Scars that strangle (1) – adhesions

Many of us have a scar from abdominal surgery or damage. If so, you know what scar tissue is like: whitish, almost bloodless and as tough as leather.  Our bodies know how to do a thorough repair job.  But what we see and feel on the skin is often only the harmless part.

Do you suffer from chronic abdominal pain? Many people do, and scar tissue in the abdomen is an all-too-frequent cause.

Almost all surgery (but especially work done inside the abdominal cavity) results in a web of scar tissue called “adhesions” that develops below the visible scar. These scars develop out of our sight, below the wound as it heals, from tissue that was damaged. They often form a web between the healed incision and internal abdominal organs, but they can even develop between these structures. Like the scars we can see and feel as white, hard and lumpy, these hidden adhesions consist of very dense and strong fibrous tissue that can sometimes be felt beneath a deep scar.

This illustration from the website of “Clear Passage”, a clinic that treats adhesions by massage and physiotherapy, shows very clearly what adhesions are and why they can cause great grief. Read more at this link.

Adhesions develop as the body works to repair itself. This will occur after surgery, infection, trauma, radiation, or resulting from conditions like endometriosis. The body’s repair cells cannot tell the difference between one organ and another. If an organ that has to repair itself comes into contact with another part of itself, or another organ, scar tissue may form to connect the two surfaces. Adhesions can also form when abdominal organs are damaged by handling or drying in fresh air, or from the carbon dioxide gas commonly used in keyhole surgery to create clear space for the surgeon to work.

Although adhesions begin to form immediately after surgery, they usually do not produce symptoms for months or even years. Scar tissue begins to restrict the working of the small intestines and it becomes more difficult for food to pass through the digestive system. The liver and its ducts are also affected sometimes after upper abdominal surgery such as the relief of infant pyloric stenosis.

Doctors prefer to eliminate all other possible causes of pain before they consider and investigate adhesions. This is because surgery to remove adhesions will in time almost inevitably cause new scar material to develop – and quite possibly more trouble. 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 non-surgical remedies.

About 10% of all people develop adhesions naturally (without surgical or other damage), but it is estimated they occur in over 90% of people who have abdominal or chest surgery or radiation therapy.

We can be thankful that most adhesions are painless and cause little or no trouble. However, they cause 60 – 70% of small (upper) bowel obstructions in adults and can be the cause of chronic pelvic pain.

My interest in infant surgery and my own experience with pyloric stenosis surgery has led to my discovering that many, many of us who have had infant surgery have trouble with adhesions later in life.

Adhesions are just one reason why it’s well worth new parents knowing something about whether there are responsible alternatives to submitting your little one for surgery.

In my next few blogs I want to pass on some of what I have learnt about adhesions, both from the web and from those who have suffered with them. I am grateful to have had no significant trouble myself with adhesions.

Next time: I had infant surgery, I now suspect I have trouble with adhesions! What options do I have?

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