abdominal adhesions?

Okay, 'pros'...need some help here.

I've had 2 c-sections and a laporoscopy many years ago. Occassionally, I've had pains when I've strained my abdominal muscles...feeling like someone is sticking a knife in my scar or feeling like that knife goes through to my rectum. These pains are usually gone in a day or so.

Perhaps it's just because I'm getting older, but it seems each time is getting worse and lasts longer. A new 'symptom' is that I am very gassy and when I try to move my bowels it's as though a sword is being pushed through me.

Back when I was menstruating, I would get my cramps in my back. Well, I'm long past that, but, my back pain is so much worse with this situation. I can't help but think it's related.

I'm sure you'll say I should see a doctor, but, which type? What type of test should I seek? CT? MRI? What would show the status the best? I have a history of ovarian cysts and fibroids of the uterus, but was told this would all 'disappear' after menopause...so I haven't seen a GYN in years! Should I?

This pain is keeping me down for days!!!

Pitmom:
Your self-diagnosis of adhesions seems Right On.

Welcome to the Adhesions Club.

Adhesions are basically bands of scar tissue that act like a rubber band, tethering a segment of the small bowel to another segment of small bowel, or tethering to an adjacent organ, or tethering to the abdominal wall. The tethering results in a transient “kink” in the small bowel, analogous to a “kink” in a garden hose with running water.

Symptoms of a partial instructions: repeated waves of abdominal pain; nausea; projectile vomiting; little passage of gas and poop; abdominal distension.

Things you can implement to keep episodes tolerable:
A. Use an osmotic laxative daily. Miralax or Milk of Magnesia or supplemental magnesium citrate capsules. The goal is to add water to digested food material in the intestinal tract, to make the consistency more liquidity, so that “poop” can pass more easily trough narrows passageways.

B. Focus on hydration and liquids for nutrition and calories during an “episode.”
Consume only soft foods and keep portion sizes very small as you do re-introduce foods. You do not want to overwhelm the intestinal tract with too much volume or bulk. Avoid foods that are high in insoluble fiber.

C. Keep moving
The intestines are a tube of smooth muscle and rely on the body’s activity for motility. Walking is your friend. Practicing basic beginning yoga postures is a Best Practice for those with adhesions. Yoga posture and stretches act as a form of intestinal massage.

D. Hot showers, hot packs
Warm showers and hot packs to the abdomen help relax muscles that contract due to pain and guarding.

Unfortunately, adhesions are not visible by x-ray nor by imaging CT scans nor by MRI. Adhesions are radio-opaque to imaging. The effects of an active bowel obstruction can be only seen on imaging when the obstruction/narrowing is extreme enough to cause gastric distension and ballooning above the area of kink or structure OR as a goodly volume of fecal back-up/constipation takes place due to the obstruction and this fecal back-up becomes weighty and discomforting. Extensive fecal constipation will show on imaging.

Protocol for a partial small bowel obstruction is bowel rest. Stop intake of solid food. Sip on clear liquids. Dose freely with Miralax to help clear the partial restriction. Walk and stretch.

When to go to the ER? Excruciating abdominal pain, it will literllly bring you to your knees; projectile vomiting, repeated; no passage of gas or bowel movement.

I have had several small bowel obstructions. None of them pleasant. It sounds as though yours are intermittent and transient in nature. Cut back on solid food for now with a focus on hydration with clear liquids. Focus on hydration. Lie on your left side, as this often helps sift the intestines to drop down. Begin to use an osmotic laxative on a daily basis as a preventative measure.

Deep tissue masage by a physical therapist is one avenue you can discuss with your physician. Deep tissue massage has known benefits in reducing the incidence of small bowel obstructions by making scar tissue more subtle. You can Google “deep tissue abdominal massage for management of adhesions” to learn more.
Karen

Post Edited ((Seashell)) : 12/22/2018 11:44:32 AM (GMT-7)

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Pitmom:
Yours sounds like a case of adhesions causing a transient partial small bowel obstruction. Not a total obstruction. That you have a bowel movement along with your symptoms of stabbing pains and gas would point to adhesions that are causing intermittent “kinks” or a narrowing - but not enough to cause a complete stoppage of food material moving down and through.

With a partial obstruction, the segment of intestine above the link or narrowing becomes dilated due to pressure. While some fecal matter passes through the narrowed section, a residual remainder of fecal matter is retained and collects and intestinal motility slows and is erratic. Gas production increases from the retained food that is essentially “rotting” in the intestinal tract and from gas released from normal bacterial flora.

Transient sbo’s are often self-limiting and clear within 2-3 days. Only to be reappear and problematic at a later date.

It is the nature of how the small bowel moves that leaves it suseptible to a sbo. The small bowel is a narrow tube of small muscle, about 3/4 inch in diameter. It lies under a moist, fatty apron called the omentum. The small bowel slithers and glides under the moist omentum much like a snake, slithering and wiggling 24-7. The slithering motion makes the small bowel both vulnerable to becoming entangled in adjacent scar tissue as well as enabling it to free itself from tethered holdings. A catch-22.

The large intestine, on the other hand, is rarely involved in a partial or full obstruction. The large bowel has a larger diameter (2 inches) and moves in paristaltic waves only 6-8 times a day. The large intestine is less active and less apt to move into a position where it may become entangled.

Anywho . . . A partial sbo due to scar tissue fits the bill of your symptoms. The suggestions that I listed may offer you a way to lessen the severity of symptoms during an episode and/or lessen the number of transient episodes.

Gas expelled as the partial sob clears is as you describe. It is like a ballon that has been momentarily twisted, then releasing air with a vengeance. The use of GasX as suggested by Straydog is good advice. But know GasX and similar symethecone reduce gas as formed in the stomach and will llittle effect on gas build-up and gas pressure owing to a partial sbo, per say.

As quickly as adhesion symptoms appear they can also disappear just as quickly. Adhesions and their effects are fickle.
Karen