• Dr Peter Chew


Q. I had 3 caesarean sections, the last one was about 6 months ago. Recently I had lower abdominal pain on and off near the right side of my abdominal wound. My obstetrician told me that it is due to adhesions. What is adhesion? What are the causes? Is it serious? Do I require another surgery? What can I do to relieve the pain?

A. Adhesions are bands of fibrous scar tissue formed on the surface of the abdominal organs such as intestines and the womb (see figure 1&2). Normally, these organs are lying freely in the abdominal cavity without sticking to one another. Their surfaces are smooth and are covered by a thin membrane.

However, if this membrane is breached from handling by surgeon during abdominal operation, inflammation will occur with subsequent scar formation. The scar will bind the organs together and/or induce the organs to stick to the abdominal wall. It has been estimated that adhesion will develop in more than 90% of patients after an abdominal surgery. The more times the surgery is performed, the more extensive the adhesions.

Another cause of adhesion is infection. It can be a result of a ruptured appendix or pelvic infection. In women with endometriosis, a chronic condition in which there is a backflow of menstrual blood into the pelvic cavity, the menstrual deposits may cause widespread scar formation resulting in the pelvic organs gumming together.

Most adhesions do not cause symptoms except for occasional cramps. The abdominal pain is intermittent and usually resolves by itself without treatment. But in some patients, the adhesions can be severe and cause partial or complete blockage of the intestines.

If the intestines are partially blocked, abdominal pain may become severe and the abdomen is bloated with gas. There may be nausea and occasional vomiting. With conservative treatment using medications and intravenous fluid therapy, the blockage is often settled If there is complete blockage, non-stop vomiting with abdominal distension can occur. The patient needs immediate medical attention. Otherwise, severe dehydration, fever, shock and death may occur. Urgent surgery to relieve the intestinal obstruction is required.

Abdominal adhesions are permanent and there is no way to prevent their formation. Since you have mild abdominal cramps without nausea or vomiting, you probably do not have intestinal obstruction. Surgery is probably not necessary. Medications to relieve the intestinal spasms will help. A low-fibre diet, which is easier to digest and a regular bowel habit are important to prevent an intestinal blockage.

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