What are adhesions and how do they develop after C-sections. How can adhesions impact women’s health following abdominal surgery. 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 normally connected. They develop as part of the body’s natural healing process following surgery, infection, injury, or inflammation. C-sections, being a major abdominal surgery, can often lead to the formation of adhesions.

Adhesions may appear as thin sheets of tissue resembling plastic wrap or as thick fibrous bands. They commonly affect areas such as:

• Female reproductive organs (ovaries, fallopian tubes)
• Bowel
• Area around the heart
• Spine
• Hands

The prevalence of adhesions following abdominal surgery is strikingly high, with up to 93% of patients developing them post-operatively. Even without prior surgery, about 10% of people may develop abdominal adhesions.

Common Symptoms of C-Section Adhesions

While many adhesions are asymptomatic, they can cause a range of problems for some women following C-sections. Common symptoms include:

• Chronic pelvic or abdominal pain
• Infertility
• Dyspareunia (painful intercourse)
• Bowel obstruction or blockage
• Urinary bladder dysfunction

In some cases, adhesions can lead to a complex set of problems known as adhesion-related disorder (ARD). Symptoms of ARD may include:

• Chronic, generalised abdominal pain
• Difficulty with bowel movements
• Pain during movement (walking, sitting, or lying in certain positions)
• Emotional disorders such as depression

Risks and Complications Associated with C-Section Adhesions

Adhesions following C-sections can pose several risks and complications:

1. Increased post-operative complications (e.g., leaks, wound infections, hemorrhages)
2. Longer hospital stays
3. Higher risk of small bowel obstructions
4. Infertility issues
5. Chronic pelvic pain
6. Increased complexity and complications during subsequent surgeries

Is the risk of adhesions higher with multiple C-sections? Yes, women who undergo multiple C-sections or other major abdominal surgeries are at an even greater risk of developing adhesions. The incidence of adhesions has increased alongside the rise in gynaecological procedures, with up to 90% of women experiencing post-operative adhesions following major gynaecological surgery.

Diagnosing C-Section Adhesions: Challenges and Methods

Diagnosing adhesions, particularly those causing chronic pain, can be challenging. Many common diagnostic tests are ineffective in detecting adhesions:

• Blood tests
• X-rays
• CT scans
• MRIs
• Ultrasounds

How can adhesions be definitively diagnosed? The only definitive test for diagnosing adhesions is a diagnostic laparoscopy. During this procedure, a surgeon can visually confirm the presence of adhesions and potentially release them in the same surgery.

For adhesions affecting the uterus or fallopian tubes, a hysterosalpingography (an X-ray that views the inside of these organs) may be helpful in diagnosis.

Differential Diagnosis

Symptoms of adhesions or ARD can often be mistaken for other conditions, including:

• Chronic fatigue syndrome
• Endometriosis
• Irritable bowel syndrome
• Fibromyalgia
• Depression and anxiety

Given this overlap in symptoms, healthcare providers typically order a range of diagnostic tests to rule out other medical conditions before considering adhesions as the primary cause.

Treatment Options for C-Section Adhesions

The primary treatment for adhesions is surgical intervention, known as adhesiolysis. This can be performed through open surgery or laparoscopic (keyhole) procedures.

Laparoscopic Adhesiolysis

Laparoscopic adhesiolysis is generally preferred due to its minimally invasive nature. During this procedure, surgeons use small incisions to insert a camera and specialized instruments to cut and remove adhesions.

Open Adhesiolysis

Open adhesiolysis involves a larger incision and may be necessary for more extensive or complex adhesions. However, it’s important to note that open surgery itself can lead to the formation of new adhesions.

Can adhesions recur after treatment? Unfortunately, adhesions can recur following treatment. In fact, about 70% of cases may develop new adhesions following adhesiolysis. This risk of recurrence makes the decision to perform adhesiolysis complex, especially for less severe cases.

Preventing Adhesions: Strategies and Considerations

Given the high risk of adhesion formation following C-sections and other abdominal surgeries, prevention strategies are crucial. Some approaches include:

1. Minimally invasive surgical techniques: Laparoscopic procedures generally result in fewer adhesions compared to open surgeries.
2. Careful surgical technique: Gentle tissue handling, meticulous hemostasis, and irrigation can help reduce adhesion formation.
3. Use of adhesion barriers: These are materials placed during surgery to separate tissues and prevent adhesion formation.
4. Proper closure techniques: Using absorbable sutures and avoiding excessive tissue trauma during closure can help minimize adhesion formation.

Are there any non-surgical methods to prevent adhesions? While surgical techniques are the primary focus of adhesion prevention, some studies have explored non-surgical approaches such as:

• Physical therapy and massage to maintain tissue mobility
• Anti-inflammatory medications to reduce post-operative inflammation
• Nutritional support to optimize healing

However, these methods are generally considered supplementary to surgical prevention techniques.

Living with C-Section Adhesions: Management and Coping Strategies

For women living with adhesions following C-sections, managing symptoms and improving quality of life are key priorities. Some strategies include:

1. Pain management: This may involve medications, physical therapy, or alternative therapies like acupuncture.
2. Dietary modifications: Some women find relief from adhesion-related digestive symptoms by adjusting their diet.
3. Exercise and movement: Gentle exercises and stretches can help maintain mobility and reduce pain.
4. Psychological support: Dealing with chronic pain and potential fertility issues can be emotionally challenging. Professional counseling or support groups can be beneficial.
5. Regular follow-ups: Maintaining regular check-ups with healthcare providers can help monitor adhesion-related symptoms and catch any complications early.

How can women prepare for future pregnancies with a history of adhesions? Women with a history of adhesions should discuss their plans for future pregnancies with their healthcare provider. This may involve:

• Assessing the extent and location of existing adhesions
• Discussing the potential need for adhesiolysis before attempting pregnancy
• Planning for potential complications during pregnancy or delivery
• Considering alternative delivery methods if adhesions are extensive

Emerging Research and Future Directions in Adhesion Management

The field of adhesion prevention and treatment is an active area of research. Some promising directions include:

1. Advanced adhesion barriers: Researchers are developing new materials that can more effectively prevent adhesion formation without impacting healing.
2. Pharmacological interventions: Studies are exploring drugs that can modulate the inflammatory response and reduce adhesion formation.
3. Tissue engineering: There’s ongoing research into using engineered tissues to replace damaged peritoneum and reduce adhesion formation.
4. Minimally invasive techniques: Continued improvements in laparoscopic and robotic surgery aim to further reduce adhesion formation.

What role might regenerative medicine play in adhesion treatment? Regenerative medicine approaches, such as stem cell therapy and growth factor treatments, are being investigated for their potential to promote healing without excessive scar tissue formation. While still in early stages, these approaches could potentially revolutionize adhesion prevention and treatment in the future.

The Importance of Patient Education and Informed Consent

Given the high prevalence of adhesions following C-sections and other abdominal surgeries, patient education is crucial. Healthcare providers should discuss the risk of adhesions with patients before surgery, including:

• Potential symptoms and complications
• Prevention strategies
• Treatment options if adhesions do occur
• Impact on future pregnancies and surgeries

This information allows patients to make informed decisions about their care and be proactive in monitoring for adhesion-related symptoms post-surgery.

In conclusion, while adhesions are a common and often unavoidable consequence of C-sections and other abdominal surgeries, ongoing research and improved surgical techniques offer hope for better prevention and management strategies. Women who have undergone C-sections should be aware of the potential for adhesions and work closely with their healthcare providers to monitor and address any resulting symptoms or complications.

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.