Posted by Article on 2/5/2002, 11:11 am

[Continued from above article] Adhesion Formation As previous newsletters have noted, adhesions are your body’s natural defense mechanism for dealing with intra-abdominal injury. The adhesions form as your body tries to wall off the injured area. This is basically a very good process. However, it concerns us when it affects the function of the ovaries or tubes and interferes with fertility. It also becomes a problem when it causes active organs (such as the bladder, uterus, tubes, ovaries, and/or intestine) to become bound together. This can cause pain because tissue that was designed to float freely within the pelvic is now stuck together. Adhesions usually form in the immediate post-op period. We use every available technique to protect the active organs listed above from becoming involved with adhesions. Still, some adhesions may form. We certainly expect them more often in Stage III-IV patients due to the more extensive surgery needed to totally excise all their disease. Most of the time, adhesions can exist harmlessly in the abdomen without creating painful problems. However, the potential for pain or infertility is certainly increased in the endometriosis patient. Interestingly, we have observed in some women the recurrence of symptoms attributed to adhesions in the one to five year period post op. It is my opinion that once adhesions have formed in the immediate post-op period, they will not continue to form unless there is a new insult to the tissues such as injury, infection, additional surgery, etc. The best explanation for the change in symptoms seems to be that the adhesions already present may undergo a very slow process of coalescing or shrinking. If this process begins to limit the mobility of organs that need to change size and/or position, painful symptoms can result. If these symptoms become severe, they are usually easy to treat with laparoscopy. Most of the repeat surgeries I do after initial LAPEX do not show significant endometriosis, but I find other pelvic problems, of which adhesions are at the top of the list. Painful Bowel Movements Pain with a bowel movement is another scary event after surgery. There may be several possible causes. Patients who have had a bowel resection, or excision of endo from the bowel, cul-de-sac, or recto-vaginal septum are likely to experience this due to the passage of gas, liquid and solids through the injured and swollen area in the wall of the intestine. Additionally, if the bowel stays relaxed for a period of time after the surgery (especially if you’ve done a bowel prep), the first bowel movement may be difficult. You can use a glycerin suppository for help, but only if you did not have a bowel resection. When painful bowel movements occur substantially later, we need to consider other factors, including constipation, use of pain medication, adhesion formation, etc. If pain with bowel movements is associated with a general increase in abdominal pain and/or a fever over 100.5o, it is time to call your physician. Painful Intercourse Most of our patients who have not had a hysterectomy can resume sexual relations at three weeks assuming they feel comfortable about it. Sometimes the physical movement of the tissues at the top of the vagina will create tenderness or pain. In some cases with very slow recoveries, it can take 2-3 months for sex to become comfortable. "Traditional" Medicine We periodically get calls from patients who struggle with the confusion created when what they have learned about endometriosis through educational sources like this newsletter conflicts with what their doctors are telling them. It is good to keep in mind that the vast majority of physicians are practicing the best medicine that they can. They use the information they learned when they were trained, and use it excellently. Some of the information that we distribute is contrary to the traditional approach to endometriosis. We are using the experience we have gained to add to the traditional understanding of endo. There are very few specialists in endo in the world today, and change takes time. Updating the traditional approach is a gradual, evolving process. We have seen great changes, for example, in the ability to recognize early forms of endo at surgery by general gynecologists. However, we still find that the majority of practitioners are not aware of the evidence that would change their prescribing habits, surgical approaches, and referral patterns. If you struggle in a situation with your personal practitioner because he or she is only aware of the traditional approach or is skeptical about LAPEX or its consequences, I think it helps to determine if he or she is open to evaluating for themselves the changing opinions of experts in this area. Good ways to do this are: Take them copies of these materials, and ask them to review them at their leisure Be sure they get a post-op packet from the CEC with a copy of your op and path reports, as well as information about the Center Ask them if they would be willing to telephone me or Dr. Lyons about your particular situation, or to answer any questions they might have. If you find that they are not willing to review new information and relate it to their approach, you must decide whether or not to stay with them or to seek another caregiver.

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