An adhesion refers to the growing together of different organs. It is usually caused by major injuries and surgery. The consequences of adhesions can be both harmless and life-threatening (intestinal obstruction).
What are adhesions?
Adhesions, or adhesions in medical terms, often occur after major surgery in the abdomen. In this case, an adhesion represents the growing together of different organs. As a result of wound healing, adhesions may occur, which, if prolonged, becomes an adhesion due to the formation of a layer of connective tissue. Often, a strand of scar tissue, also known as a bride, forms between the fused organs. Within this connective tissue strand, blood vessels and nerve connections continue to form. Colloquially, this is referred to as an “adhesion belly”. The medical term synechiae is also used. In most cases, the peritoneum is involved in an adhesion. The peritoneum is made up of connective tissue that can form adhesions with other internal organs when injured. However, adhesions can also occur in endometriosis. If the adhesion film persists for more than five days, new connective tissue cells form, which connect the connective tissue of different organs.
Cause
In most cases, the cause of adhesion is a surgical procedure in the abdominal cavity, during which injury to the peritoneum occurs. However, peritonitis can also lead to adhesions. Furthermore, sometimes endometriosis plays a role in the development of adhesions in women. Endometriosis is a benign but painful chronic disease characterized by the presence of uterine tissue outside the uterine cavity on foreign organs. For example, if the peritoneum is injured, a layer of fibrin initially forms to cover the wound. Fibrin is a sticky coating designed to speed the healing process. Within the abdominal cavity, however, the organs lie very close together and are often only separated from each other by a narrow gap through a film of fluid. However, adhesions can then occur in damaged areas. Normally, the fibrin layer is broken down again within five days after the onset of wound healing. The adjacent organs separate again. However, if the fibrin degradation is delayed, new connective tissue cells are formed, which connect the peritoneum with the connective tissue of the other organ. An adhesion forms. Adhesions can form anywhere in the abdomen after surgery. Due to carryover of wound fluid, it is even possible for adhesions to occur at a site in the abdomen that is far away from the surgery.
Symptoms, complaints, and signs
In most cases, adhesions are harmless and do not cause symptoms. In a few cases, however, they can have serious consequences. However, chronic lower abdominal pain is common, caused by decreased mobility of the organs affected by the adhesion. Nerve connections form within the strand of adhesions, causing the pain when strained. The pain often affects the patient’s quality of life. However, worse consequences result from the late effects that may develop. For example, adhesions in the area of the ovary or fallopian tube can lead to infertility because egg transport is no longer optimal. A far worse consequence, however, could result from an adhesion with the intestine. In addition to chronic abdominal pain, stool irregularity and bloating, the development of intestinal obstruction is also possible.
Diagnosis and course of the disease
Diagnosis of adhesions is often difficult because the symptoms are usually nonspecific. In X-ray or ultrasound examinations, adhesions are often not found at all. However, if an adhesion is suspected, such imaging techniques as high-resolution ultrasound or special adhesion abdominal magnetic resonance imaging can provide information. But even these techniques are not specific enough. Only laparoscopy using keyhole techniques can prove an adhesion beyond doubt.
Complications
In most cases, there is no discomfort or complications due to the adhesions.They occur very frequently and are a common symptom after surgery. However, adhesions can cause severe pain in the patient’s abdomen. Significantly reduced mobility also occurs due to this pain, thereby having a very negative effect on the patient’s quality of life. Furthermore, those affected may suffer from paralysis or other disturbances in sensitivity, as the adhesions can pinch nerves or even damage them completely. In women, adhesions can also lead to infertility if they negatively affect egg transport. Sufferers also suffer from discomfort in the intestinal area, and in the worst cases, intestinal obstruction can occur. Likewise, flatulence and bloating occur, which continue to significantly complicate the daily life of the affected person. As a rule, adhesions can be treated with surgical procedures. However, they can also be prevented directly during surgery. Complications do not occur. If the adhesions are diagnosed at an early stage, the course of the disease is positive. The life expectancy of the patient is then also not negatively affected.
When should one go to the doctor?
Regular personal hygiene should be performed to prevent adhesions. Checking the growth of nails can normally be done independently or by nurses. A doctor is not necessary for the procedures of body cleansing. In addition, regular applications of foot care or manicure can be used to eliminate early discomfort. Medical assistance is needed when impairments occur that can no longer be remedied by the patient’s own means. Pain, restrictions in mobility or changes in the appearance of the skin should be examined and treated. If there are disturbances of the blood circulation, abnormalities of the gait or unsteadiness in locomotion, there is a need for action. The formation of pus must be monitored, as in severe cases it can lead to sepsis. If specifics of pus development occur, a physician is needed. Disturbances in managing daily responsibilities, a visual blemish, or poor posture should also be discussed with a physician. A general persistent malaise, a feeling of illness or a steady increase of complaints should be clarified by a doctor. Medical tests are needed to make a diagnosis as well as to clarify the cause. To avoid long-term damage or permanent impairment of quality of life, a physician should be consulted if the physical irregularities persist for several weeks.
Treatment and therapy
Treatment of an adhesion often proves difficult. It is true that the fused organs can be separated again by a new operation. However, new adhesions often form again in the process. Only temporarily, the chronic pain disappears immediately after the operation and returns after some time. If only single brides are present, the operation promises to be a success. However, this is not guaranteed either. If there are several adhesions, we wait to see if the symptoms will subside without surgery. The operation is usually performed via a keyhole procedure. Today, there are methods of applying so-called adhesion barriers during the operation. These are solid or liquid separating layers that are intended to prevent the different tissues from sticking together. Solid adhesion barriers represent membranes that are applied to the wound site after surgery to keep the tissues apart during the healing process. After healing, these barriers degrade after a few weeks. When liquid adhesion barriers are used, the entire abdominal cavity is flushed after surgery to prevent adhesion. After a few days, the body has completely absorbed the liquid. However, there is no complete guarantee to prevent adhesion even with these methods.
Prevention
Gentle surgical technologies that cause as little tissue defect as possible are increasingly being used to prevent adhesions. Therefore, keyhole surgery is increasingly used. Prophylactically, solid or liquid adhesion barriers can now be used after extensive surgical procedures.However, the successes of these methods have not yet been clearly proven by medical studies and are therefore not yet widely used.
Follow-up
The aftercare of adhesions – mostly caused by accidents or surgery- does not exclude the need for a new surgical treatment. This is based on the discomfort and limitations for the patient resulting from the adhesions. If the patient is symptom-free, no special follow-up is required and in many cases the adhesions are only discovered by chance diagnosis in the course of other treatments or examinations. However, if an adhesion causes discomfort to organs, the adhesions must be surgically restored to their normal state. In the case of adhesions in the abdominal cavity, this can often be done by endoscopic surgery under general anesthesia. The hospital stay is short, but depends on the extent and degree of adhesions. There are no methods or home remedies to alleviate adhesions, only a medical specialist can help the patient and take over the aftercare. Adhesions of the skin, for example due to burns, are a special feature. These can usually be quickly repaired by minor outpatient surgery or sometimes by purely non-invasive treatment by a dermatologist. In this case, no special further aftercare is then required, since the cause is no longer present.
What you can do yourself
Adhesions usually need to be surgically removed and the pain treated with medication. Affected people can do a few things themselves to reduce the adhesions or to support medical treatment. First, massages and the use of natural pain relievers are recommended. Regular pressure massages can loosen the tissue. In addition to massages, acupuncture or acupressure may also be an option. Acupressure may be particularly useful for nerve pain. Depending on the location of the adhesions, yoga or physiotherapy can also be used as supportive measures. If the adhesions have a negative effect on mental health because self-esteem suffers, talk therapy is recommended. Discussions with friends or family members who themselves suffer from adhesions are often more effective. In the long term, adhesions that cannot be removed by massage must be treated surgically. After surgery, typical general measures apply, such as monitoring the surgical wound and taking it easy on the body. Sporting activity is usually forbidden, as rapid and intense movements can open the stitches. If this happens, the doctor must be informed immediately. In general, however, adhesions can be treated well, provided that the patient takes the right measures.
