What causes adhesions after surgery. Treatment of adhesions after surgery

Organs abdominal cavity most often subject to adhesions. In most cases, the formation of adhesions is associated with previous operations. Let us consider in more detail what intestinal adhesions are, for what reasons they are formed and by what methods they are treated.

Intestinal adhesions are formations of connective tissue (strands) between the abdominal organs and intestinal loops, leading to fusion or gluing of the serous membranes of the organs to each other. The adhesion process contributes natural feature peritoneum to adhesion (adhesion).

As you know, the peritoneum is a thin film that envelops internal organs. If for some reason an inflammatory focus is formed in the abdominal cavity, the film of the peritoneum, as it were, sticks to the inflamed area and prevents the pathological process from spreading to other organs.

But this useful protective function has another side. Sometimes the adhesion process can go too intensively, which leads to dysfunction and deformation of the organs enclosed in such a peritoneal membrane. Can be pinched blood vessels, often there is a narrowing of the intestine due to the compression of its walls by adhesions.

Why do intestinal adhesions form?

Doctors identify several main reasons leading to the formation of adhesions:

Doctors recognize that surgical operations are the most common cause of adhesion formation. According to statistics, they are formed in 15% of patients, and the more severe and voluminous the surgical intervention, the greater the risk of formation of adhesions between the internal organs.

Since the formation of adhesions is a rather long process, its symptoms do not appear immediately. Sometimes the pathological process does not manifest itself in any way and is discovered by chance during the examination. This causes patients to seek medical assistance already with a complicated adhesive process. So, what are its main symptoms:

• Periodically arising pulling pains, which are localized in the area of ​​the postoperative scar. Pain may worsen after physical exertion, especially associated with sharp turns trunk and weight lifting.
• Dysfunction in the work of the gastrointestinal tract, expressed in bloating, a tendency to constipation, a feeling of fullness in the navel.
• Violation of the act of defecation, which manifests itself in persistent constipation. This is due to a slowdown in the patency of the intestinal contents through the areas pinched by adhesions.
• Nausea and vomiting may occur after eating.
• In the chronic course of the process, the patient may experience weight loss.

In some cases, serious complications may occur that pose a threat to the life of the patient and require immediate surgical intervention.

Diagnostics

Typical complaints of pain and intestinal disorders help to suspect an adhesive process in a patient. The doctor should conduct a thorough examination and question the patient about the nature of the pain, clarify whether there have been surgical interventions or abdominal injuries in the past. After a digital examination of the rectum, the patient is assigned laboratory tests and instrumental examinations.

Treatment of intestinal adhesions

Treatment adhesive process carried out by conservative methods, folk remedies and through surgery.

Treatment with conservative methods

In about half of the cases, when diagnosing an adhesive process, it is possible to do without surgical intervention, using conservative methods treatment in conjunction with traditional medicine and a special diet. If adhesions do not manifest themselves in any way and there is no pain syndrome, special treatment is not required. Enough observation and preventive examinations of the doctor.

With minor pain and minor functional disorders, the patient is prescribed antispasmodics and analgesics. The doctor may prescribe enzyme injections, vitreous body, preparations of aloe, splenin, contributing to the partial resorption of adhesions. For chronic constipation, it is necessary to take laxatives prescribed by your doctor.

Diet and proper nutrition for intestinal adhesions

If you suspect an adhesive process, you must follow a special diet. In no case is it recommended to starve or overeat, this can lead to an aggravation of the problem and the development of complications. It is highly desirable to observe the regimen and eat at certain hours.

Food should be fractional, in small portions, you need to eat 4-5 times a day. Heavy and fatty foods, foods rich in fiber and provoking flatulence and bloating are excluded from the diet. These include:

• legumes,
• cabbage,
• grape,
• radish,
• corn,
• radish,
• turnip.

It is not recommended to consume whole milk, any carbonated drinks, spicy seasonings, sauces. The menu should include foods containing calcium, eat more cheese and cottage cheese. Fermented milk products, especially kefir, are very useful. They help move the contents through the intestines.

It is better to drink kefir at night, it must be fresh, since three-day kefir, on the contrary, has a fixing effect. Food should not be hot or cold, it should be taken warm. This will help relieve intestinal spasm.

Patients with adhesive disease can eat:

• low fat broths
• steam or boiled fish,
• soft-boiled eggs or in the form of an omelet,
• boiled chicken meat,
• butter in a in large numbers.

The patient must refuse marinades, smoked meats, hot spices, canned food. Compliance with such a diet helps prevent exacerbations of the disease and serves as a kind of prevention of the adhesive process.

Surgical treatment: removal of adhesions through surgery

If the doctor suspects that the patient has a violation of the blood supply to the intestine due to the adhesive process, the operation should be carried out immediately. Surgical intervention will be aimed at removing obstructions and restoring the normal passage of intestinal contents. The essence of the operations is reduced to the dissection of adhesions, for which two types of operations are used: through the incision of the peritoneum and a minimally invasive laparoscopic operation.

The main problem of the surgical treatment of the adhesive process is the fact that any abdominal operation can again cause the formation of adhesions. Therefore, they try to carry out operations with minimal trauma: adhesions are separated with an electric knife or a laser. Another way is hydraulic compression of adhesions and the introduction of a special liquid under pressure into the connective tissue.

To date, two types of surgical intervention are used to remove adhesions:

1. Laparoscopy. A low-traumatic, sparing operation, during which a fiber-optic tube with a miniature camera and lighting is inserted through a puncture in the abdominal cavity. Through two additional incisions, manipulators with a surgical instrument are carried out, allowing, under the supervision of a camera, to dissect adhesions and cauterize blood vessels. After such a procedure, the patient quickly recovers and can return to normal life in a week.
2. Laparotomy. This method is used in the presence of a large number of adhesions. The operation is performed through an incision in the anterior abdominal wall, about 15 cm long, which allows you to get extensive access to the internal organs.

When choosing the tactics of surgical treatment, the doctor must take into account many factors. The first is the age of the patient. Elderly people are trying to carry out a sparing laparoscopic operation. Accompanying pathologies play an important role. For example, if a patient has problems with the heart or blood vessels, this may be a contraindication to surgery.

The choice of tactics crucial renders the number of adhesions. If a patient has single adhesions, a laparoscopic operation is indicated; if there are a large number of adhesions, surgery with a median incision of the peritoneum will be required.

Postoperative period

AT postoperative period important point is to provide the intestines with functional rest until the wounds are completely healed. This is ensured by refusing food on the first day after the operation. The patient is allowed to take only liquid.

On the second-third a day you can gradually, in small portions, take liquid food: dietary broths, liquid pureed cereals and liquid vegetable purees. In addition to water, you can drink herbal decoctions, diluted juices. As the patient's condition improves, you can gradually switch to the next nutritional option.

A week after the operation to remove adhesions, foods of a denser consistency begin to be added to the diet. The patient's diet should be complete and contain all the necessary nutrients, vitamins and minerals necessary for speedy recovery health. But the diet still remains sparing, the food is pre-crushed, wiped, the food is steamed or boiled.

At this time, protein-rich foods are useful - eggs, boiled lean meat or fish, vegetable puree from carrots, beets, grated apples. It is recommended to use fermented milk products (kefir, yogurt). To avoid irritation of the intestinal mucosa, food must be thermally processed. You can drink plenty of fluids:

So that fresh juices do not irritate the intestines, they are diluted with water. Under no circumstances should you drink unboiled chlorinated tap water.

After an operation of this kind, the intake of alcohol, strong coffee, and chocolate is categorically excluded. The diet should not contain flour, confectionery, smoked meats, salty, spicy, spicy, fatty and fried foods. Compliance with such a diet will allow the patient to quickly recover and soon return to a full life.

Treatment of intestinal adhesions folk remedies

Alternative methods for the treatment of adhesions can be used only after consultation with the attending physician and in cases where the disease is mild. Most often, traditional healers advise taking herbal decoctions:

Folk recipes should be treated with caution. In case of deterioration of health or appearance adverse symptoms need to seek medical attention as soon as possible.

Prevention of intestinal adhesions

In order to prevent the development of adhesions in the intestines, it is necessary to avoid food poisoning and any inflammatory processes abdominal organs. After surgical operations, it is necessary to follow the recommendations of the doctor, and already on the second day, try to turn from side to side.

This will help prevent adhesions. It is useful to perform deep exhalations and inhalations, tilts and turns of the body, if these exercises do not worsen the patient's condition and do not interfere with the healing of postoperative wounds.

It is equally important to choose proper diet and follow a diet, eating often and in small portions. It is necessary to monitor the proper functioning of the gastrointestinal tract,. Keeping an active lifestyle is helpful in preventing adhesions, but strenuous exercise should be avoided. By adhering to these recommendations, you will protect yourself from the occurrence of adhesions and will live a healthy and fulfilling life.

The organs of the abdominal cavity, according to experts, are more susceptible to the development of the adhesive process. As a rule, the formation of such a pathology is associated with previous operations. In this article, you can find out what intestinal adhesions are. The symptoms and treatment of this problem will also be discussed.

general information

Intestinal adhesions are formations of connective tissue, localized mainly between the abdominal organs and directly intestinal loops and leading to a gradual fusion of the serous membranes. The development of such a pathology is facilitated by the natural tendency of the peritoneum to the adhesion process.

The peritoneum itself is formed from a thin film that literally envelops all the internal organs. If, due to any reason, an inflammatory process begins to develop in this area, the film sticks to its focus, thereby preventing the further spread of the pathology to other organs.

Sometimes adhesion is excessively intense, which provokes a violation of the primary functions of the organs enclosed in the peritoneal membrane and their deformation. As a result, blood vessels are pinched, the intestine itself gradually narrows due to constant compression by adhesions.

Such formations, by their nature, can be congenital and acquired (formed as a result of injuries or during an inflammatory process).

The reasons

• Open and closed mechanical injuries of the abdomen.
• genetic predisposition. Increased synthesis of enzymes provokes the growth of connective tissue. Even with minor damage to epithelial cells, intestinal adhesions can form.
• The causes of pathology in the fair sex often lie in inflammatory diseases of the internal genital organs (appendages, ovaries).
• Inflammatory and infectious processes in the abdominal cavity (for example, acute appendicitis, peritonitis, stomach ulcer).
• Radiation therapy used in the treatment of cancer.

Intestinal adhesions after surgery

According to experts, most often a pathology of this nature develops after surgical procedures. Adhesions are reported to form in approximately 15% of patients. Note that the heavier and more voluminous the intervention, the higher the risk of adhesions.

The mechanism of development of pathology

The abdominal cavity is lined from the inside with a special film, which has two sides (visceral and parietal). The first is the outer shell of the organs. It can cover both the entire organ and some part of it. The parietal lining the wall of the abdominal cavity. Due to its smooth texture, the internal organs are in contact with each other and simultaneously with the parietal peritoneum.

If, for any reason, an inflammatory focus begins to form from the peritoneum, connective tissue is actively formed in this area, which in its structure resembles well-known scars, and these are adhesions.

Clinical picture

What are the symptoms of intestinal adhesions? Symptoms and treatment of this pathology are described in as much detail as possible in a specialized medical literature. Since adhesions form gradually, primary signs do not occur immediately. As a rule, patients seek help already at the stage of development of complications. Below we list the main symptoms by which we can judge the presence of adhesions in the intestine.

• Nagging pain. Sometimes this kind of discomfort does not bother the patient for a sufficiently long period of time. Pain is usually localized at the site of postoperative scars and only intensifies after intense exercise.
• Digestive disorders (diarrhea/constipation, bloating, bloating in the navel, vomiting and nausea) very often accompany this pathology.
• Intestinal obstruction. Treatment is required if the patient has no stool for two days or more. Inattention to one's own health can be fatal.
• In the chronic course of the pathology, the patient may experience unreasonable weight loss.

Possible Complications

Intestinal adhesions can lead to the development of quite serious complications that already require immediate surgical intervention. These include the following:

1. Necrosis of part of the intestine. This is the necrosis of the walls of the organ as a result of a violation of the normal blood supply. This condition necessarily requires resection of the intestine, that is, the removal of the affected part of it.
2. Acute intestinal obstruction. Treatment in this case implies immediate surgical intervention. This is the most common complication of adhesions, occurs due to squeezing of the intestine and is manifested by the absence of stool for several days.

Diagnostics

The doctor should first of all examine the patient, collect a complete history, clarify the presence of recent surgical interventions. Then a number of additional laboratory tests are already assigned.

• Clinical blood test. With it, you can determine the presence of an inflammatory process by increasing the number of leukocytes.
• X-ray of the intestine using a contrast agent.
• Laparoscopic diagnostics. During the procedure, the doctor inserts a fiber optic tube with a flashlight and a camera at the end into the abdominal cavity. It provides an opportunity to study the state of the loops in as much detail as possible and determine the presence of formations. Laparoscopy of intestinal adhesions is sometimes prescribed for medicinal purposes.
• Colonoscopy. During the procedure in anus the patient is introduced a special device through which you can examine in detail the state of the intestine.

Conservative treatment

How to treat intestinal adhesions? In approximately 50% of cases, with the timely diagnosis of such a pathological process, it is possible to avoid surgery by using conservative treatment options, coupled with traditional medicine and following a special diet. If the pathology does not manifest itself in any way, special therapy not required. Prophylactic observation and regular examination by a specialist is enough.

With minor pain and functional disorders, the patient is prescribed antispasmodics ("No-shpa", "Drotaverin") and analgesics ("Ketanov", "Analgin"). In case of chronic constipation, it is recommended to take laxatives. They can only be prescribed by the attending physician on an individual basis.

What should be the food?

Significant improvement in the patient's condition special diet with intestinal adhesions. It primarily implies fractional nutrition. There should be approximately the same time to minimize the burden on the digestive organs. Products with a ban are high content fiber. Dishes that promote bloating (cabbage, legumes, grapes, whole milk) are also not recommended. All seasonings are strictly contraindicated and spicy dishes, alcoholic drinks, tea and strong coffee.

What can you eat? The diet should be diversified with foods high in calcium, kefir is especially useful. This drink improves the movement of contents through the intestines. Low-fat broths, steam fish and chicken meat, soft-boiled eggs are also useful.

Compliance with such principles of nutrition allows you to prevent the exacerbation of pathology and serves as its kind of prevention.

Intestinal adhesions: symptoms and treatment with folk remedies

To recipes alternative medicine in the fight against this pathology, you can resort only after consulting a doctor and only at the initial stage of the disease. Most often, traditional healers recommend taking herbal decoctions.

• Infusion of bergenia roots. You will need to take three tablespoons of the roots of this plant crushed in a blender, pour 300 ml of boiling water and leave to infuse in a thermos for 3 hours. After this time, it is necessary to strain the broth. This medicine should be taken three days in a row, 3 teaspoons approximately one hour before meals. Then you can take a break for a few days and continue the course of treatment.
• A decoction of wild rose, lingonberries and nettles. To prepare a healing infusion, you need to mix all the ingredients in equal proportions. Pour two tablespoons of the resulting mixture with a glass of boiling water, leave for 2 hours in a thermos. Ready broth must be filtered, should be taken in half a glass twice a day.
• With pain in the abdomen, compresses with flax seeds are excellent. 3 tablespoons of seeds should be placed in a canvas bag, and the bag itself must be dipped in boiling water for several minutes. excess liquid can be pressed. The resulting compress should be applied to the affected area.

Alternative treatment of intestinal adhesions is not an alternative to conservative therapy. If you feel worse or new symptoms appear, you should immediately seek medical help.

When is an operation required?

The main problem of surgical intervention in the adhesive process is that absolutely any operation can lead to the re-formation of formations. That is why specialists try to resort to the help of low-traumatic procedures.

• Laparoscopy. This is the most gentle procedure, during which a fiber optic tube with a miniature camera at the end is inserted through a small puncture in the abdominal area. Then, through two additional incisions, instruments for surgical manipulations are inserted, with the help of which intestinal adhesions are removed. After this procedure, the patient usually recovers very quickly and can return to work after about a week.
• Laparotomy. This method is used in the case of a large number of adhesions.

When choosing a specific treatment tactic, the specialist must take into account several factors at the same time (the age of the patient, the presence of concomitant ailments, the number of adhesions, etc.).

An important point in rehabilitation period is to provide the intestines with the so-called functional rest. On the first day after surgical procedures, patients are advised to completely refuse food, it is only allowed to drink liquids. Literally after three days, you can start eating in small portions (liquid pureed cereals and vegetable puree, dietary broths). After a week, the diet should gradually be diversified with products of a denser consistency. To avoid unnecessary irritation of the intestines, food must be thermally processed without fail. Compliance with such a fairly simple diet allows the patient to quickly recover and return to the usual working rhythm.

Prevention

Can intestinal adhesions be prevented? Symptoms and treatment of this pathology deliver significant discomfort to the patient. In order not to encounter it, doctors strongly advise avoiding food poisoning and the development of inflammatory processes directly in the abdominal cavity if possible. After surgery, you should follow all the recommendations of the doctor.

It is equally important throughout life to observe a diet, monitor the work of the digestive tract, and lead an active lifestyle. By following these recommendations, you can protect your body from the formation of adhesions.

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Questions and answers on: adhesions after hysterectomy

2012-04-26 05:55:29

Ludmila asks:

After the removal of the uterus and appendages on the right, 3 years have passed, during intercourse, severe pain in the abdomen and gives in all directions and into the anus, when ultrasound was done a year ago - adhesions, how can I alleviate my condition and are adhesions curable?

Responsible Kravchenko Elena Anatolievna:

Good afternoon, Lyudmila. Adhesive disease is treated surgically. To alleviate your condition, visit a gynecologist, he will examine you and prescribe a treatment and a consultation with a surgeon.

2014-07-10 12:35:49

Carey asks:

I have adhesions after the operation to remove the ovarian cyst, and there was also inflammation of the appendages, The gynecologist prescribed vitamins B1, B6 and aloe intramuscularly, the inflammation went away, but colposcopy showed erosion of the cervix, Yesterday I was cauterized with erosion of the cervix, I also continue to take injections intramuscularly Vitamins B1, B6 and aloe, tk. the course is not over yet, is it harmful after cauterization of erosion?

2013-11-08 19:12:13

Margaret asks:

Hello November 5 this year was a milk surgery in gynecology. Dissection of adhesions after 2 cesarean removal vapors of an ileal cyst from the fallopian tube removal of adenomeosis from the abdominal cavity and between the muscles of the plastic suture on the uterus. How to behave after the operation I have 2 children 3 and 5 years old
I am alone with them. what is needed and how long does it take recovery process what is not possible?

Responsible Serpeninova Irina Viktorovna:

Recovery period, requiring restriction of physical activity, usually lasts six months, but in each case, recommendations are given by the operating doctor.

2012-01-04 14:09:56

Ludmila asks:

Hello. In August 2011, I had an operation to remove the uterus (myoma). In December, signs of adhesions-pain began to appear, there was even an attack. I want to ask if I can take the drug Longidase in suppositories rectally. I myself am a pharmacist, I know about this drug, I want to consult with you. an assumption about them. After the operation, a histology of the tissues was done - there was a leomyoma of the uterus, leukoplasia of the cervix with stromal fibrosis. Thank you in advance for your answer.

Responsible Serpeninova Irina Viktorovna:

Longidaza is a powder for preparing a solution for intramuscular or s / c injections in ampoules or vials. It is not produced in suppositories and there is no evidence whether its properties will be preserved when preparing suppositories from it on its own. Use it in the way recommended by the manufacturer.

2011-03-06 18:36:34

Ramsia asks:

Hello dear doctors!
07/01/2009 at the age of 47, I underwent surgery for cervical dysplasia of the 3rd degree. (The focus was in the neck measuring 05. * 1 cm) - cervical extrusion with appendages. There was no menopause and the ovaries were healthy, but the gynecologist-oncologist advised me to urgently remove the ovaries before the operation, as well. taking into account their experience and my pathology, I can get to them again on the operating table with such a pathology or even worse. They left me no other options and I agreed.
After the operation, she felt more or less satisfactory.
But after 8 months there was pain in the lower abdomen, a feeling of heaviness. The pain radiates to the sacrum, rectum. I stopped feeling the urge to defecate. I feel some kind of unpleasant sensation, and when digital examination I feel that the ampulla of the rectum is full of feces and I feel the bulging of the vaginal stump into the rectum. Weakness, fatigue. These pains have been tormenting me for a year now. She became nervous and irritable. I'm already thinking about suicide (I wish I had a drink sleeping pills and fall asleep, forget about this pain). I have been taking Angelique for 7 months, because. there were hot flashes and increased glucose, cholesterol and problems with bladder. It got a little better.
On CT scan of the small pelvis - Condition after extirpation of the uterus with appendages. The stump of the vagina with clear uneven contours, the surrounding tissue with fibrous changes and "small" calcifications. Bladder is very full regular shape with clear, even contours, the content is homogeneous.
Ultrasound of the pelvic organs: In the small pelvis, there is an adhesive process, no visible formations have been identified. The bladder has clear, even contours, the walls are compacted, without visible additional formations.
Volume of initial urine:-350 ml.
The volume of residual urine is 55 ml.
Irriography - With the retrograde introduction of a liquid barium suspension, all sections of the large intestine were performed up to the dome of the blind. The localization of the loops of the sigma and the descending colon is disturbed. The descending colon is displaced medially, binds the knee bend, the sigma forms multiple loopy bends and kinks against the background of its lengthening, the displacement of the loops is sharply limited and painful. In descending colon, in the sigma, the haustration is smoothed, uneven, the mucosal folds are moderately thickened. The rest of the colon has a symmetrical haustration. No organic constrictions or filling defects were found.
conclusion: R signs of violation of the anatomical localization of the distal colon as an indirect sign adhesive disease, signs of chronic colitis.
EGDS-Esophagus is freely passable. The mucosa is pink. Gastric mucosa, pink, edematous. Pyloric sphincter concentric. Bulb 12 of the duodenum is not deformed, the mucosa is pink, it looks like “mannoly cereals!” The onion part is pink.
Conclusion - superficial gastritis. Moderate inflammation. Indirect signs of pancreatitis.
Colonoscopy - perianal area is clean. Colonoscopy was performed up to the splenic angle of the colon. The mucosa is pink throughout, the vascular pattern is not changed. The peristalsis is uniform. The conclusion is that there were no signs of inflammation.
A few days ago, I went for a consultation with a surgeon and a gynecologist about adhesive disease. The gynecologist prescribed electrophoresis on the lower abdomen with lidase (1.5 years have passed since the operation), will lidase help now? I heard about longidase. What is it? Does it help?
The surgeon looked at my examination results and sent me to an oncologist: let them figure out what kind of "small" calcifications on the peritoneum! If the adhesive process
then we will wait for the OKN. Then by emergency indications let's operate.
IN HOW! So you have to wait for OKN or peritonitis or intestinal necrosis! And if the ambulance does not arrive on time or will bring to a drunken surgeon for the holidays! What then! Die!
2 days ago I went to another surgeon, because. no strength to endure the pain. The female surgeon looked at all the examinations and my stomach and diagnosed it as an adhesive disease of the abdominal cavity. Dolichosigma. Colonoptosis. Coccygodenia.
She prescribed Movalis, candles. Milgama No. 10 Magnetotherapy on the cross. Electrophoresis with novocaine No. 10.
She advised me to go for a consultation with a proctologist - maybe she says prolapse of the small intestine?
I'm tired of doctors, drugs and pain. I don't want to live! But it seems like she’s not old yet, and I need to work a lot, I have a loan in a bank. But I can’t work.

Tell or Say please, it is possible to remove commissures by a laparoscope. I heard it's done. We do not have it in Astrakhan, and our surgeons are against this method of removing adhesions. They say how you inflate your stomach with carbon gas when you have it all in spikes, even normal anatomical position bowels broken! Yes, and you can die during this operation. In general, they consoled me.
And further. Please tell me what research method and which doctor can diagnose prolapse of the small intestine?
If in my situation it is possible to cut the adhesions with a laparoscope, then where is it done well (so as not to earn more more problems and not die) After the extirpation of the uterus with appendages, for cervical dysplasia 3 tbsp. In the histological response after the operation, the endometrium is in the proliferation phase. FBG, fibromyoma. In the neck of the endocervix gland. In the area of ​​​​the external pharynx squamous epithelium with parakeratosis, hyperkeratosis. In the ovaries - theca tissue, white bodies. Given the results of this histological picture did i have endometriosis? if so, can there be pain in the abdomen due to this or is it adhesions? If you have endometriosis, how can you treat it?
Help me please. Thank you.

Responsible Tovstolytkina Natalia Petrovna:

Hello Ramsia. Let's start with the last question. The data of your histological conclusion do not give any reason to suspect you have endometriosis. Regarding the adhesive process, it is very doubtful that it began 8 months after the operation. Rather, it could have been earlier, but it is necessary to look for another cause of the pain that has appeared. You need to start with a consultation with a neurologist, perhaps an MRI scan to rule out diseases of the spine that can give similar pain. Hormonal is also required. replacement therapy- then the thoughts of suicide will pass by themselves. With regard to enzyme preparations, it is very doubtful their effect in a year or two after the operation. After another operation to cut the adhesions, you may develop new ones, because. This is how your body reacts to surgical interventions. And don't forget about healthy way life - a diet in which there is no constipation, physiotherapy, swimming pool, etc. 80% of health is you yourself, without doctors and medicines. Good luck.

2008-10-19 01:43:38

Anna asks:

Hello! Please advise how should I proceed. In 2005, I had a cyst removed from my left ovary (laparoscopy). She was then treated with danazol for 5 months. X-ray tubes showed complete obstruction of the left and partial right. Now they put (ultrasound) adenomyosis of the uterus, initial stage. Symptoms of endometriosis appeared 4 months ago (discharge 2 days before menstruation and heavy clots on day 2). I was scheduled for an operation to dissect adhesions and remove foci of endometriosis and HSG. Should I pass hormonal treatment before surgery.

Responsible Bystrov Leonid Alexandrovich:

Hello Anna! Usually, endometriosis undergoes hormone therapy after laparoscopy, because. laparoscopy can also reveal other forms of endometriosis. If there is a laparoscopy, then the HSG is no longer needed.

2016-03-30 15:58:25

Christina asks:

Hello!
I am 34 years old, married for 4 years, I can not get pregnant, myoma or polyp on the leg inside the uterus. After MRI and ultrasound, the doctors did not determine.
I'm going for an operation to remove this disease and at the same time check the patency fallopian tubes.
The doctor said about postoperative adhesions, so he warned that he would use Intercoat gel.
What do you think: is it harmful to use this gel?
And after this surgical intervention, will I be able to carry a child after artificial insemination?

Thank you in advance,
Kristina

Responsible Palyga Igor Evgenievich:

Hello Christina! Are you planning a laparoscopy? Or a hysteroscopy? In any case, after these two interventions, postoperative adhesions are not formed. If the fallopian tubes turn out to be impassable, then not a single gel will help. If the gel is injected into the uterine cavity, it will not negative impact for embryo implantation during IVF, as well as for carrying a pregnancy.

2014-10-03 17:08:27

Natalia asks:

Please tell me, is it possible to engage in masturbation and oral sex after laparoscopy of uterine fibromyoma (5 subserous nodes) and removal of adhesions. The mother was left. The operation was 24 days ago. The doctor said sexual rest for 2 months.

2013-08-07 11:41:27

Elena asks:

Hello, I am 35 years old, 5 pregnancies 1995 - abortion, 1997 abortion, 1999 - pregnancy ended in birth healthy child(rupture of the cervix during childbirth), 2010 - frozen pregnancy (no one saw the fetus on ultrasound, ended in miscarriage, pregnancy was diagnosed posthumously by hCG, 2013 - pregnancy after IUI, froze for a period of 6 weeks 4 days.
Per Last year experienced the following:
1. August 2012 - cyst rupture, resulting in an attack of appendicitis, abdominal surgery, 2 courses of antibiotics.
2. October 2012 - hospitalization in an ambulance, pain syndrome, endometrioma + terrible endometriosis + adhesive process was diagnosed, no surgery, a course of antibiotics. Appointed Visan, did not take it, decided to consult with other specialists.
3. It turns out that every 2 months (when the left ovary is working) a pain syndrome occurs, literally the whole body hurts, the temperature is up to 38.
December 2012 - planned laparoscopy to remove the endometrioma (3.7 cm), dissection of adhesions. Before operation again a pain syndrome. Terrible endometriosis was not confirmed by laparoscopy. No hormonal support after the operation they did not register, they said to become pregnant.
4. May 2013 - IUI (in addition to all of the above, there is also a male factor. Before IUI, an endometrioid cyst of 3.5 cm was visible on ultrasound. Pregnancy occurred on the first attempt. After ultrasound at 6 weeks, the doctor canceled utrozhestan. Pregnancy froze for 6 weeks 4 days.
5. July 2013 - vacuum regulation, on the 4th day after it, pain syndrome.

What could be the most likely cause of the fading?
1. The presence of an endometrioid cyst.
2. Cancel Utrozhestan
3. genetic abnormalities(analysis for karyotypes not yet ready)
4. Long flight by plane (at 4 and 6 weeks)

And the most important question: is it possible to attempt IUI again and when, and how it can end. 2 missed pregnancies - a trend, the 3rd time is scary.

During such a minimally invasive operation, there is no wide tissue dissection. Injuries and inflammation are minimized, which does not give rise to the re-formation of adhesions between organs. However, laparoscopy still does not guarantee that the disease will not return after a few months.

To improve the effectiveness of treatment after surgical dissection of adhesions, it is recommended to use active methods prevention.

6. treatment of the underlying disease;

7. regular visits to the doctor.

Physiotherapy.

• Electrophoresis. During electrophoresis, medicinal substances are introduced into the pelvic cavity under the influence of an electric field. The most effective is the use of drugs containing the enzyme hyaluronidase. It is able not only to inhibit the formation of the connective tissue that makes up the adhesions, but also to loosen the formed formations, increasing their elasticity. The full course consists of 10-15 sessions. This is usually enough to prevent the recurrence of adhesions after laparoscopy.
• Electrical stimulation. Electrical stimulation is the direct effect of weak electrical impulses on tissues. They improve tissue metabolism. Due to this, the fibrin protein formed after the operation will quickly dissolve and will not turn into a dense connective tissue.
• Applications of ozokerite and paraffin. During these procedures, local heating of the pelvic area occurs by exposure to conventional heat. This may somewhat slow down the adhesive process. However, applications are rarely used on early stages, because in the presence of chronic infections and inflammatory processes, the risk of their exacerbation is high.
• Laser therapy. The procedure is the heating of tissues with the help of directed laser energy. The effect of laser therapy will be more noticeable than with paraffin or ozocerite applications. In the first weeks after surgery, in the absence of complications, laser therapy is the most effective means of prevention.
• Ultrasound. Ultrasound is often used to soften formed adhesions and eliminate pain. Sound waves disrupt microprocesses and the structure of adhesive fibers. This prevents their formation in the first months after the operation.

Massotherapy.

• infectious complications after surgery;
• skin diseases in the abdomen and pelvis;
• oncological diseases.

Physiotherapy.

Osteopathy.

Dieting.

• Increase gas production. These include some fruits and vegetables ( cabbage, pears, cherries), legumes ( beans, peas), carbonated drinks. An increase in intra-intestinal pressure will lead to bloating of the intestines and adhesion of organs in the small pelvis.
• Slow down tissue regeneration. First of all, these products include alcohol.
• Increase risk postoperative complications. Such foods are any excessively salty, spicy or fatty foods.

Treatment of the underlying disease.

Regular visits to the doctor.

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Adhesions after surgery

The internal organs of a person are covered with a serous membrane, which allows them to be separated from each other, to change their position during body movements. With the development of a pathological process in one of the organs, the formation of connective tissue often occurs, which glues the serous membranes together, preventing them from moving and functioning properly. In medicine, this condition is called adhesive disease or adhesions, which in 94% of cases develop after surgery. Outwardly, adhesions are similar to a thin plastic film or thick fibrous strips, it all depends on the degree of adhesive disease, as well as the organ in which the pathological process has developed. Adhesions after surgery can appear between almost any internal organs, but most often they develop in the intestines, lungs, between the fallopian tubes, ovaries or heart. What are adhesions, how dangerous are they, and how to treat adhesions after surgery.

What are adhesions after surgery

Normally, after the operation, the internal organ that was submitted to outside intervention should heal, a scar appears on it, and its healing is called an adhesive process, which is a normal physiological process and passes over time without disturbing the work of other organs. The adhesive process has nothing to do with adhesive disease, in which pathological growth and thickening of the connective tissue occurs. In cases where the scars after the operation are more than normal, the internal organ begins to fuse tightly with other organs, preventing them from functioning properly. It is this process that is referred to as adhesive disease, which has its own symptoms and requires additional treatment under the supervision of a doctor.

Adhesions - proliferation of connective tissue

Reasons for the development of adhesions

The appearance of adhesions after surgery largely depends on the professionalism of the surgeon who performed this intervention. A specialist in the field of surgery must have excellent skills in applying sections and sutures, the quality of operating materials and the technical equipment of the clinic itself also matter. Because the quality of the operation depends on it. If there are doubts about the professionalism of the surgeon or there are no ideal conditions in the clinic, then you should look for another hospital or buy the necessary and high-quality materials on your own that will be used during the operation.

Postoperative suture - the cause of the development of adhesions

Probably each of us has heard various sources that there are cases when, during the operation, due to the negligence of a doctor or medical staff, some suture materials, tampons, gauze, or some surgical instruments were left inside. The presence of these factors also contributes to the formation of adhesions after surgery.

Adhesion formation after gynecological operations

Postoperative adhesions are most often formed after surgery on the intestines or pelvic organs. So adhesions after surgery to remove the uterus can form as a result of inflammatory processes or infection. Presence of adhesions after surgery reproductive organs often leads to the development of infertility or other disorders. A fairly common cause of the development of adhesive disease after surgery is tissue hypoxia, when the internal organ does not receive enough oxygen. Adhesions after surgery on the organs of the reproductive system are often formed with endometriosis, and in the intestine after surgery for appendicitis, intestinal obstruction or stomach ulcers. Adhesions appear after an abortion, surgery on the ovaries, heart or lungs. Thus, it can be concluded that adhesions after surgery can appear for many reasons, but in any case they cannot be left without due attention of the doctor, since their appearance significantly impairs the functionality of internal organs and often causes complications.

Symptoms of adhesions after surgery

The process of formation of adhesive disease is quite long and directly depends on the organ that was submitted to the surgical intervention. The main symptom of adhesions after surgery is pain in the area of ​​the surgical scar. Initially, there is no pain syndrome, but as the scar thickens, it has a pulling character. Pain is aggravated after physical exertion or other body movements. So after surgery on the liver, pericardium or lungs, pain is felt when deep breath. If intestinal adhesions after surgery, then pain manifests itself with sudden movements of the body or physical exertion. The presence of adhesions on the pelvic organs causes pain during intercourse. In addition to pain, there are other symptoms of adhesions after surgery, but it is important to note that clinical picture directly depends on the localization of adhesions and disorders in the body. Consider the most common signs of postoperative adhesions:

• violation of defecation;
• frequent constipation;
• nausea, vomiting;
• complete absence of stool;
• pain on palpation postoperative suture;
• redness, swelling of the external scar;
• increase in body temperature;
• labored breathing, shortness of breath.

Pulling pain in the area of ​​the postoperative suture - a symptom of adhesive disease

In cases where adhesions have formed after removal of the uterus or surgery on the ovaries, fallopian tubes or vagina, a woman feels pain during intercourse, pulling pains in the lower abdomen, a violation menstrual cycle, various secretions from bloody to gray in color with an unpleasant odor. The formation of adhesions after surgery should be monitored by a doctor, but if they appear a few weeks or months after surgery, then the patient needs to seek help on his own.

Possible Complications

Adhesions are a rather complex complication after surgery, which can not only disrupt the functioning of internal organs, but also provoke complications, including:

• acute intestinal obstruction;
• necrosis of the intestine;
• peritonitis;
• infertility;
• violation of the menstrual cycle;
• bending of the uterus;
• obstruction of the fallopian tubes;
• ectopic pregnancy.

Complications of adhesive disease

Complications of adhesive disease often require immediate surgical care.

Diagnosis of the disease

If you suspect the presence of postoperative adhesions, the doctor prescribes a series of laboratory and instrumental examinations to the patient:

• A clinical blood test will show the presence or absence of an inflammatory process in the body.
• Ultrasound examination (ultrasound) - visualizes the presence of adhesions.
• X-ray of the intestine.
• Diagnostic laparoscopy.

The results of the research allow the doctor to determine the presence of adhesions, consider their shape, thickness, determine how the internal organs work, and prescribe the necessary treatment.

Treatment of adhesions after surgery

Treatment of adhesions directly depends on the state of health of the patient. In order to reduce the development of adhesive disease, the doctor in the postoperative period prescribes anti-inflammatory drugs, various enzymes for the resorption of adhesions, less often antibiotics, and also advises to move more, which will prevent displacement and "gluing" of organs to each other. A good result can be obtained from physiotherapeutic treatment: mud, ozocerite, electrophoresis with medicinal substances and other procedures.

Physiotherapy in the treatment of adhesive disease

In cases where the postoperative period has passed without suspicion of the presence of adhesive disease, but after a while the patient still has large scars, appear severe symptoms, the only correct solution would be re-holding operations, but already to remove adhesions. Removal of adhesions after surgery is carried out by several methods:

Laparoscopy - the introduction of a fiber optic tube into the abdominal or pelvic cavity with a microscopic camera. During the operation, two small incisions are made, into which a manipulator is inserted with instruments that allow you to dissect adhesions and cauterize bleeding vessels. This method of surgical intervention is less traumatic, since after its implementation there is a minimal risk of complications, and the patient himself can get out of bed already on the 2nd - 3rd day.

Laparoscopy - removal of adhesions

Laparotomy - provides full access to the internal organs. During the operation, an incision of about 15 cm is made. With the help of special equipment, the adhesions are excised and removed. This method of surgical intervention is performed in cases where it is not possible to perform laparoscopy or with a large number of adhesions.

After the operation, the doctor cannot give a 100% guarantee that adhesions do not form again. Therefore, the patient needs to periodically visit a doctor, strictly adhere to his recommendations and carefully monitor his health.

Folk remedies for the treatment of adhesions after surgery

In addition to conservative and operational method treatment of adhesive disease, many seek help from traditional medicine, which can prevent the growth of adhesions in the early stages. It is important to remember that the treatment of adhesions with alternative methods can only be used as an adjunct therapy to the main treatment. Consider a few recipes:

Recipe 1. For cooking, you need 2 tbsp. Flax seeds, which need to be wrapped in gauze and dipped in boiling water (0.5 l) for 3-5 minutes. Then the gauze with seeds should be cooled and applied to the sore spot for 2 hours.

Recipe 2. You will need dried and well-chopped herb St. John's wort in the amount of 1 tbsp. l. Grass should be poured with 1 cup of boiling water and boiled over low heat for about 15 minutes. After the broth, you need to drain and take ¼ of a glass three times a day.

Treatment of adhesions with St. John's wort

Recipe 3. For cooking, you need aloe, but one that is not less than 3 years old. Aloe leaves should be put in a cold place for 2 days, then chopped, add 5 tablespoons of honey and milk, mix well and take 1 tbsp. 3 times a day.

Recipe 4. You need to take 1 tbsp. milk thistle seeds, pour 200 ml of boiling water, boil for 10 minutes, let cool and strain. The finished broth should be drunk warm, 1 tbsp. l 3 times a day.

Prevention of adhesions after surgery

It is possible to prevent the appearance of postoperative adhesions, but for this, maximum care must be taken both by the doctor during the operation and by the patient himself after the operation. It is very important to follow the doctor's recommendations, move more, follow a diet, avoid physical exertion, and prevent the possibility of infection entering the suture that remained after the operation. If you do not follow all the recommendations, reduce the risk of developing adhesive disease is reduced several times.

Periodic consultation with a doctor in the postoperative period

In addition, if after the operation there are abdominal pains, a violation of the stool, vomiting, do not self-medicate, you should immediately call " ambulance". Adhesive disease is a rather serious disease, which in some cases can lead to the death of a person.

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Principles of prevention of adhesive disease in the small pelvis

The adhesive process and the formation of adhesions in the abdominal cavity and pelvic organs is a universal protective and adaptive mechanism. It is aimed at delimiting the pathological area, restoring anatomical structure the tissues themselves and their blood supply, disturbed as a result of trauma and/or inflammation.

Often, the formation of adhesions does not lead to pathological changes in the abdominal cavity and goes unnoticed. At the same time, their formation during inflammatory processes in the appendages often leads to infertility, and therefore, for example, the prevention of sexually transmitted diseases, or timely and adequate anti-inflammatory therapy, is both the prevention of adhesions in the fallopian tubes and, accordingly, the prevention infertility.

Reasons for the formation of adhesions after surgery in gynecology and obstetrics

Traditionally, the adhesive process is considered local violation in tissues, which occurs mainly as a result of surgical trauma to the peritoneal surfaces and subsequent inflammatory reactions.

The latter causes a cascade of corresponding processes in the form of exudation (effusion) of the liquid part of the blood, disturbances metabolic processes in tissues, desquamation of the peritoneal epithelial layer of cells, fibrin deposits, the formation of elastin and collagen fibers, the growth of a capillary network at the site of damage and the formation of adhesions.

A significant role in these processes is played by tissue drying, mesothelial hypoxia when using pneumoperitoneum using carbon dioxide, and surgical manipulations with tissues.

Most often (in 63-98% of all cases) the formation of pathological intra-abdominal and pelvic adhesions (adhesions) between the surfaces of organs and inner surface abdominal wall in the abdominal cavity occurs after abdominal surgery particularly in the pelvic cavity. They are one of the most important and not fully resolved problems of abdominal surgery, occupying one of the leading places in the structure of postoperative complications.

The presence of adhesions may be asymptomatic. Their clinical symptomatology is considered as an adhesive disease, which manifests itself:

• acute or chronic forms adhesive intestinal obstruction;
• violation of the function of the abdominal cavity and small pelvis;
• chronic pelvic pain, or abdominal-pelvic pain syndrome;
• menstrual disorders and tubal-peritoneal infertility (in 40% of cases) in women of reproductive age.

Prevention of the adhesive process in the pelvis allows you to avoid or significantly reduce the likelihood of developing adhesive disease. The main causes of adhesions after surgery are damage to the surface epithelial layer (mesothelium) covering the internal organs, as a result of:

• mechanical impact, leading to traumatization of the peritoneum at various stages of the surgical operation - dissection of the abdominal cavity, fixation of tissues and stopping bleeding by grasping with clamps and other instruments, excision of individual sections of the peritoneum, wiping and drying with dry gauze swabs and napkins, etc .;
• exposure to various physical factors, which include drying of the serous membrane under the influence of air, especially with a laparotomy access method, burns when using an electric and radio wave knife, laser radiation, plasma scalpel, electrocoagulation and other methods of coagulation of small bleeding vessels, washing with hot solutions;
• aseptic inflammatory process in the abdominal cavity under the influence of previous factors, as well as intraperitoneal hematomas and small hemorrhages, treatment of the peritoneum with alcohol or iodine, the use of various other concentrated solutions (antiseptics, antibiotics) for washing the abdominal cavity;
• the use of absorbable suture material for a long time, the presence of drainage in the abdominal cavity, talc from gloves, gauze or cotton pieces, etc .;
• oxygen deficiency of tissues and disorders of metabolic processes in them, as well as inappropriate temperature regime gas when using CO 2 -pneumoperitoneum for diagnostic or therapeutic laparoscopies;
• postoperative infection, which occurs more often with laparotomy than with laparoscopic access.

All of these factors, and most often their combination, are a trigger that leads to inflammatory processes that cause excessive biological synthesis of connective tissue, that is, the formation of adhesions. In operative gynecology, the maximum impact of the first three factors occurs during hysterectomy, and therefore the prevention of adhesions after removal of the uterus has highest value compared to other gynecological surgeries.

In obstetrics, delivery by caesarean section somewhat less associated with mechanical and physical damage to the pelvic organs. However, frequent surgical blood loss causes tissue hypoxia, disruption of their metabolism and immune response organism, which also contributes to the development of the adhesive process and adhesive disease in the immediate or late postoperative period. Therefore, the prevention of adhesions after caesarean section should be carried out in the same way as with other surgical interventions.

Methods for the prevention of adhesive disease

Based on observations and taking into account the mechanisms of formation of the adhesive process, the prevention of adhesion formation should be carried out already during the surgical intervention itself. It includes the following basic principles:

1. Reduction of damage to the peritoneum due to careful attitude to tissues, reduction (if possible) of the time of the operation, economical use of coagulation techniques and retractors. In addition, it is necessary to reduce the number of sutures and clips, carefully stop bleeding without disturbing blood circulation in the tissues, remove all necrotic tissues and blood accumulations, suppress infection with low-concentration antibacterial and antiseptic solutions, moisturizing tissues and washing the abdominal cavity, the use of suture material that does not cause immunological reaction, prevention of ingress into the abdominal cavity of glove talc and cotton dust from gauze wipes and tampons.
2. Reducing the severity of inflammatory processes through non-hormonal and hormonal anti-inflammatory drugs.
3. Reducing the degree of primary response to aseptic inflammation.
4. Suppression of the cascade of increasing blood clotting, reducing the activity of fibrin formation and activation of processes aimed at its dissolution.
5. The use of agents aimed at reducing the accumulation of elastin and collagen proteins, which subsequently leads to the development of fibroplastic processes (fibrinolytic enzymes).
6. The use of the hydroflotation method, which consists in introducing crystalloid solutions (Ringer's lactate solution) or dextrans (icodextrin, etc.) into the abdominal cavity together with heparin and a solution of glucocorticosteroids in order to separate the contacting surfaces, activate the fibrinolytic activity of peritoneal cells and suppress the coagulation cascade.
7. The use of barrier preparations (gels, biodegradable membranes, hyaluronic acid, polyethylene glycol, as well as the introduction of surfactant-like agents, etc.), fixed on contact surfaces in the abdominal cavity and in the small pelvis and leading to their mechanical separation.

Thus, the main mechanism in the prevention of adhesions is to minimize the trauma of surgical intervention. Surgical methods of prevention can be supplemented by other means and methods that in no case can replace the first. In this regard, the prevention of adhesions during laparoscopy has significant advantages.

The main advantages of the laparoscopic method in operative gynecology as a method to reduce the formation of adhesions are:

• minimal degree of traumatization of blood loss due to the absence of large incisions of the anterior abdominal wall in areas of abundant blood supply;
• minimal access to prevent the possibility of penetration into the abdominal cavity of ambient air and foreign reactive materials, as well as drying of the serous surface with the destruction of the phospholipid layer;
• the use of bipolar electrodes, which damage tissues much less than monopolar and ultrasonic ones, and prevent the formation of adhesions;
• work on organs and tissues enlarged with an optical camera using tools at a remote distance, which significantly reduces the risk of mechanical injury to the mesothelial layer;
• reduction of manipulations with distant organs and tissues;
• no need to isolate certain areas and floors of the abdominal cavity, for example, the intestines, with surgical napkins;
• more gentle and faster recovery of the anatomical structures and peristaltic function of the intestine;
• the positive effect of laparoscopy itself on the activity of the peritoneum in terms of fibrinolysis (fibrin dissolution).

At the same time, according to statistics, about 30-50% of all cases of pelvic pain occur after laparoscopy of ovarian cysts, fallopian tubes and other diagnostic laparoscopic manipulations. This is mainly due to the fact that:

• carbon dioxide injected into the abdominal cavity to provide laparoscopic access causes spasm of the capillaries of the superficial peritoneal layers, which leads to hypoxia and disruption of metabolic processes in the mesothelial layer; addition to carbon dioxide 3 volume percent oxygen significantly reduces these phenomena;
• gas is introduced into the abdominal cavity under pressure;
• dry gas.

Thus, laparoscopic gynecology only slightly reduces the degree of frequency and prevalence of adhesive processes, abdominal-pelvic pain syndrome and the frequency of repeated operations associated with adhesive disease. Laparoscopic methods are not a reason to abandon the basic principles of adhesion prevention. The choice of additional antiadhesion agents depends on the extent of the surgical injury.

Prevention of adhesive disease in the postoperative period consists mainly in:

• restoration of water and electrolyte balance in the body;
• conducting anti-inflammatory and anticoagulant therapy;
• early activation of the patient;
• the fastest possible recovery of bowel function.

The principles for preventing the formation of adhesions are the same for any type of surgical intervention. Their application should be complex and in accordance with the volume and nature of the injury.

How to prevent adhesion formation after surgery

and much more about how to lead a healthy lifestyle

Many people are familiar with the term spikes firsthand. They appear after any strip operation, and subsequently cause a lot of anxiety to a person. We will consider whether it is possible to prevent the appearance of adhesions, what complications the adhesive process can cause, and what methods of treatment are available.

The appearance of adhesions

Despite the great leap in the development of medicine, any patient after an abdominal operation can expect such an unpleasant complication as adhesions. What are spikes and why do they appear? The fact is that all organs of the human abdominal cavity are covered with a protective serous membrane. After the operation, this membrane is broken, and during healing with highly likely adhesions may occur. They are whitish translucent films that rigidly fix the internal organs and prevent them from interacting properly. Most often, adhesive disease is not so serious as to cause significant harm to health. But in some cases, it can cause a lot of inconvenience and reduced performance. Pulling appears, aching pain with a sharp change in body position, there may be a feeling of discomfort, and sometimes severe pain.

Prevention

During operations performed on internal organs, maximum care is taken to avoid getting into open wound foreign material and avoid drying it out. If these conditions are not observed, the risk of adhesions increases significantly. Also, their appearance is facilitated by the low mobility of the patient after the operation, so you should start physical activity as soon as possible - this will significantly reduce the risk of adhesions. Be sure to follow the prescribed diet so as not to overload the body. A course of treatment with anti-inflammatory drugs is carried out in order to avoid infections of the internal organs. Immediately after discharge, physiotherapy will be very effective: ultrasound, laser treatment, electrophoresis.

Treatment

If adhesions have already formed or have not been prevented, surgical treatment may be necessary. The most sparing method is laparoscopy: through a small puncture, using a miniature video camera, the adhesive joints are dissected. At large area lesions have to make a surgical incision to excise the connective tissue.

You can half try to treat adhesions and folk remedies. For example, this article talks about folk treatment fallopian tube adhesions in women.

Effects

Do not neglect the appointment of a doctor after surgery. Abandoning postoperative prophylaxis and physiotherapy, the patient may face a number of complications associated with adhesive disease. Incorrect bending or partial narrowing of the intestine, up to obstruction, which may require urgent intervention by the surgeon. In women, adhesions on the internal organs of the small pelvis can lead to the risk of inflammation of the appendages and even infertility.

Very often, after a hospital discharge has occurred, people are in a hurry to quickly return to their daily rhythm of life, work and household chores, without thinking about the risk of complications. In order to preserve further health, you just need to pay attention to yourself, try to organize your daily routine, start eating right and do not forget about physical exercises.

Treatment of adhesions after surgery

Adhesions are connective adhesions between internal organs, having the form of peculiar films, provoked by fibrinogen, a special substance secreted by the human body, which contributes to the healing of wounds. Adhesions can be either congenital or acquired after surgery. Blood or inflammatory fluid, not resorbed, gradually, from the 7th to the 21st day, thickens and is replaced connective tissue. During this time, adhesions from loose, which are easy to treat, become dense, blood capillaries form in them, and after 30 days, nerve fibers are already present in the adhesions.

The reasons

More often, the adhesive process is provoked by operations, but other reasons for their appearance are also possible. Adhesions in the peritoneal cavity may remain after bruises or closed injuries of the abdomen, as a result of which the outflow of blood is disturbed, the lining surface of the abdominal cavity "dries up" and the internal organs in the process of rubbing against each other without a protective "lubrication" "overgrown" with adhesions. Much less common are cases when adhesions were formed as a result of aseptic inflammation in the abdominal cavity caused by the ingress of certain substances into it, such as alcohol, iodine or a solution of rivanol. By the way, these fluids can enter the peritoneum only during the operation.

Symptoms

As a rule, the entire adhesive process as such goes unnoticed. All the signs by which the presence of adhesions in the body can be diagnosed relate to the complications they cause. Therefore, the symptoms are quite diverse and depend on the localization of adhesions and the disorders provoked by them.

Symptoms of abdominal adhesions:

• Low pressure;
• Sharp sharp pain;
• Temperature rise;
• General weakness;
• Constipation.

The adhesive process in the intestine has similar symptoms and is much more difficult to diagnose. If treatment is not started on time, adhesions in the intestines can even degenerate into malignant tumor. The most common symptoms of intestinal adhesions are constipation with occasional pain, pain during exercise, and weight loss.

When the process is running, the symptoms are already the following:

• Intestinal spasms;
• Vomiting with admixture of feces;
• Bloating of the intestines;
• Temperature rise;
• pressure drop;
• Strong thirst;
• Drowsiness, weakness.

1. Spikes in the lungs reveal themselves as pains when breathing, aggravated "by the weather."
2. The adhesive process on the liver gives pain on inspiration.
3. Adhesions on the uterus cause pain during sexual contact.

Treatment Methods

Treatment of adhesions depends not only on physical condition patient, but also from the manifestations of the disease itself. Because the main reason the appearance of adhesions is a surgical operation, then the treatment should be therapeutic. Surgical methods to remove adhesions are used only in the most extreme cases when the life of the patient is threatened.

At the first stages of the adhesive process, aloe preparations, vitamins E and folic acid. True, these funds can only stop the development of new adhesions and make existing ones more elastic.

It is customary to treat the adhesive process with physiotherapeutic methods, such as:

• paraffin applications;
• ozocerite applications;
• electrophoresis with absorbable and analgesic drugs (calcium, magnesium or novocaine);
• enzyme therapy;
• laser or magnetic therapy;
• massage.

With all of the above, there are indications for surgical intervention to get rid of the adhesive process. Laparoscopic surgery is indicated for acute course adhesive process (usually it becomes necessary for intestinal obstruction, when the attack cannot be removed within 1-2 hours). Laparoscopy is also performed with obstruction of the fallopian tubes.

The actual treatment by laparoscopy includes the dissection of adhesions using an electric knife, laser or under water pressure. To prevent the re-formation of adhesions in the postoperative period, special preventive procedures are prescribed.

Home Recipes to Treat Adhesions

Treatment of adhesions with home methods, herbal teas, lotions is very effective, it is especially good to use them in the postoperative period to prevent the adhesive process. Pharmacies offer very wide selection herbal medicines, but they are easy to prepare at home.

• Tea against pulmonary adhesions: 2 tbsp. l. rosehip and nettle, 1 tbsp. l. combine lingonberries. Add to 1 tbsp. l. mixes 1 tbsp. boiled water and leave for about 2-3 hours. Drink half a glass in the morning and evening.
• Linen lotion: 2 tbsp. l. place flax seeds in a cloth bag and dip in boiling water. Cool down in water. Make lotions on the places of adhesions at night.
• Decoction of St. John's wort: In Art. l. St. John's wort add a glass of fresh boiling water, boil for 15 minutes. Drink 1/4 tbsp. 3 times a day.
• Herbal tea: Prepare a mixture of sweet clover, coltsfoot and centaury. In Art. l. mix pour about 200 g of boiling water and leave in a thermos for 1.5 hours. Drink for a month on an empty stomach for 1/4 tbsp. 5 times a day.

Treatment of adhesions with massage at home is possible only after consulting a doctor, otherwise, instead of a cure, you can get a hernia. It is better to stick a strip of foil in place of the scar with adhesive tape.

Prevention of the adhesive process

Adhesion prevention methods aimed at reducing tissue damage during surgical operations can be divided into two main groups.

They include mainly the prevention of foreign objects, such as dressings, from entering the abdominal cavity, and careful debridement of the operating space. In addition, a scrupulous stop of bleeding and the use of appropriate antibacterial drugs are necessary.

To prevent the appearance of adhesions, the following drugs should be used:

To create a barrier between the internal organs, specialists use various chemicals, including anti-inflammatory and antihistamine drugs.

Immediately after the operation, physiotherapy, such as electrophoresis with lidase, is very effective.

These are the methods of prevention that should be used by physicians. What can the patient do to avoid the occurrence of adhesions after surgery?

First of all, it is very important not to stay too long in the postoperative period, to start restoring physical activity as soon as possible.

Be sure to follow a diet - eat a little, but often. From the menu should be excluded products, the use of which can cause increased gas formation- grapes, cabbage, fresh black bread, beans, apples.

Treat constipation in time, the stool should be regular. Limit your physical exercise in particular, never lift a load weighing more than 5 kilograms.

Usually adhesions do not cause any special complications and they do not need to be treated. But, nevertheless, we should not forget that the human body is not just a set of organs that each perform its own function, it is their interconnected complex. Violations in the operation of one system will necessarily entail the development pathological processes in another. For example, many appendix surgeries give an 80% chance that the patient will have to treat the gallbladder in the future.

Adhesions after removal of the uterus are a common complication and occur in 90% of operated women. it dangerous consequence surgical intervention, since as a result various functional disorders in the work of internal organs, up to the symptoms of intestinal obstruction.

What are spikes

Extensive adhesions of internal organs are also called adhesive disease by doctors. However, it is important to distinguish the physiological process of adhesion formation from the pathological one.

Removal of the uterus (hysterectomy) is always accompanied by the formation of connective tissue scars at the sites of scars and incisions. The resulting scars are physiological adhesions. Scarring of the wound gradually stops, due to which normal functioning organs are restored, and the symptoms of inflammation disappear.

Important! The process of formation of adhesions (or scarring) after removal of the uterus is normal physiological state which has nothing to do with pathology. If the formation of connective tissue does not stop, and fibrous cords grow and grow into other internal organs, this is a pathology called adhesive disease. It has its own symptoms and requires serious medical intervention.

These pathological fibrous bands have a whitish hue. They look like fibrous formations that connect the internal organs. The strength of the strands is high, which is why it is necessary to resort to a second operation to remove them.

Reasons for the formation of adhesions after removal of the uterus

In the body, adhesions occur mainly only after extensive operations that require the removal of one or two organs at once. The reasons for their occurrence are diverse and depend on a number of factors:

• How long was the operation.
• The amount of surgery.
• The volume of blood loss.
• Internal bleeding in the postoperative period. In this case, there is an active resorption of blood accumulated in the abdominal cavity, and this predisposes to the occurrence of adhesions.
• Infection of wounds in the postoperative period.
• genetic predisposition. This is due to the fact that a special enzyme is not formed in a genetically predisposed organism that can dissolve fibrin overlays, which ultimately leads to symptoms of adhesive disease.
• People of asthenic physique.
• In addition, the occurrence of adhesions depends on the actions of the surgeon himself. What is important here is how correctly the incision was made, what suture materials were used, how professionally the suture itself was applied.
• There are cases when surgeons left foreign objects in the abdominal cavity. It also predisposes to the development of adhesions after hysterectomy and the onset of symptoms of adhesive disease.

Symptoms of adhesions after surgery

You can suspect adhesive disease in a woman who has recently had a uterus removed by the following symptoms:

• Aching or pulling pains in the lower abdomen, forcing to take an antalgic (forced) position. Pain can be permanent or intermittent, reaching a high intensity.
• Delay and other disorders of urination and defecation, up to the absence of urine and feces.
• Symptoms of dyspeptic disorders: pain throughout the abdomen, flatulence and gas formation, " sheep feces', feeling increased peristalsis intestines and others.
• Subfebrile or febrile body temperature (increase to 38-40 C).
• Feeling of severe pain when probing the postoperative scar, its redness and swelling.
• Pain during intercourse. Discharge from the vagina is bloody.
• If several weeks have passed since the removal of the uterus, then when these symptoms appear, you should immediately contact your doctor (gynecologist).

Important! Symptoms of adhesive disease are nonspecific. This means that if a woman makes such complaints, then speak with full confidence that she has formed adhesions in the pelvis, not a single qualified doctor can. To confirm the diagnosis, instrumental and laboratory methods examinations.

Diagnosis of adhesive process in the postoperative period

A preliminary diagnosis is made after a thorough history taking, patient complaints and symptoms of the disease. To confirm the presence of adhesions, the doctor prescribes an additional examination:

• General blood analysis. Needed to check if you have inflammation in the body. Also evaluate the activity of the fibrinolytic system of the blood.
• Ultrasound of the abdominal cavity and the pelvic cavity. The visual method of examination helps with a 100% guarantee to say whether there is an adhesive process in the small pelvis after the operation of removing the uterus.
• X-ray examination of the intestines with the help of contrast (coloring) substances. An auxiliary method that allows you to judge the patency of the intestine and the degree of narrowing of its lumen.
• Laparoscopic diagnostics is also used, during which individual adhesive formations are dissected and removed, and the issue of repeated surgical intervention is also resolved.

Surgical treatment of adhesions

Mostly adhesive disease is treated surgically. This is related to the fact that conservative treatment not effective, it is used only as a prophylaxis in the postoperative period and to relieve symptoms of the disease.

There are 2 types of operation:

1. Laparoscopic surgery. It is carried out using special fiber optic equipment. At the same time, 2-3 small incisions are made on the skin of the anterior abdominal wall, and then the abdominal wall is pierced in these places. These incisions provide access to the abdominal cavity. The advantage of this operation is that the dissection of adhesions is carried out under control optical system, with minimal trauma to internal organs. With the help of special laparoscopic instruments, fibrous cords are cut, followed by hemostasis. Pain and complications after such surgery are extremely rare. The recovery period takes several days, the symptoms of the adhesive process disappear almost immediately, physical activity is possible the very next day after the operation.
2. Laparotomy. Shown in two situations:
   • There is no possibility of laparoscopic surgery.
   • The presence of symptoms of an extensive adhesive process in the abdominal cavity.

   In this case, the lower middle access is used first, and then it is expanded upwards to 15-20 cm. This is done in order to carefully examine all organs and remove overgrown adhesions. Such an operation is highly traumatic, has a risk of postoperative complications or recurrence of the disease. The recovery period takes about two weeks.

After the operation of dissection of adhesions, it is necessary to constantly visit the attending physician in order to observe the processes occurring in the small pelvis

Important! No doctor can give a full guarantee that adhesive disease will not return to you again. Removal of adhesions is the same operation as removal of the uterus, which means that fibrous bands between organs can form again. To prevent this from happening, follow the doctor's recommendations in the postoperative period and prevent the recurrence of the disease.

Prevention of adhesion formation

If you are scheduled for surgery to remove the uterus, carefully approach the choice of a surgeon. The course of the postoperative period largely depends on it.

What will the doctor do

For wound closure, use only absorbable surgical suture material. This is necessary as a hysterectomy is an extensive and highly traumatic operation. The threads are foreign body, which will be overgrown with connective tissue and subsequently form adhesions.

Professionally sutures when the edges of the wound are in contact throughout with each other.

Drug prevention of adhesive disease in the postoperative period. The doctor prescribes broad-spectrum antibiotics (to prevent infection, suppress inflammation), anticoagulants.

Early appointment of physiotherapy with electrophoresis of enzymes that destroy fibrin (lidase, hyaluronidase and others). They destroy dense adhesive formations, which contributes to the rapid extinction of the symptoms of the disease.

Dynamic observation after surgery, careful monitoring of the state of the pelvic organs using ultrasound.

What should you do

Early physical activity after hysterectomy is important for the prevention of adhesions. The fact is that while walking improves intestinal motility, which prevents the development of adhesions.

The second point is diet. Eliminate salty, spicy, fried, alcohol, carbonated drinks. They disrupt digestion, and intestinal motility weakens. It is necessary to eat up to 6-8 times a day in fractional small portions. This will not overload the intestines, which means it will not be constricted by fibrous overlays.

With regards to folk methods of treatment, they can be used as an addition to drug therapy and only after consulting the attending physician. For the prevention and treatment of adhesions in folk medicine, infusions and decoctions of plantain, dill, flax seeds, St. John's wort, aloe leaves are used.

Summing up

Adhesive disease disrupts the physiological functioning of all organs of the abdominal cavity. It is a consequence of highly traumatic operations. Advanced forms of adhesive disease can only be treated by surgery, but this also harms the body. To prevent this from happening, it is necessary to follow the recommendations of the attending physician in the postoperative period and to prevent the recurrence of the disease. When the first symptoms appear, indicating the presence of adhesions in the body, you should immediately consult a doctor for consultation and subsequent diagnosis.

Video: When to be afraid of adhesions? The main symptoms of impending problems