Symptoms of Adhesions

WHAT ARE THE SYMPTOMS OF ADHESIONS?

Adhesions in the abdomen pull on parts of the intestines and sometimes cause an obstruction.

Symptoms may include:

  • pain
  • cramps
  • intermittent vomiting
  • difficulty with passing gas or having a bowel movement
  • swelling of the abdomen

Symptoms vary depending on the tissues involved.

For example, in the gastrointestinal tract, bowel obstructions may occur.

Mechanical small bowel obstruction after previous surgery can be the most severe effect of adhesions.

In the uterus and in the pelvis, adhesions can cause infertility and other reproductive problems. The adhesions can block the ends of the fallopian tubes causing infertility.

Doctors associate signs and symptoms of adhesions with the problems an adhesion causes rather than from an adhesion directly.

As a result, people experience many complaints based on where an adhesion forms and what it may disrupt.

Typically, adhesions show no symptoms and go undiagnosed. These adhesions cause no problems at that moment , but they can obstruct the intestine in about 2 percent of all patients. These obstructions can occur several years later.

Most commonly, adhesions cause pain by pulling nerves, either within an organ tied down by an adhesion or within the adhesion itself.

  • Adhesions above the liver may cause pain with deep breathing.
  • Intestinal adhesions may cause pain due to obstruction during exercise or when stretching.
  • Adhesions involving the vagina or uterus may cause pain during intercourse.
  • It is important to note that not all pain is caused by adhesions and not all adhesions cause pain.
  • Small bowel obstruction (intestinal blockage) due to adhesions is a surgical emergency.
    • These adhesions trigger waves of cramplike pain in your stomach. This pain, which can last seconds to minutes, often worsens if you eat food, which increases activity of the intestines.
    • Once the pain starts, you may vomit. This often relieves the pain.
    • Your stomach may become tender and progressively bloated.
    • You may hear high-pitched tinkling bowel sounds over your stomach, accompanied by increased gas and loose stools.
    • Fever is usually minimal.
  • Such intestinal blockage can correct itself.

However, you must see your doctor. If the blockage progresses, these conditions may develop:

  • Your bowel stretches further.
  • Pain becomes constant and severe.
  • Bowel sounds disappear.
  • Gas and bowel movements stop.
  • Your belly will grow.
  • Fever may increase.
  • Further progression can tear your intestinal wall and contaminate your abdominal cavity with bowel contents

Intra-abdominal adhesions are usually the result of surgical or gynecologic operations, pelvic inflammatory disease (gonococcal or chlamydial), appendicitis or endometriosis.

Adhesions may be responsible for chronic persistent abdominal pain without associated pelvic pathology.

Though adhesions probably cause pain by entrapment of expansile viscera, the relationship of adhesions to abdominal pain is still controversial.

In contrast, mechanical small bowel obstruction after previous surgery demonstrates unequivocally the most severe effect of adhesions.

Patients with chronic or recurrent abdominal pain and a history of numerous abdominal surgical procedures are often denied treatment if they are not obstructed or symptomatic of intermittent bowel obstruction.

WHAT IS ADHESIONS RELATED DISORDER (ARD)?

Adhesion related disorder is a complex of symptoms related to adhesions.

Patient’s primary complaint is usually chronic abdominal pain.

Their symptoms can be primarily in one area of the abdomen but are often generalized, vague, crampy and difficult to define.

The symptoms of ARD could include:

  • Chronic pain
  • Infertility
  • Bowel obstruction
  • Gastro-esophageal reflux disease, (GERD)
  • Urinary Bladder dysfunction
  • Pain and difficulty having a bowel movement
  • Pain on movement such as: Walking, sitting or laying in certain positions.
  • Loss of Nutrients due to poor eating habits or loss of appetite.
  • Loss of employment due to lost work days
  • Loss of family and social life
  • Emotional Disorders such as: Depression, Thoughts of Suicide, Hopelessness

Other intestinal problems can accompany the pain.

Constipation or obstruction is sometimes encountered.

Alternating constipation with diarrhea from partial obstruction can also be seen.

Symptoms may also be related to the gynecologic orders in women as this disorder frequently affects women.

Changes in the menstrual cycle, infertility, and pain with sexual intercourse can be encountered.

Other symptoms, not directly related to the adhesions, can also be encountered.

Since ARD generally results in chronic problems, anxiety and depression can result.

Strained relationships can occur especially when the disorder affects sexual function.

Difficulty with conception can result.

This further adds to the anxiety and problems with self esteem experienced by women who suffer with this disorder.

Difficulty eating can result in poor nutrition, weakening suffers overall medical condition and can also lead to a decrease in immune function leading to many other illnesses.

Since many of the symptoms related to ARD are vague and wide spread and often include emotional factors, they are often difficult to diagnose.

Symptoms of ARD will often be attributed to other abnormalities.

Patient will often carry multiple diagnoses including chronic fatigue syndrome, endometriosis, irritable bowel syndrome, fibromyalgia, depression, anxiety, along with a whole host of other possible syndromes.

While multiple disorders can certainly exist in one patient, the confusion over which abnormality is truly causing the symptoms adds to the frustration of ARD. This, unfortunately, adds to the discomfort experienced by those who suffer with adhesions.

Undiagnosed chronic pain causes so much physical and emotional pain for victims of adhesion related disorder – and fills their lives with so much indecision.

In time the effects of ARD will begin to affect the lives of their families, their relationships and their jobs. This inordinate control by ARD has the power to erode and change our lives – and not necessarily for the better!

It is so important to believe in yourself, trust the feelings you have about your pain, and tell it like it is. You have the right to be listened to and treated with respect – nothing less!!

HOW DO ADHESIONS CAUSE CHRONIC PELVIC PAIN (CPP) ?

Many women are held captive by a recurring or constant pain in the abdomen. The pain can be intense and sometimes debilitating. It may last for months or even years, leading some women to jump from physician to physician in search of a cure.

Chronic pelvic pain is defined as a pain in the pelvic or lower abdomen area, not related to the menstrual cycle, which persists for six months or more. Because of its vague and inconsistent symptoms, chronic pelvic pain is difficult to diagnose. But it is real, and in most cases it can be treated.

There may be one factor causing the pain or there may be many. If the pain is gynecological, it could be caused by such conditions as pelvic adhesions, endometriosis, or pelvic inflammatory disease.

Adhesions are believed to cause pelvic pain by tethering down organs and tissues, causing traction (pulling) of nerves. Nerve endings may become entrapped within a developing adhesion. If the bowel becomes obstructed, distention will cause pain.

Some patients in whom chronic pelvic pain has lasted more than six months may develop “Chronic Pelvic Pain Syndrome.” In addition to the chronic pain, emotional and behavioral changes appear due to the duration of the pain and its associated stress.

According to the International Pelvic Pain Society:

“We have all been taught from infancy to avoid pain. However, when pain is persistent and there seems to be no remedy, it creates tremendous tension. Most of us think of pain as being a symptom of tissue injury. However, in chronic pelvic pain almost always the tissue injury has ceased but the pain continues. This leads to a very important distinction between chronic pelvic pain and episodes of other pain that we might experience during our life: usually pain is a symptom, but in chronic pelvic pain, pain becomes the disease.”

Chronic pelvic pain is estimated to affect nearly 15% of women between 18 and 50 (Mathias et al., 1996).

Other estimates arrive at between 200,000 and 2 million women in the United States (Paul, 1998).

The economic effects are also quite staggering. In a survey of households, Mathias et al. (1996) estimated that direct medical costs for outpatient visits for chronic pelvic pain for the U.S. population of women aged 18-50 years are $881.5 million per year. Among 548 employed respondents, 15% reported time lost from paid work and 45% reported reduced work productivity.

Not all ADHESIONS cause pain, and not all pain is caused by ADHESIONS.

Not all surgeons, particularly general surgeons, agree that adhesions cause pain.

Part of the problem seems to be that it is not easy to observe ADHESIONS non invasively, for example with MRI or CT scans.

However, several studies do describe the relationship between pain and adhesions.

According to an early study (Rosenthal et al., 1984) of patients reporting CPP, about 40% have adhesions only, and another 17% have endometriosis (with or without adhesions).

Kresch et al., (1984) also studied 100 women and found ADHESIONS in 38% of the cases and endometriosis in another 32%.

Overall estimates (Howard, 1993) of the percentage of patients with CPP and ADHESIONS is about 25%, with endometriosis accounting for another 28%. These figures must be understood in their context.

It is important to recognize that emotional stress contributes greatly to the patients perception of pain and her/his ability to deal with the pain.

Rosenthal et al. (1984) found that of the patients in whom a possible physical cause of pain (including ADHESIONS) could be identified, 75% had evidence of psychological influences on the pain.

Because pelvic pain can be caused by a myriad of disorders, it is important to find a doctor who is sensitive to your needs and willing to take the time to solve the problem. Don’t let anyone dismiss it as being ” all in your head.”. The solution may require time and energy, but most causes of pelvic pain can be treated successfully.”