adhesions after colorectal surgery

Adhesions........

You want the good news first or the bad news first? Bad?

The bad news is: there is no good news. (that was easy)

Adhesions are formed as a result of the body's normal healing process. It's like a scab, or callous, only it's internal instead of where you can see it.

There are procedures and products that a surgeon can use during surgery to keep the instances of adhesions to a minimum. After surgery? Good luck. There is nothing that can prevent an adhesion from forming and the only way to remove an adhesion is via surgery. And...... abdominal surgery causes more adhesions. It's a no win situation.

Some individuals (like me) are more prone to the formation of adhesions than others. For other individuals, intestinal adhesions never seem to be a problem. Go figure? Maybe DNA/genetics, or sheer luck? Or maybe the surgeon handled the organs more delicately; smaller hands, not as clumsy? Or perhaps used surgical products designed to keep adhesions to a minimum.....

An adhesion forms to help protect the scuffed, damaged, or bruised organ. Unfortunately, the protective formation involves the surfaces of the organ(s), often causing them to stick (adhere) together. And an adhesion can form around the organ (intestine) like a rubber band, tightening over time until it totally chokes the flow going through the intestine.

Some adhesions will cause the intestine to stick (adhere) to another organ. Since the intestine was designed to flex and twist as necessary for the movement of the food product to easily pass through, any restriction of it's ability to flex and move can cause a blockage of it's internal contents.

So:
1. There is no "cure" other than surgery for an adhesion that's formed.
2. Abdominal surgery is the cause of most adhesions.
3. Surgery to remove an abdominal adhesion almost always results in new adhesions.
4. Limiting your diet is not the answer; what you eat isn't the cause.

But....... If you have an Ostomy, you should have been told the most important rule for survival: Chew your food well. You can eat anything you feel like, but chew the hell out of it.

The formation of the stoma, and the intestine's new 90 degree angle for exit can be a problem for bulky un-chewed items. A solid section of broccoli stem may have a difficult time making that 90 degree turn to get out of your body. (hello blockage) Chew well, pulverize the food, and life shall be good. Some things, like nuts and fiber, do not dissolve in our system. Too much at once could be a problem, causing a "log jam". Even more so, if it's not chewed into a powder or gravy consistency. CHEW WELL.

The Ostomy's 90 degree exit is a problem that we can deal with; there are ways to clear an obstruction at the stoma if/when it occurs. But we can't see or get to an adhesion that's formed deep inside us, making it very difficult, if not impossible to clear something that's blocking the path of flow inside the intestine.

If you have a blockage, you may feel nauseated, bloated, experience great abdominal pain, have a fever, feel lethargic....etc. A trip to the ER should be planned ASAP, since a ruptured intestine is quite possible if the blockage isn't resolved. They will take an x-ray, scans, and usually a sonogram in an attempt to diagnose the reason for your discomfort. They may insert an "NG" tube (we call it a "NFG" tube, and you will also after your first experience). The NG tube goes in via your nostril, down the back of your neck and into your stomach. It will allow intestinal gas to escape and relieve much of the pain.

Prior to the period of sheer panic before calling for the ambulance, you can try drinking hot water and massaging the area where there is the most internal pressure. Laying on your left side often helps the food product move through the intestine easier. (that's the advice often given to pregnant women to help relieve constipation; left side down helps movement). But if the pain is severe, go to the ER. Going by ambulance will get you in quicker. Good to know, unless you enjoy sitting for three hours in the lobby.

It is important to have a good, well experiences colorectal surgeon at your call. Make an appointment with one and explain that if/when you need a surgeon, you want it to be with him/her. And it's a good idea to have a gastroenterologist in your pocket as well. It's better to have physicians you know and trust, than to have one appointed to your case in an emergency situation.

About the "pain"?.  If you have a blockage, taking something for pain is not going to help matters. Pain meds slow your digestive tract. You're already suffering from stopped movement, don't add to the problem. And taking the pain away does not resolve the problem causing the pain.

If you have adhesions that are causing problems as you have described, it would be in your best interests to locate a well experienced colorectal surgeon and gastroenterologist ASAP.

The only resolve is via surgery. It is not something you can treat. The adhesion will continue to be a problem if it is not surgically removed, and eventually will result in a total, life-threatening intestinal blockage.

Get the help you need now, before it gets worse.

My best hopes for you.

John