# Adhesions after abdominal surgery



## rudibear (Jul 28, 2012)

I had abdominal surgery in January. Started having multiple bowel movements in April. Still am and now have bloating and pain. Pain has been pretty bad today. My gassy doc (gastroenterologist) has been thinking IBS. But another possibility, that of adhesions, is coming to light. Just wondering if anyone here has run into that or knows anything about it.


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## AIRPLANE (Mar 15, 2004)

Yes- adhesions can cause pain and digestive problems- both constipation and diarrhea or incomplete evacuation. Adhesions can be the result of surgery, endometriosis, injury and inflammation(such as IBD, burst ovarian cysts). Some people are even born with them.Unfortunately, it can be difficult to find help for them because they do not show up on any imaging scans since they are essentially like skin. The only way to actually see them is via exploratory laparoscopy which most doctors will not do without enough justification. And most doctors just will not talk about them, period.Also, it was hoped that doing surgery via laparoscopy instead of traditional, large incisions would reduce the problem of adhesions. However, laparoscopy requires filling the abdomen with gas that can cause drying and that itself can increase adhesion formation.Another problem is that they tend to reform after removal (adhesiolysis). Surgery for them needs to be done by a highly skilled and up-to-date surgeon who knows about the latest adhesion barriers (substances applied to the affected area to keep them separate during the first few days of healing after which they dissolve). There are also surgeons who do what they call a 2nd or even 3rd-look laparoscopy a week or so later to remove any new adhesions that have formed. Supposedly, removing the new adhesions is easier when they are new and softer and thus their removal leaves behind less damage than the first one. But I doubt that this is common practice due to insurance- from what I've read, insurance will not cover adhesiolysis.There is even a name for problems due to adhesions- ARD which stands for adhesion-related-disorders. IMO, adhesions are not talked about enough and it seems like there is a gag order out on them. I have read of some patients leaving the U.S. for treatment because they couldn't find any help here. I have also heard of a one-week physical therapy treatment called the Wurn technique but they only have 5 U.S. locations and I have not read enough first-hand accounts to convince me that it works and it is pricey and you'd likely have to pay for it yourself. I've asked local physical therapists about it and they were skeptical that a one-week treatment could be effective for any length of time.So for now, if you suspect adhesions (do you have areas that feel tight, twisted or feel pulling sensations, possibly along with pain?) then about all you can do is look for a physical or massage therapist who deals with them. I've been to 3 of them in the past few years and they all said I had a lot of very tough adhesions. I go to a massage therapist who does myofascial release and visceral manipulation which helps to a degree but not completely. I have told doctors what the physical therapists said about adhesions but they refuse to consider them as a possible cause of my symptoms- saying there is no way anyone could know I had them without going in and looking and that is the end of it. Of course, I can't prove that I do have adhesions but they can't prove I don't and actually I did read that some were seen on a previous surgery report. Plus I do have a history of several surgeries which would make them suspect. As I said, it feels like there is a gag order regarding adhesions when it comes to doctors!


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## rudibear (Jul 28, 2012)

AIRPLANE said:


> Yes- adhesions can cause pain and digestive problems- both constipation and diarrhea or incomplete evacuation. Adhesions can be the result of surgery, endometriosis, injury and inflammation(such as IBD, burst ovarian cysts). Some people are even born with them.Unfortunately, it can be difficult to find help for them because they do not show up on any imaging scans since they are essentially like skin. The only way to actually see them is via exploratory laparoscopy which most doctors will not do without enough justification. And most doctors just will not talk about them, period.Also, it was hoped that doing surgery via laparoscopy instead of traditional, large incisions would reduce the problem of adhesions. However, laparoscopy requires filling the abdomen with gas that can cause drying and that itself can increase adhesion formation.Another problem is that they tend to reform after removal (adhesiolysis). Surgery for them needs to be done by a highly skilled and up-to-date surgeon who knows about the latest adhesion barriers (substances applied to the affected area to keep them separate during the first few days of healing after which they dissolve). There are also surgeons who do what they call a 2nd or even 3rd-look laparoscopy a week or so later to remove any new adhesions that have formed. Supposedly, removing the new adhesions is easier when they are new and softer and thus their removal leaves behind less damage than the first one. But I doubt that this is common practice due to insurance- from what I've read, insurance will not cover adhesiolysis.There is even a name for problems due to adhesions- ARD which stands for adhesion-related-disorders. IMO, adhesions are not talked about enough and it seems like there is a gag order out on them. I have read of some patients leaving the U.S. for treatment because they couldn't find any help here. I have also heard of a one-week physical therapy treatment called the Wurn technique but they only have 5 U.S. locations and I have not read enough first-hand accounts to convince me that it works and it is pricey and you'd likely have to pay for it yourself. I've asked local physical therapists about it and they were skeptical that a one-week treatment could be effective for any length of time.So for now, if you suspect adhesions (do you have areas that feel tight, twisted or feel pulling sensations, possibly along with pain?) then about all you can do is look for a physical or massage therapist who deals with them. I've been to 3 of them in the past few years and they all said I had a lot of very tough adhesions. I go to a massage therapist who does myofascial release and visceral manipulation which helps to a degree but not completely. I have told doctors what the physical therapists said about adhesions but they refuse to consider them as a possible cause of my symptoms- saying there is no way anyone could know I had them without going in and looking and that is the end of it. Of course, I can't prove that I do have adhesions but they can't prove I don't and actually I did read that some were seen on a previous surgery report. Plus I do have a history of several surgeries which would make them suspect. As I said, it feels like there is a gag order regarding adhesions when it comes to doctors!


Airplane, thank you for your response. I was feeling a bit ignored on this post. I wish you had more encouraging news for me though. I'm sure you wish that too. My finances leave me totally at the mercy of my insurance. Not a good deal. My surgeon did bring the topic up when I went back to him with my stomach issues. He did not seem totally opposed to opening me up, but also was not eager. But then, NEITHER AM I!







Then if they are removed, there is no guarantee they won't come back. I am certainly not interested in repeat surgeries. At the moment the odds favor IBS, but I want a second opinion from a doctor who cares. I have not experienced areas that fee tight, twisted, or have pulling sensations. I will take that as good news. I sure hope you can find relief from yours. Even though a CT would not show the actual lesions, you would think it would show if any organs had been shifted in and unusual position.


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## AIRPLANE (Mar 15, 2004)

rudibear said:


> Even though a CT would not show the actual lesions, you would think it would show if any organs had been shifted in and unusual position.


Yes, in certain cases, CT scans will show if organs are twisted or kinked or if there is a total obstruction which is considered an emergency. But most of the time, adhesions just cause what could be called 'frozen abdomen' or 'frozen pelvis'- just like you hear with 'frozen shoulder'. Things are just locked into place and cannot move when they are normally supposed to slide against each other. This can cause motility problems. The body can rebel against the restrictions and cause spasms. Adhesions also can cut off the circulation which restricts the supply of blood and oxygen which can result in pain.


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## Twin Mom (Jun 16, 2014)

This is an old post but I just came across it. What are the symptoms of adhesions? I've had IBS-D symptoms for about five years now (occasional diarrhea, lots of gas and abdominal pain). The funny thing is that usually my pain comes AFTER my bowel movements, and is not always when I have diarrhea. Like I'll have one normal BM in the morning, then another smaller one, then a third loose one and that is when the pain starts, and it lasts the rest of the day. My insides just feel irritated.

My symptoms started not long after I had a c-section giving birth to my twins and I've always wondered if there might be some sort of correlation? I've tried lots of other tests and treatments and so far nothing has really come up positive or helped too much. I'm waiting on the results of a SIBO breath test right now. Wondering if I should mention adhesions to my physician when I see him next week. He is a functional medicine physician so is a lot more open than the gastroenterologist I used to see.


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## annie7 (Aug 16, 2002)

yes, do mention adhesions when you talk to your doctor.

and yes, surgery--especially open abdominal surgery--can cause adhesions. i had open abdominal surgery--a right hemicolectomy--two years ago. last fall i started to notice a tightness and a "pulling" feeling in my abdomen. not all the time, thankfully, but periodically, especially when i get bloated. i mentioned the possibility of adhesions to both my gastro docs and my new surgeon, and they all agreed that these are some of the symptoms and that yes, i very probably did have them. we'll find out when i have my next surgery (for a different problem) in a few weeks, since my new surgeon will be operating in that same area. fingers crossed my adhesions won't be too bad...

other symptoms of adhesions are pain and also constipation and other bowel problems if they are in the vicinity of your colon. like Airplane said, adhesions can adversely affect any organs or muscles--anything, really-- that they come in contact with. they can really gum things up.

and yes, unfortunately if adhesions are removed, they will just come back all the stronger soon or later....not a good thing.


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## JimLoya (Aug 27, 2015)

A great post. Glad I found it, and glad it was re-visited after a long period of time.

I had open abdominal surgery in 2009 to remove a diseased sigmoid due to chronic diverticulitis. About 18" of colon was removed. About 6 months after the surgery I began having extreme pain all of the time, enough to keep me from doing just about anything but laying in bed. Seemed just the normal functioning of my bowels was the culprit. I was diagnosed with IBS and IBD many years earlier and have been on dicyclomine (bentyl) as long as I can remember. It helped reduce some of the pain, especially post-bowel movement when it was the worst.

After many visits to my surgeon and GI, I was put on vicodin and gabapentin for the severe pain (they originally tried percocet but it made me the walking dead). Adhesions and scar tissue was the diagnosis, but nobody was interested in going back in to rip some of it out, seeing as it would just cause more problems in the long run.

I started practicing yoga with a focus on the gut. It helped, short term. An hour or two of slight relief, but nothing that would return me to a normal quality of life. I visited a chronic pain clinic and was suggested to have PT, specifically myofascial massage. Talk about pain... when they would break an adhesion I came up off the table and groaned like Frankenstein -- but it helped. The pain would settle down after a few hours and it did make a profound difference.

I would suggest looking into this PT, as it did make a difference. I still suffer from chronic gut pain, specifically the lower left quadrant where my surgery was (my descending colon was attached directly to my rectum, so my colon was now shaped like a question mark). I still take vicodin when the pain is unmanagable. I don't suffer from narcotic bowel or OIC -- it actually helps slow down the IBS flare-ups and make them less frequent.

So anyway, consider the myofascial massage. It might make a difference.


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## annie7 (Aug 16, 2002)

oh yes--it can make a difference if the PT is highly trained and really knows what he/she is doing.

but it's tricky. on another health board i read a chilling story from a woman who had myofascial release treatments at a clinic in florida. it was a very intense treatment program and it had helped others but in her case it really made things worse. her adhesions were very strong and were coating her bladder as well as some other organs. the PT pulling and manipulating these adhesions just made them stronger and tore at the woman's bladder, causing more damage. each session left her with a lot of pain. and ultimately, as she put it, all this just made her situation more dire. the doctor she saw afterwards told her that massage was not a safe option for her adhesions..

after reading her story and the responses from others on that thread, i decided not to take the chance. but that's me... i know there are people who say they've been helped by myofascial massage. from what i've read though, if the massage is painful, it's best to stop --just to be safe--because it could be pulling on organs...

but i'm glad that it helped you, Jim--that's wonderful.


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