Postoperative intestinal adhesions - what, the intestines are stuck together?

Many people experience abdominal pain and bloating after abdominal surgery. Due to the lack of timely and systematic treatment, intestinal adhesions or even intestinal obstruction occur, and they have to undergo a second operation after the operation. According to statistics, about 80% of patients experience intestinal adhesions after surgery. Therefore, if you experience abdominal pain after abdominal surgery, you must seek medical attention in time.

01 Why does my stomach still hurt after the operation?

02 What is postoperative intestinal adhesion

Incidence and susceptible populations: 60% to 90% of gynecological patients develop varying degrees of intestinal adhesions after pelvic and abdominal surgery, which can occur at any age.

Causes of adhesion: Surgery can greatly damage the peritoneum, triggering our body's inflammatory response, and adhesions will occur during the tissue repair process.

Common manifestations: Dull pain or bloating in the abdomen, which often occurs after eating (eating a lot or eating some food that is not easy to digest can lead to increased intestinal motility and thus worsening abdominal pain), poor nutritional status, and mild tenderness in the abdomen at the adhesion site.

Consequences: Postoperative pelvic and abdominal adhesions may lead to infertility, chronic abdominal pain/pelvic pain, intestinal obstruction and other complications, and may also increase the incidence of complications of reoperation. About 35% of patients with adhesions need to be hospitalized again for a second operation.

03 How to determine whether you have intestinal adhesions

Clinical symptoms: There is often dull pain or bloating in the abdomen, which often occurs after eating, indicating poor nutritional status.

Objective examination: It can be determined through gastrointestinal angiography, ultrasound examination, and surgical exploration. Surgical exploration can visually determine the adhesion site and adhesion degree, and is the gold standard for diagnosing postoperative adhesion.

Grading of severity of intestinal adhesions:

04 How to determine whether you have intestinal obstruction

Intestinal obstruction is the most serious complication of intestinal adhesion. As the name suggests, it means that the intestines are blocked and the contents of the intestines cannot pass smoothly. So after intestinal obstruction, it is found that in addition to abdominal pain, you can't fart, you can't defecate, your stomach is bloated, and you vomit. There are very few patients who are hospitalized just because of intestinal adhesions. Usually, they are admitted to the hospital for treatment when intestinal adhesions are secondary to intestinal obstruction. Intestinal adhesion combined with intestinal obstruction is also called postoperative adhesive intestinal obstruction, which can occur at any time after surgery, most of which are within 2-3 years, and early cases can also occur within two weeks after surgery. It can be diagnosed through abdominal fluoroscopy, X-rays, and laboratory tests.

05 How can you prevent and treat intestinal adhesions?

Preoperative prevention:

(1) Reduce the number of abdominal surgeries. The higher the number of surgeries, the higher the incidence of intestinal adhesions. For childbirth, it is recommended to reduce the number of cesarean sections and try to have a natural birth;

(2) If there are symptoms such as placenta previa and amnionitis before surgery, contact the doctor to actively control inflammation;

(3) Use anti-adhesion drugs for treatment, such as local application of medical chitosan on the uterine incision.

(4) Eat three meals a day regularly to reduce the burden on your stomach and intestines

(5) Increase aerobic exercise, such as walking and going up and down stairs. These exercises can provide good blood supply to the peritoneum and gastrointestinal tract, improve gastrointestinal motility, and speed up wound repair and reduce the occurrence of inflammation after surgical injury.

After surgery:

(1) Functional exercise

Early postoperative period

① If the condition permits, turn over and move around early and change body position frequently.

In the early postoperative period, if there is no increase in pain and physical strength allows, various body positions can be changed, such as lying on the left or right side, lying flat, and semi-sitting on the bed.

② Get out of bed and move around as soon as possible

Getting out of bed and moving around can effectively improve blood circulation, promote wound recovery, and reduce the formation of blood clots; it can also increase gastrointestinal motility and promote gastrointestinal health.

Generally speaking, if it is a normal birth, you can get out of bed 6 to 12 hours after delivery, and if it is a caesarean section, you can get out of bed and move around 24 hours after delivery. If there is infection, trauma, etc., the rest time will be increased as appropriate.

As the body gradually recovers, the frequency, range and time of getting out of bed will gradually increase.

③ Functional exercises in bed

In the early postoperative period, when it is inconvenient to get out of bed, you can do some simple functional exercises in bed, such as leg flexion, hip lifting, and sitting trunk exercises, and be careful to avoid abdominal exertion. Each time for 3 to 5 minutes, 4 to 5 times a day.

Mid- to late-stage postoperative

You can perform appropriate leg-lifting exercises one week after the operation, especially get out of bed more often, and be able to take care of yourself in daily life.

You can do simple walking activities in a standing position and go outdoors more often. Later, you can actively participate in family life. For example, half a month to one month after delivery, you can do some simple housework, such as sweeping the floor and folding clothes. Then gradually increase the difficulty of activities and return to normal life.

(2) Physical therapy:

① Microwave: Microwave is an electromagnetic wave with a frequency between 300-300000MHz. It can produce microwave thermal effect when acting on human tissue, enhance blood circulation, accelerate metabolism, reduce inflammation and pain, reduce tissue adhesion, and promote wound healing.

②Ultrasound: Ultrasound refers to mechanical vibration waves with a frequency above 20kHz, which is beyond the hearing range of our human ears. It can increase blood circulation and raise the pain threshold, thereby playing an anti-inflammatory and analgesic role and relieving tissue adhesion.

(3) Actively controlling your diet is important

① Eat regularly and avoid overeating, which will increase the burden on your stomach and intestines.

② Pay attention to food hygiene to prevent gastrointestinal inflammation and abnormal gastrointestinal motility.

③It is not advisable to engage in strenuous physical activities after a meal, especially those that require sudden changes in body position.

06 I have intestinal adhesion. Do I need another surgery?

Adhesive intestinal obstruction is mostly simple obstruction. If there is no sign of intestinal strangulation, non-surgical treatment should be used first. If there is a sign of intestinal strangulation, adhesive intestinal obstruction requires surgical treatment. However, surgical treatment can also cause new adhesions, so avoid unnecessary surgery. At the same time, it is also necessary to prevent intestinal ischemia and necrosis caused by delaying the timing of surgery due to non-surgical treatment. Be sure to go to the hospital for specific treatment and listen to the doctor's advice. In short, most surgeries will cause abdominal adhesions, so surgery is only performed when it is necessary.

References

[1] Xu Shuai, Liu Shujuan, Wang Jianliu, Zhang Shiqian, Wang Jiandong, Wang Yudong. Expert consensus on the prevention and diagnosis of pelvic and abdominal adhesions after gynecological surgery (2020 edition)[J]. Chinese Journal of Minimally Invasive Surgery, 2020, 26(06):481-488.

[2] Lv Huixian, Lv Huiling, Qi Yue. Analysis of risk factors and prevention and treatment of pelvic and abdominal adhesions after cesarean section[J]. Modern Diagnosis and Treatment, 2015, 26(08): 1833-1834.

[3] Li Xiaoyan, Leng Jinhua. Mechanism and preventive measures of postoperative adhesions in pelvic and abdominal cavity[J]. Chinese Journal of Minimally Invasive Surgery, 2012, 12(02): 124-128

[4] Ma Xiao et al., Intestinal Adhesions, Shaanxi Science and Technology Press, 1988.

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Author: Yuan Mei, Bi Xia, Zhao Jiangxia, Zhoupu Hospital, Shanghai University of Medicine and Health Sciences

About the Author

Yuan Mei

A therapist at the Rehabilitation Medicine Department of Zhoupu Hospital Affiliated to Shanghai Health and Medical College, she holds a master's degree in rehabilitation therapy and has published three rehabilitation-related papers. She is good at postpartum rehabilitation and rehabilitation of cervical and lumbar diseases.

About the Author

Bi Xia

Director of the Rehabilitation Medicine Department of Zhoupu Hospital Affiliated to Shanghai University of Medicine and Medical Sciences, and Vice President of the School of Rehabilitation of Shanghai University of Medicine and Medical Sciences. He was selected into the Excellent Discipline Leader and Leading Talent Training Program of the Pudong New Area Health System in 2010, 2018 and 2019. He has published 4 SCI papers and more than 30 core journal papers as the first author and corresponding author.

Professional fields: stroke rehabilitation, fracture postoperative rehabilitation, spinal cord injury rehabilitation, artificial joint perioperative rehabilitation, hand injury rehabilitation, etc.

Main academic positions: Member of the Geriatric Rehabilitation Branch of the Chinese Rehabilitation Medicine Association, Member of the Medical and Nursing Integration Committee of the Chinese Rehabilitation Medicine Association, Rehabilitation Committee Member of the Geriatric Rehabilitation Branch of the Chinese Medical Doctor Association, Executive Director of the Shanghai Rehabilitation Medicine Association, Member of the Physical Medicine and Rehabilitation Branch of the Shanghai Medical Association, Vice Chairman of the Rehabilitation Treatment Committee of the Shanghai Rehabilitation Medicine Association, Member of the Orthopedic Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Member of the Spinal Cord Injury Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Member of the Community Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Member of the Sports Health and Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Chairman of the Rehabilitation and Physiotherapy Committee of the Shanghai Pudong New Area Medical Association, and other academic positions.

Funded by Shanghai Science and Technology Commission's Science Popularization Project

(Project No.: 20DZ2311100)