HEALTH ADHESIONS AND BLOCKAGES

Adhesions and Blockages what are they...and how they may affect you

Jeanette Berry CNS Stoma Care Epsom General Hospital Surrey

What are adhesions? What causes abdominal Signs and symptoms may include:- adhesions? • Severe abdominal pain or cramping Abdominal adhesions Abdominal adhesions are most • Abdominal distention are bands of tissue commonly caused after abdominal • Vomiting surgery by unavoidable handling of • Loud bowel sounds that form attachments organs. It has been shown that • Inability to pass flatus between abdominal adhesions that form after surgery are • Constipation tissues and organs a result of the body’s normal healing process and that they develop during A person with these symptoms rather like an the first three to five days. Almost should seek medical advice internal scar. everybody who undergoes abdominal immediately. surgery develops adhesions, however the risk is greater after lower How are abdominal adhesion Normally internal abdominal and pelvic operations, and obstruction diagnosed? tissues and organs including bowel and gynaecological No tests are available to diagnose surgery. They may become larger and adhesions, and they cannot be seen have slippery surfaces, tighter as time passes, causing through imaging techniques such as which allow them problems years after surgery. x-ray or an ultra sound scan. Most adhesions are found during to shift easily as the Adhesions that form after surgery are exploratory surgery. An intestinal body moves. Adhesions a result of the body’s normal healing obstruction, however, can be seen cause tissues and process. A less common cause is through abdominal x-ray, barium and inflammation from sources not contrast studies and computerised organs to stick together. related to surgery i.e. abdominal, tomography. This results in an gynaecological infections and radiation treatment for cancer. How are they treated? abnormal bond It is not unusual for several organs to Treatment for abdominal adhesions is between two parts be adhered to each other causing not usually necessary, as most do not of the body. traction or pulling of nerves. Nerve cause problems. Surgery is currently endings may also become entrapped the only way to break adhesions that within a developing adhesion causing cause pain, intestinal obstruction, or Adhesions may severe pain. fertility problems. More surgery, however, carries the risk of additional cause chronic How do they cause adhesions and is avoided when abdominal pain an obstruction? possible. A complete intestinal and pelvic pain. They Small bowel obstruction is a obstruction usually requires significant consequence of post immediate surgery. A partial are also a major surgical adhesions. The adhesions can obstruction can sometimes be cause of intestinal kink, twist or pull the intestine out of relieved with a liquid or low residue place and prevent the flow of content diet. A low residue diet is high in obstruction (blockage) through the digestive tract. A small dairy products, low in fibre and more and female infertility. bowel obstruction can occur 20 years easily broken down into smaller or more after the initial surgery. A particles by the digestive system. complete obstruction is life threatening and requires medical Can abdominal adhesions be attention and often surgery. prevented? Abdominal adhesions are difficult to What are the signs and prevent, however surgical techniques symptoms of abdominal can minimise adhesions. Laparoscopic adhesions? surgery avoids opening the abdominal Although most abdominal adhesions wall with a long incision. Instead the go unnoticed the most common abdomen is inflated with gas whilst symptom is chronic abdominal or special surgical instruments and a pelvic pain. It may mimic other video camera are threaded through a conditions such as diverticulitis and few small abdominal incisions. appendicitis. Inflating the abdomen gives the

4 2 | TIDINGS | WINTER2010 surgeon room to operate. A film like regular times. Balance your diet and References: material has been clinically trialed eat fruit and vegetables, avoiding only The UK Adhesion Society and has been shown to reduce foods known to cause excessive http:/www.adhesions.org.uk adhesion formation when, if a large unwanted reactions. National Institute of Diabetic and incision is required, it is inserted Digestive Diseases between organs or between organs Your stoma care nurse can give and abdominal incisions. It looks you the appropriate advice to and Kidney Diseases similar to wax paper and is absorbed meet your dietary needs. The www.digestive.niddk.nih.gov by the body in about a week. Other Colostomy Association have a steps taken during surgery to reduce leaflet available entitled adhesions are using starch and latex “Healthy Eating”. free gloves, handling tissue and organs gently, shortening surgery time To avoid blockages follow the and not allowing tissues to dry out. guidance above. Eat regularly, have plenty of fruit and vegetables, take How to avoid blockages regular exercise and drink plenty of Editors Comment The output and consistency from your fluids especially in hot weather, stoma may depend on the position of approximately two and a half litres of If you would like share your your stoma on your large bowel. After water a day if you are able to. Avoid experiences with Jan surgery good nutrition is necessary for carbonated and caffeine based drinks. contact the editor healing as the body needs more To lessen wind try fruit and e-mail: calories and protein. You need to eat peppermint tea, non-alcohol based [email protected] a variety of foods to ensure that you drinks but if you had problems with or write to: get the right balance. Initially some wind before surgery this will not people experience excessive wind; change after. However it is important Colostomy Association this is normal and can take time to to be aware that you can still become 2 London Court East Street settle down. During this time certain constipated or experience diarrhoea. Reading RG1 4QL foods should be introduced more It is important to remember that or email: gradually to your diet, as eating eating should be a pleasure! [email protected] sensibly with a stoma is important to or telephone: encourage regular bowel function. If you are concerned about 0118 939 1537 Remember eat in a relaxed blockages, diet or any of the atmosphere and at regular times. issues mentioned in this article Don’t eat and drink at the same time please discuss them with your as this may cause wind. Enjoy small stoma nurse. meals and eat little and often at

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