After you have certain kinds of abdominal surgery, you can expect to have some internal scars. Also known as abdominal adhesions, they are tough tissue bands that form between your abdominal tissues and organs.
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The idea that you have internal scarring might make you worry about the potential for future health complications — or the possibility of needing more surgery down the line.
However, colorectal surgeon Anuradha Bhama, MD, reassures that abdominal adhesions generally won’t cause you problems.
Here are 5 things to know about this scar tissue.
You didn’t do anything to cause abdominal adhesions
Abdominal adhesions are normal — and common. In fact, 93% of people who have abdominal surgery develop at least one adhesion.
“Any time you have surgery in your belly or pelvis, you have a chance of developing abdominal adhesions,” says Dr. Bhama. “This is normal scar tissue. Just like you might have scars on your skin, you can have scars inside your body as well.”
In other words, you didn’t do anything to cause these abdominal adhesions. They’re a normal result of the post-surgery healing process.
You can’t prevent abdominal adhesions
Dr. Bhama also stresses that you can’t do anything to prevent abdominal adhesions. Plus, the number of abdominal adhesions you develop can vary.
“It’s impossible to predict what the scar tissue inside your body is going to look like,” Dr. Bhama explains. “I’ve seen people who have had one operation develop a severe abundance of scar tissue. But I’ve also seen people who have had several operations with minimal scar tissue.”
Factors that might influence how severe your abdominal adhesions are include:
- Your initial reason for having surgery. Dr. Bhama says that different scenarios can impact your development of adhesions—for example, if any infections were present or your nutrition status.
- The approach to surgery — for example, minimally invasive surgery (a robotic or laparoscopic procedure) is known to cause less scar tissue.
- Any medications you were taking.
- Your overall health.
In addition, adhesions can form if blood or blood clots aren’t washed away after a procedure, or if your organs dry out during the operation.
Abdominal adhesions can cause side effects and complications—but these are rare
Most abdominal adhesions don’t cause symptoms. However, in rare cases, they can cause complications. For example:
- They can make your normally slippery internal tissues and organs stick together.
- They can twist and pull your small or large intestines, causing obstructions and pain.
Dr. Bhama also notes that after you’ve had surgery in your abdomen or pelvis, you’re at risk of developing a bowel obstruction from abdominal adhesions.
“Scar tissue can cause a blockage,” she explains. “And then your intestines might swell, and that’s why things get backed up.”
Crampy gas pains are usually the first symptoms to appear, Dr. Bhama says. “Other warning signs include bloating, nausea, vomiting, and constipation,” she adds. “You have episodes where you’re not passing gas and not having stools and are bloated. It feels like there’s a blockage.”
You’ll rarely need surgery because of abdominal adhesions
The good news is it’s “exceedingly rare” to need surgery to address abdominal adhesions, stresses Dr. Bhama. “If you don’t have any problems from the adhesions — and the vast majority of people don’t — then you don’t need to consider surgery or even be evaluated for surgery.”
One of the reasons doctors avoid doing surgery for scar tissue is because they can’t prevent or predict whether you’ll develop new scar tissue. “For example, if you had a scar on your arm removed, there’s no way to ensure that you won’t have future scar tissue build up,” Dr. Bhama says. “It could leave another scar behind.”
How to clear up a bowel obstruction
If you’re one of the rare people to develop a bowel obstruction from abdominal adhesions, “80 to 90% of the time” these can also be resolved without surgery, Dr. Bhama adds.
Sticking to a clear liquid diet often helps clear up any blockages in a day or two. If your discomfort doesn’t go away — and if your symptoms worsen — a visit to the ER might be in order.
“If you’ve never experienced a blockage before, it’s recommended you go to the emergency room and get evaluated to ensure you’re not too dehydrated,” says Dr. Bhama.Doctors there can diagnose bowel obstructions either with CT scans or with X-rays of the abdominal cavity or intestines.
But even if you are admitted to the hospital, she adds that surgery for a bowel obstruction isn’t inevitable.
“Typically, decompressing your stomach with a tube that goes down your nose, along with getting IV fluids and resting your bowels, will help resolve the obstruction so that you don’t need surgery.”
If you have repeated bowel obstructions over and over again to the point that it’s impacting your quality of life, ability to work and ability to participate in social activities, surgery may be warranted. This is extremely rare, Dr. Bhama stresses.
“For example, I saw someone who was admitted twice a year for six years in a row after rectal cancer surgery,” she says. “And after thorough imaging, it was determined this was being caused by scar tissue. The blockage was always the exact same spot every time. In this case, I did perform surgery, which helped resolve the recurrent obstructions.”
Abdominal adhesions won’t necessarily prevent you from having future surgeries
Dr. Bhama says it’s a misconception that having abdominal adhesions will prevent you from getting other needed surgeries.
“I hear this a lot,” says Dr. Bhama. “People will say, ‘The surgeon told me I can’t have any more surgery in my abdomen.’ But, you can’t predict how severe adhesions will be, so if someone has said you’re not a candidate for surgery based on the likelihood of adhesions, I’d get evaluated at a specialty center.”
At the end of the day, you can’t prevent abdominal adhesions from forming—and you can’t minimize your chances of developing them. That can be frustrating. But for most people, abdominal adhesions are something they live with and they don’t impact their day-to-day life.