominal adhesions after a c-section. Surgeons can cut or burn (lyse) adhesions, but the invasive procedure leads to the formation of new adhesions. Some women are able to live without treatment, while others experience recurring, debilitating pain and dysfunction. If you or a woman you know is suffering from adhesions after a c-section, we encourage you to fill out a contact form or call us at 1-352-336-1433. You will be able to schedule a phone consultation with one of our certified therapists, at no cost, and learn whether our non-surgical treatment is appropriate for you. References: http://www.ncbi.nlm.nih.gov/pubmed/25304098http://www.ncbi.nlm.nih.gov/pubmed/18178195http://www.ncbi.nlm.nih.gov/pubmed/21306338

chronic pain caused by adhesions

Table of Contents

C-sections are one of the most common surgeries in the U.S. For many women a c-section isn’t a choice — it is the only safe way to deliver the baby. Most c-section are routine and go as planned. However, many women are unaware of the post-surgical complications that can occur months or even years after a C-section. When the body heals from the procedure, it forms bands of internal scar tissue called adhesions. Adhesions can cause a host of problems if left untreated, including chronic pain, female infertility and life-threatening bowel obstructions. Unfortunately, they are often misdiagnosed because adhesions and pelvic adhesions do not appear on diagnostic tests such as x-rays. Many of us know about the scar that is left after c-section, but you may be surprised to learn that the way your scar looks can be an indication of your internal healing. Research now suggests that there is a strong correlation between the physical characteristics of an external c-section scar and the adhesions underneath it. Women can use researchers’ findings to help determine whether they have adhesions after a c-section.

What are adhesions?

C-section scar tissue is strands of collagen that form in the body after a surgery, trauma, infection or inflammation. Unfortunately, they are rarely discussed and many patients have never heard the term ‘adhesions.’ Because they are part of the body’s natural healing process, there is no way to prevent adhesions from forming and the surgeries designed to remove them cause more to form. Adhesions can look like spider webs covering the organs or like filmy, white strands of nylon rope constricting structures inside the body. These powerful strands of collagen wrap around structures at the healing site and can restrict blood flow or reduce the function of internal organs. They can bind tissues and organs, resulting in mild to excruciating pain.

Symptoms of Post C-Section Adhesions and Scar Tissue

When we talk to patients, they often have an ‘aha moment.’ We begin describing what someone with post-surgical adhesions typically experiences and the common response is “Wow, you’re describing me!” Women who have had c-section often know something is wrong – they can feel it, whether is a specific pain or a tightness that they have trouble describing. Unfortunately, many physicians will tell them that pain after c-section is common and that there is nothing to be done about it. The following are common symptoms of adhesions after a c-section. If these describe you, you may have adhesions.

• Non-diagnosable abdominal pain (sometimes years after your c-section)
• Trouble standing up straight
• Swollen/bloated abdomen
• Pain during intercourse
• Painful bowel movements
• Secondary infertility
• Chronic pelvic pain
• Increased menstrual pain (since c-section)
• Pain/tenderness at the location of your scar
• Swelling after c-section
• c-section scar pain

Now that you are familiar with the symptoms of post c-section adhesions, we will look at the different visual characteristics of a c-section scar and what it can tell you about the presence of adhesions.

How to Tell if You Have C-Section Scar Tissue

Lay flat on your back and examine your c-section scar. Women with flat, small scars without significant pigment changes (changes in skin color) are less likely to have adhesions in their pelvis. However, a scar that pulls towards the back (indented) or one that is raised and thick — with or without changes in the color of the skin in that area — suggests the presence of dense adhesions. Additionally, women with scars that are darker in color than the rest of their skin are are much more likely to have adhesions, regardless of whether the scar indents, lays flat or protrudes out. If your scar looks like the example above — indented without any changes to the pigment — there is a high probability that you have adhesions. Because the skin is indented, women with this type of scar are more likely to have dense adhesions than those whose scar looks similar but is flat, without indentation. If you have c-section scar pain you most likely also have c-section scar tissue. If you scar looks similar to this second image above (raised with pigment change), you also likely have adhesions. Women with this type of scar are most likely to have dense adhesions, which cause pain and dysfunction, because the scar exhibits characteristics from both risk categories — raised and different pigmentation than the surrounding skin.

What to Do if You Think You Have Adhesions

If your symptoms match those described in this article and your scar resembles the examples provided, there is a high probability that you have adhesions. Few options exist for women with abdominal adhesions after a c-section. Surgeons can cut or burn (lyse) adhesions, but the invasive procedure leads to the formation of new adhesions. Some women are able to live without treatment, while others experience recurring, debilitating pain and dysfunction. If you or a woman you know is suffering from adhesions after a c-section, we encourage you to fill out a contact form or call us at 1-352-336-1433. You will be able to schedule a phone consultation with one of our certified therapists, at no cost, and learn whether our non-surgical treatment is appropriate for you. References: http://www.ncbi.nlm.nih.gov/pubmed/25304098http://www.ncbi.nlm.nih.gov/pubmed/18178195http://www.ncbi.nlm.nih.gov/pubmed/21306338

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Adhesions of the abdominal cavity: symptoms, causes and treatment

Adhesions of the abdominal cavity are connective tissue strands that “glue”, solder organs together. Adhesions can provoke a complete or partial overlap of the lumen of a hollow organ, infringement, atrophy and necrosis of its walls, and make it impossible for the food bolus to pass through the gastrointestinal tract.

Adhesions can form in various organs (eg, pleural cavity, fallopian tubes), but adhesions are most often referred to in the context of abdominal bands. They glue together intestinal loops, omentum, abdominal walls and pelvic organs. The formation of multiple adhesions is called adhesive disease.

Why adhesions are formed

A young adhesion is a film of fibrin protein, which is released at the site of an injury or inflammatory process in order to isolate the focus of inflammation or the area of ​​damage, to protect surrounding organs from it. Normally, after healing, fibrin resolves. But if the inflammation lasts for a long time, the focus is large or a negative genetic factor is connected (abundant release of fibrin with insufficient activity of enzymes for its resorption), the benefit turns into harm. More dense collagen is added to light fibrin, which is no longer subject to autolysis. Blood capillaries grow into the cord, and then nerves. The thin tender membrane turns into a tight screed that compresses the loop of the intestine and can lead to intestinal obstruction – a condition that poses a threat to the patient’s life.

Spikes always have at least two “support points”. They can form between two parts of the intestine, the intestine and the parenchymal organ, the intestine and the peritoneal wall. In women, adhesions can affect the fallopian tubes and uterus, which does not pose a direct threat to life, but leads to infertility or can cause an ectopic pregnancy.

Sometimes you can hear the expression “adhesions in the stomach.” It is anatomically incorrect, an adhesion can form only on the outer serous membrane of the stomach when it is injured or inflamed in the abdominal cavity, but this happens infrequently. The main targets of adhesive disease are the intestines and organs of the female reproductive system.

Adhesions occur as a result of purulent appendicitis and phlegmonous cholecystitis, diffuse peritonitis, perforated gastric or duodenal ulcer, liver abscesses, endometriosis, salpingo-oophoritis and other acute and chronic inflammatory diseases of the abdominal cavity and small pelvis. The adhesive process accompanies the healing of penetrating knife, bullet and shrapnel wounds of the abdomen, especially if the victim does not receive adequate treatment in a hospital.

Intestinal adhesion after cavitary operation was a fairly common complication before the invention of minimally invasive laparoscopic methods of surgical treatment. The more traumatic the operation, the more actively the body tries to “protect itself”, the more fibrin the peritoneum secretes.

Adhesions can be caused by small instruments accidentally forgotten in the abdominal cavity, tampons, remnants of suture material, which can become a source of fibrin clot formation and adhesion formation. The process of adhesion formation is capable of initiating talc from surgical gloves that has fallen on the peritoneum – which is why surgeons carefully wash it off before starting the operation with swabs with alcohol. In people with a hereditary tendency to adhesion formation, the adhesion processes are even more intense, they can form adhesions even in response to ovulation.

Symptoms of adhesive disease

What is intestinal adhesion for the intestine as a transport system? This is a slowly but surely growing elastic “noose” that compresses the intestinal wall and gradually blocks its lumen. Unlike a malignant tumor, the spike does not grow into adjacent tissues, but mechanical compression of the tubular organ is fraught with tangible troubles.

Symptoms of intestinal adhesions depend on their location. Individual adhesions may not manifest themselves in any way or respond with moderate pain in the abdomen in response to sudden movements of the body. If the adhesion caused the infringement of the intestinal area, symptoms of increasing intestinal obstruction develop: nausea and vomiting, flatulence, bloating, constipation or lack of defecation. There are phenomena of intoxication and encephalopathy – headache, apathy, increased irritability, confusion.

In surgical practice, a five-point scale for assessing the severity of adhesive disease after surgery and inflammatory processes has been adopted:

• 0 points – no adhesions;
• 1 point – one adhesion, thin, loose, not narrowing the intestinal lumen;
• 2 points – two loose adhesions, without germination of blood capillaries, the intestinal lumen is not narrowed, the intestine may be somewhat deformed;
• 3 points – three or more adhesions, or a smaller number of them, but the adhesions are dense, germinated by blood capillaries, covering at least 50% of the intestinal lumen;
• 4 points – a conglomerate of dense adhesions, provoking a narrowing of the intestinal lumen by more than 50%.

Fortunately, adhesive obstruction of the intestine increases gradually, and usually the pain syndrome and deteriorating state of health force the patient to consult a doctor before life is threatened.

Diagnosis of abdominal adhesions

The insidiousness of adhesive disease is that the symptoms of intestinal adhesions are similar to other diseases, and strands on intestinal loops are difficult to detect by instrumental methods due to the extreme “accuracy” of organs in the peritoneum. On ultrasound, adhesion tissue is almost indistinguishable from intestinal tissue. In some cases, radiopaque examination or computed tomography may be informative. Only laparoscopy is truly visual (a puncture in the abdominal wall and the introduction of a probe with a camera).

It is important to take the patient’s history carefully. If in the past he underwent abdominal or laparoscopic abdominal surgery, a penetrating wound, an inflammatory process of the abdominal cavity cured by therapeutic methods, then the diagnosis of “adhesive disease” becomes very likely.

Prevention of adhesion formation and recurrence of adhesive disease

The formation of fibrin films is a natural protective reaction of the body to inflammation or injury. It is impossible to turn off the protective mechanism, and it is not necessary, but it is important to avoid injury to the peritoneum during surgical interventions and treat inflammatory diseases in a timely manner. Laparoscopic methods are in absolute priority over open operations, but if wide access cannot be avoided, surgical trauma should be minimized.

If abdominal adhesions are confirmed, monitoring of the patient is recommended. If adhesions provoke significant discomfort or there are signs of intestinal obstruction, surgical intervention is indicated.

Adhesion dissection can in most cases be performed laparoscopically under general anesthesia. Three punctures are made in the abdominal wall, an inert gas is injected into the peritoneum, which inflates the stomach and opens access to the organs. Adhesions are dissected, blood vessels are coagulated by electric current. After the operation, the patient remains in the hospital for two or three days and is discharged under the supervision of a surgeon at the place of residence. With developed intestinal obstruction or a significant adhesive process in the abdominal cavity, an intervention from a wide access is indicated.

References

• Adamyan L.V., Kozachenko A.V., Kondratovich L.M. Adhesions in the abdominal cavity: history of study, classification, pathogenesis (literature review) // Probl. reproductions, – 2013, – No. 6, – p. 7-13.
• Kotkov P.A. The current state of the diagnosis of abdominal adhesive disease // – Collection of materials “Mechnikov Readings-2011”, – St. Petersburg, – 2011, – p. 351-352
• Kotkov P.A. Opportunities for the prevention of abdominal adhesive disease // Collection of materials “Mechnikov Readings-2012”, – St. Petersburg, – 2012, – p. 235-236
• Kulakov V. I., Adamyan L.V., Mynbaev O.A. Postoperative adhesions (etiology, pathogenesis, prevention) // – M .: Medicine, – 1998.

Adhesions: signs, causes and methods of treatment

What is an extensive adhesive process, how to determine the presence of adhesions and eliminate the pathology. Prevention of adhesions during and after surgery

0003 what is the adhesion process and when do adhesions occur? This pathology is noted in case of damage to the peritoneum and as a result of inflammatory diseases with the further formation of connective tissue that glues the internal organs. In this case, they are displaced, blood circulation and functions are disturbed. The incidence of adhesive disease as a postoperative complication is up to 75-90% of all patients. The disease is chronic, more common in women and requires long-term treatment.

Causes of adhesive disease

The peritoneum, which protects the internal organs, has several important functions. One of them is to ensure the sliding of organs relative to each other and to prevent their fusion with each other. Violation of this function leads to adhesion formation, which is noted in the following cases:

1. Bruises and blunt injuries of the abdomen. Clots of clotted blood act on the tissues of the peritoneum as foreign bodies, provoking inflammation, fibrin prolapse and the formation of adhesions.
2. Inflammatory diseases of the internal organs. They are more common in women (up to 75% of cases) and can lead to infertility.
3. Consequences of surgery. Damage to blood vessels, installation of drains, suturing the wall of the stomach or intestines, prolonged disruption of capillary blood flow, drying, and other causes can provoke the formation of adhesions. Most likely, pathology occurs after appendectomy and gynecological operations.
4. Penetration into the abdominal cavity of the contents of the intestine or stomach (perforated ulcer, appendicitis, wounds).

Adhesions occur less frequently after caesarean section and laparoscopic surgery. The more concomitant factors are observed, the more pronounced the manifestations of the disease.

How to detect adhesive process , symptoms:

• Pains of varying intensity, diffuse, radiating to the groin, lower abdomen, rectum. With diaphragmatic adhesions, pain radiates to the sternum, and there is also a violation of breathing. Discomfort occurs regardless of food intake, at different times of the day, may be minor or manifest in an acute form.
• Digestive problems (gastrointestinal discomfort). Bloating, chronic constipation, vomiting, pain are slight or absent.
• Bowel obstruction. Sudden severe pain, spasms, vomiting, cessation of stool discharge, bloating. Requires emergency surgery.

In the latent form, adhesions are detected during examinations, for example, for infertility.

Adhesive disease must be distinguished from other pathologies. So, inflammatory bowel disease can give similar symptoms. Colitis and its prevention require examination by a specialist and comprehensive diagnostics.

Dynamics of adhesion development

The adhesion process can be local and can be detected only in the area of ​​operation (suturing). In some cases, the disease progresses over time, and functional disorders of the internal organs occur. The most dangerous complication is recurrent adhesive disease with intestinal obstruction. At the same time, an extensive adhesive process is observed with adhesion of intestinal loops and the formation of dense conglomerates.

The diagnosis is made on the basis of the patient’s complaints and after carrying out the necessary diagnostics, including:

• X-ray examination, including the introduction of a contrast agent.
• Ultrasound diagnostics. It is uninformative, it is prescribed for adhesions in the pelvic area and is carried out with a preliminary introduction of contrast.
• Laparoscopy – the introduction of optical equipment through a puncture in the abdominal wall.

If pelvic adhesions are suspected, sonohysterography is indicated. If the data obtained are insufficient to make a diagnosis, an abdominal CT scan is performed.

The development of adhesive disease is influenced by factors such as the amount of surgery or the severity of the injury (wound). At the same time, the spread of adhesions after minimally invasive operations cannot be ruled out – in this case, the provoking factors may be chemical and medications used during the operation. Adhesions is a pathology that requires observation and, unfortunately, can lead to life-threatening conditions. It is possible to draw conclusions about the patient’s condition only after a complete examination, even if he has an adhesive disease in his diagnosis.

How to treat adhesive process in the abdominal cavity

Conservative treatment of the disease is rarely used – in the initial stages, as well as in a chronic, slowly relapsing course. It includes the introduction of drugs that reduce swelling and improve blood circulation in the damaged area. With adhesions in the pelvic area, anti-inflammatory drugs and suppositories are prescribed, but their effectiveness is insufficient.

Positive dynamics is observed during the operation:

• Dissection of adhesions between the intestine and peritoneum.
• Removal of tissues damaged by adhesive processes.
• Major surgery for spreading adhesions through intestinal loops and cicatricial changes.

The choice of treatment depends on the condition of the patient. Preference is given to laparoscopic operations, in which damage to the peritoneum is minimal.

How to avoid adhesions?

The main method of prevention is the choice of an effective and safe method of treatment. Of great importance is preoperative preparation aimed at compensating the patient’s condition, the use of anti-adhesion barrier agents and solutions. Prevention of the adhesive process after surgery includes early activity of the patient – on the second day after the intervention, it is necessary to turn over in bed, take deep breaths with the participation of the abdominal muscles. Food should be fractional. After removing the sutures, therapeutic exercises are necessary to prevent adhesion and fusion of tissues. It is important to take steps to boost immunity, as well as get rid of bad habits, and move more.

Questions for the doctor

What are the pains associated with adhesions?

Pain in adhesive disease is constant or intermittent, aching, pulling, not dependent on nutrition. With adhesions in the small pelvis – extending to the genitals, anus.

Is it true that laser adhesions can be cured?

Complex treatment of adhesive disease. Laparoscopic surgery (through a puncture) with dissection of adhesions with a laser can be used.

Can adhesions form again in the same place after treatment?

The adhesive process is affected by a complex of reasons, including the state of the patient’s immune system.