Ask Doctor K: Abdominal adhesions may cause pain

DEAR DOCTOR K: I had abdominal surgery last year. Soon after, I started experiencing severe pain and swelling in my abdomen. It turns out I have abdominal adhesions. I’d never heard of them. What are they, and how are they treated?

DEAR READER: Abdominal adhesions are bands of fibrous scar tissue. They can cause organs that are normally not connected to stick to one another or to the wall of the abdomen.

In most patients, adhesions do not cause any symptoms. Some are just unlucky: Adhesions form in a location that makes them more likely to pinch and block the intestines.

In any event, the fibrous bands of scar tissue can block the intestines either completely or partially. It can cause cramping abdominal pain. Sometimes an area of intestine alternates between being blocked, then unblocked. As a result, symptoms come and go.

More significant intestinal obstruction can cause:

• Severe, cramping abdominal pain;

• nausea and vomiting;

• swelling of the abdomen;

• inability to pass gas and absent or infrequent bowel movements;

• signs of dehydration. These include dry skin, dry mouth and tongue, severe thirst and infrequent urination.

Rarely, a portion of the bowel twists tightly around a band of adhesions. This cuts off the normal blood supply to the twisted bowel, causing “strangulation.” When this emergency happens, immediate abdominal surgery is required to remove the adhesions and restore blood flow to the bowel.

So surgery is both a cause of, and a treatment for, abdominal adhesions. When surgery is done to remove an intestinal obstruction caused by adhesions, the surgery can cause adhesions to form again and create a new obstruction. Laparoscopic surgery can reduce the risk of abdominal adhesions.

So the surgeon’s decision on whether to perform surgery can be a complicated one. When adhesions are causing strangulation, however, it’s not complicated: Surgery is not only necessary, but often lifesaving.