FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

SURGERY -- BOTH CAUSE AND SOMETIMES TREATMENT FOR ADHESIONS

Question: Recently I've been having abdominal pain, cramping and some diarrhea. I underwent a colon X-ray, CT scan and other tests to identify the cause of my problems. My doctor tells me that adhesions resulting from my abdominal surgery about seven years ago are responsible for the pain I experience. I hope you can tell me what an adhesion is, why it happens, why it hurts and how long after surgery it can occur?

Answer: I think the simplest answer to "what an adhesion is" can be taken from my American Heritage Dictionary that defines it as: "A condition in which bodily tissues that are normally separate grow together." But I think it will take a bit more information to answer the "why" part of your question.

First, adhesions are a fairly common consequence of surgery done on any of the abdominal organs. The organs that are part of the digestive system -- the stomach, small intestine and large intestine (also called the colon) -- fill most of the abdomen and are most commonly involved in adhesions. Of course, the pancreas, liver, kidneys, urinary bladder, female reproductive organs and others are also present in the abdomen, but these organs are less frequently involved.

Adhesions are a consequence of the healing that follows surgical injury to organs. As an example, the colon may be "surgically injured" to remove a section that is damaged by ulcerative colitis or by colon cancer. The remaining good portions of the colon are then sewn back together. As the wound heals, the part of the colon that has been operated upon can become attached to the side of a section of the small intestine that lies against it. As healing continues, the two areas of intestine grow together and become firmly attached to each other -- thus becoming an adhesion.

The digestive tract normally wiggles, squirms and generally moves as it goes about its business of turning the food we eat into either the nutrients we need or into the waste we eliminate. Because, continuing with my example, one section of the small intestine has formed an adhesion with an area of the colon, both will be prevented from moving normally. In some cases, the tough, fibrous bands of tissue that form adhesions may even encircle a section of the colon or small intestine and, thereby, limit the diameter of material that can pass through. This disturbance in normal motion and function is the underlying cause of your abdominal pain and diarrhea.

Abdominal pain is a common symptom when there are adhesions involving abdominal organs. Both U.S. and German studies have found that in 70 to 80 percent women with abdominal and pelvic pain of undefined cause adhesions were to blame. Surgical removal of the adhesions was effective at providing relief from the pain for a period of one year or longer in only 49 to 58 percent of the individuals.
However, to put it in perspective, these results are really quite good. Remember surgery caused the original problem. So, it’s not surprising that surgery to remove the adhesions can sometimes provide an opportunity for more adhesions to form. But at times, the problems from adhesions are so severe that surgery to remove them is still the best choice.

Adhesions form during the healing process after abdominal surgery or other abdominal injury. However, problems from adhesions may not become apparent for many years because the tissue in your digestive organs is relatively supple and can compensate for the abnormalities in motion and function produced by the adhesions. However, as you get older this tissue becomes less resilient and pain begins. This is why your abdominal pain started fairly recently, even though you had the surgery that produced these adhesions seven years ago. Now, you and your surgeon will need to decide if your symptoms are sufficiently severe to warrant another surgery.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.