Adhesions: Managing Chronic Constipation After Surgery

Intestinal adhesions causing bowel obstruction?

Five years ago, I underwent a hysterectomy due to uterine fibroids.
For the past two years, I have been unable to have regular bowel movements and have relied on laxatives to go to the bathroom.
However, despite trying many types of laxatives prescribed by my doctor (both granules and liquid forms), I experience severe bowel cramping and discomfort to the point of feeling nauseous, yet I still cannot have a bowel movement.
Ultimately, I have to use glycerin suppositories to relieve myself.
Recently, I underwent a barium study and a colonoscopy at the hospital, where the doctor noted that my intestines are quite twisted, particularly in the sigmoid colon area, and there is also intestinal adhesions.
However, there are no other abnormalities or blockages in the intestines.
Lately, I have been experiencing frequent dull pain in my lower left abdomen and severe lower back pain, which has caused significant disruption to my daily life.
The doctor mentioned that my condition does not require surgery and advised me to consult a surgical outpatient clinic.
I would like to ask Dr.
Ke, is surgery really not an option to resolve this? If so, how can I improve my condition? Is the lower back pain related to the adhesions?

jj, 40~49 year old female. Ask Date: 2016/03/02

Dr. Ke Fangxu reply Surgery

Intestinal adhesions can indeed be a troublesome issue, and surgery is typically not performed unless the adhesions cause bowel obstruction.
In most cases, treatment is primarily medication-based, as surgical intervention may lead to further adhesions and worsen the condition.
When you mention that you cannot have a bowel movement without medication, it implies that taking medication resolves the issue.
If that is the case, I recommend that you consistently take the medication for a period of time, maintain a light diet, and uphold a good lifestyle routine.
If there is no improvement, then discuss the possibility of surgical treatment with your physician.

Reply Date: 2016/03/02

More Info

Chronic constipation following abdominal surgery, such as a hysterectomy for uterine fibroids, can be a challenging condition to manage. It is not uncommon for patients to experience changes in bowel habits after such procedures, particularly due to the formation of adhesions, which are bands of scar tissue that can develop between organs and tissues in the abdomen. These adhesions can lead to a variety of gastrointestinal issues, including bowel obstruction, altered bowel motility, and chronic pain.

In your case, the findings from the barium study and colonoscopy indicate that while there are no significant blockages, the presence of adhesions and the noted curvature of the colon, particularly in the sigmoid colon, may be contributing to your symptoms. Adhesions can restrict the normal movement of the intestines, leading to discomfort, pain, and difficulty in passing stool. The left lower abdominal pain and lower back discomfort you are experiencing could indeed be related to these adhesions, as they can cause tension and pulling on surrounding structures.

Regarding surgical intervention, it is essential to understand that not all cases of adhesions require surgery. Surgeons often weigh the risks and benefits of an operation, especially since surgery to remove adhesions (adhesiolysis) can sometimes lead to the formation of new adhesions. This is particularly true if the underlying cause of the adhesions is not addressed. Therefore, if your doctor has advised against surgery, it may be because they believe that the potential risks outweigh the benefits in your specific situation.

To manage your chronic constipation and associated symptoms, consider the following strategies:
1. Dietary Modifications: Increasing your fiber intake through fruits, vegetables, whole grains, and legumes can help promote regular bowel movements. Additionally, ensure you are drinking plenty of fluids to help soften stool.

2. Physical Activity: Regular exercise can stimulate bowel function. Even light activities, such as walking, can be beneficial.

3. Medications: While you have tried various laxatives, it may be worth discussing with your doctor the possibility of trying different classes of laxatives or medications that promote bowel motility, such as prokinetic agents.

4. Pelvic Floor Therapy: If your constipation is related to pelvic floor dysfunction, working with a physical therapist who specializes in pelvic health may help improve your symptoms.

5. Pain Management: Addressing your lower back and abdominal pain may also improve your overall quality of life. Discuss pain management options with your healthcare provider.

6. Regular Follow-ups: Keep in touch with your healthcare provider to monitor your condition. If your symptoms worsen or new symptoms arise, further evaluation may be necessary.

In conclusion, while surgery may not be the immediate solution for your adhesions and chronic constipation, there are several non-surgical approaches that can help manage your symptoms. It is crucial to work closely with your healthcare team to develop a comprehensive management plan tailored to your needs. If your symptoms persist or significantly impact your quality of life, seeking a second opinion from a gastrointestinal specialist or a surgeon experienced in managing adhesions may also be beneficial.

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