Scars that strangle

Readers of this post may well know what adhesions are, but just to be sure, let’s start at the very beginning…

What are adhesions?

Adhesions are bands and webs of tough, fibrous and inelastic scar tissue which develop after tissue damage resulting from injury, surgery, an internal infection, endometriosis, some chemotherapy, or radiation therapy.  They can affect the functioning of muscles, joints, and ligaments, but cause most problems in the abdomen and chest where they can grow between our organs and the abdominal wall, or restrict the movement and work of our organs, causing pain and possibly restricting their function.

Adhesiolysis01.jpgAbout 10% of all people develop adhesions naturally (without surgical or other damage), but it is estimated that they occur in over 90% of people who have abdominal or chest surgery – which means many of us! So we may be thankful that they cause significant problems for only a minority – but that’s small comfort if you belong to that minority.

These problems range from unsightly sunken scars and pain to life-threatening abdominal blockages.  Adhesions cause 60 – 70% of small (upper) bowel obstructions in adults and can be the cause of chronic pelvic pain.

Some of us who have had infant surgery for infant pyloric stenosis, or for that matter any of a list of the diseases of the abdomen and chest may find thatadhesions are one of the long-term consequences, and parents are not always told about the long-term risks of their child’s surgery.  Sometimes adhesions appear after only a few years and sometimes they take a decade or more to develop, but we can be thankful that often they cause no trouble.  Scar tightness and pain and unexplained abdominal discomfort, irregularity and pain are possible symptoms.

How do I deal with adhesions?

Sadly, if you have been unlucky enough to develop troublesome adhesions, any surgery to deal with them is more likely to trigger the growth of more adhesions than to bring lasting relief. It’s a bit like scratching the scab covering a wound: it will set you up for a worse scab… except that adhesions do not eventually disappear like scabs do!

If your adhesions choke the bowel, this may well show on x-rays, but because our bowels are in constant motion the blockages are usually temporary and happen anywhere, making them hard to pick up on one x-ray or an ultrasound session.

So it won’t surprise that many doctors don’t want to know about adhesions.  They are easy to suspect, but hard to diagnose and almost impossible to remedy.

There are several possible ways of dealing with adhesions, none of them a sure fix, and thus treatment may be a waste of money and a recipe for even more trouble.  The most immediately obvious and radical remedy (having them removed) is quite likely to worsen your discomfort – and probably more in the medium to long term. Various shields and preventative treatments are being used to reduce the chance of troublesome adhesions forming – but if you are already battling this menace it’s unlikely you are going to risk having more surgery unless it’s unavoidable.

However, blocked bowels and associated pain and troubles can become impossible to live with, so that some of us will need to choose surgery and hope for at least temporary relief.

Expect to find that many GPs are unwilling to listen to your adhesions woes and refer you for diagnostic tests.  Doctors prefer to eliminate all other possible causes of pain before they consider and investigate adhesions. Most will wear you out with a list of other possible diagnoses and tests!  Finding a GI specialist who’s willing to work on this may be a rare find!

If we can avoid surgery . . .

What can we do to live with adhesions while avoiding the knife?

  • Learning what foods work best for you should be the first stop.  It’s worthwhile for many kinds of abdominal and digestive discomfort, including reflux and IBS.
  • Adhesions - yoga01
    Yoga or just stretching exercises and massage help some people

    Electric heating pads, hot baths and lots of swimming or other whole-body exercise can be really good to relieve pain and keep things moving.

  • Strong pain killers are a whole other issue, and you have problems from them too, so try and avoid them but sometimes you may have to resort to using them.
  • Simple self-massage or careful and honest professional massage to relieve the disruption caused by adhesions is another help: there’s some info on this on the web, for example at this Massage Today site.
    Be very wary of surgeons who claim they can remove adhesions for good, and of masseurs who promise to “break up” your adhesions.

How your doctor sees the problem

Some people have had several surgical operations to remedy adhesions.  Research tends to show that surgery to relieve adhesions is not more often successful than the non-surgical kind of remedies listed above.

The problem, says Dutch laparoscopic surgeon Dingeman Swank, MD, is that the rate of serious complications with the scar removal surgery is relatively high: the patients who have it appear to fare no better than those who have diagnostic laparoscopy (a look via a keyhole to see what is wrong) without the actual removal of abdominal adhesions.

“We are not saying that diagnostic surgery should not be done, because in 5% to 7% of patients, causes for pain other than adhesions can be found and successfully treated,” Swank tells WebMD.  “But removing adhesions offers no benefits for patients.”

Some practical considerations are –

  1. Avoid abdominal surgery if at all possible.  Most surgeons will urge parents of infants with an abdominal problem to consent to surgery, which is quick (and lucrative).  However, conditions like infant pyloric stenosis in most cases can be managed with lower risks and costs (but taking longer) by medical drug treatment (… and yes, the statistics show this).
  2. Find a surgeon who is known for skilful and successful work. Small incisions, minimal organ handling, and careful wound repair are essential to reduce the risk of later problems.
  3. Or ask your doctor to refer you to a skilled surgeon – one she or he would ask to work on his or her body!
  4. Assess your surgeon’s ability to talk about the professional standards for surgery that keeps the area worked on free of excessive damage and contamination.
  5. Ask your surgeon to give you a drug that inhibits adhesions.
  6. Ensure that your surgeon uses synthetic material to inhibit adhesion formation inside the body.

I want to recommend the best web forum I have found that is devoted to this subject: MedHelp’s Abdominal Adhesions User Group.  By following this link you’ll be able to read what a good selection of people with problem adhesions have experienced, tried, and sometimes found helpful.  Reading through these sites will also encourage those afflicted by adhesions to try the generally agreed on management (notably, a good diet and pain management) and also to try some of the less agreed-on recommendations (for example, physiotherapy and herbal medicine).

For more detailed information, check out websites such as –

http://www.ehow.com/how_4451464_prevent-abdominal-adhesions.html

http://www.laparoscopytoday.com/2004/01/when_to_operate.html

http://www.laparoscopyhospital.com/laparoscopy_and_postoperative_adhesion.htm

http://postoperativeadhesions.elsevier.com/ – a free website with downloads about adhesions

Below are several posts (with embedded links) that I have written about adhesions on my related blog, Surviving Infant Surgery

Blog # 12 – 3 March 2011 – Scars that strangle (2) – Kathryn’s story

Blog # 29 – 23 June 2011 – Scars that Strangle (4) – Adhesions and Pregnancy

Blog # 97 – 27 September 2012 – Adhesions (1) – unhappy ties that bind – (more personal stories)

Blog # 98 – 4 October 2012 – Adhesions (2) – Does surgery help? – (and why it usually does not)

Blog # 119 – 20 February 2013 – Adhesions – what helps, what doesn’t? – (personal stories)

Blog # 122 –18 March 2013 – Help with adhesions – (a professional’s suggestion)

Blog # 162 – 3 January 2014 – Adhesions and Pregnancy – (again)

Blog # 183 – 5 June 2014  Networking after pyloric stenosis: Adhesions – (personal stories)

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Author: Fred Vanderbom

A stable upbringing in a Christian home, a long and happy marriage and family life, a lifetime of productive and steady work in close touch with many people - and with the God our world can know through Jesus Christ, many good and shaping experiences - I believe I've been very privileged. By some blogging and other work in retirement I am enjoying being able to offer some of what I've learnt for those interested. Your comments are always welcome.

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