Re: IBS/adhesions/surgical outcomes-Tina

From: Christine M. Smith (
Sat Oct 16 19:21:20 1999

At Sat, 16 Oct 1999, Tina Shelby wrote: >
>Hi all -
>I just wanted to comment about the adhesion/IBS relationship - I think some
>of us may have been diagnosed with IBS first because IBS is what we call a
>diagnosis of exclusion - which basically means that no disease process (like
>IBD, diverticulitis etc) was found on GI work-up. Since no "visible"
>pathology is found then IBS will usually be the diagnosis. It would astound
>you how many people have a GI work-up and come out with a diagnosis of IBS.
>When comparing the symptoms of IBS with the symptoms of adhesions - they are
>very close in nature - diarrhea/constipation/nausea/vomiting/pain with BM's
>etc. One "red flag" symptom that is not supposed to be assoicated with IBS
>is night attacks of pain. True IBS episodes only happen when the sufferer is
>awake. Other symptoms such as fever and an elevated white count are also not
>considered to be IBS symptomology.
>GI specialists are not the best choice for treatment of adhesions. Having
>assisted with 100's of colonoscopy procedures, I know first hand that if a
>patient has a difficult colonoscopy because of adhesions the GI specialist
>will note it on the op report and then write that the colonscopy was normal.
>Most either do not or choose not to recognize adhesions as a possible
>explaination for the patient's pain.
>According to one study (Menzies&Ellis) - in a study of 210 patients who had
>> 1 abdominal surgery history - 93% had intra-abdominal adhesions. However
>only 2-3% of those patients experienced pain from the adhesions. A study
>done at UCLA (Rapkin) indicated a direct relationship between complaints of
>pelvic pain and the density of adhesions. The adhesions were rated according
>to density ranging from filmy, moderate, and dense. Those with the dense
>adhesions had more complaints of pelvic pain than those who did not. Other
>studies that used a rating scale to define the severity of the adhesions
>also found a relationship beween the complaints of pain and the severity of
>the adhesions.
>In our best interest - there is enough well-documented research that
>indicates adhesions do cause abd/pelvic pain. So in the past - when I
>encountered a GI specialist or surgeon who said adhesions did not cause pain
>- I was able to show them - in their own medical research journals - that
>they were not correct. Some appreciated the info - others did not. If your
>health care provider will not acknowledge that adhesions can cause pain -
>consider finding one who does.
>I'm sorry for the length of this post - but I would like to add one more
>comment. DON'T believe a surgeon/specialist if they tell you they have never
>had a "case like yours" because some are experts at "playing dumb", and tell
>you they have never seen such an outcome or of heard anyone complain of such
>symptoms (leaving you to believe it is just you and no one else in the whole
>world has had these kinds of problems.) It is for this reason that re-state
>what Helen Dyna has so often said - knowledge is power - the more you know
>about what you are dealing with - the less likely someone will be able to
>convince you that you are strange or that the problem is mental instead of
>physical. Some health care providers can be hard to convince that a person
>is having problems when tests and lab results are normal or there is no test
>to provide an objective measure. Most of us have come to realize that the
>ONLY true test for adhesions is actually visualization inside the abd cavity
>by surgery. Sometimes a small bowel series or that torturous entercolysis
>test will show places where adhesions might be but for most - these tests
>are usually normal.
>I hope this helps -

Hi Tina:

You have given some excellent advice. It is very good to hear from someone who understands the problem first hand and also is familiar with the experiences of many other patients. When my gi doctor did the colonoscopy he told me afterwards that I was "letting them know" it was painful so they gave me more meds and I remember nothing. He also told me it was "essentially normal." My husband said he probably meant that out of everything he looked at, it was normal, but it is impossible to look at absolutely everything. My gyn told me that colonoscopies do miss some abnormalities. Do you think my gi doctor had some idea of why I had such pain during the procedure? The colo-rectal surgeon said that when you are looking through a colonoscope you get a very limited view at any one time, so the gi doc might not have realized the tube was actually going to the right, not the left. Wouldn't he have met some resistance as he tried to push the tube to the left of the pelvis, following what would be the normal course, but the bowel really went to the right first before it went back left? This abnormal configuration was supposed to have been fixed during my second lap. (the colonoscopy was done before this and I didn't even know about the abnormal position until after the second lap) If i should ever have another colonosocpy is there anything I can/should have done ahead of time to find out if it (sigmoid colon) has reverted back to the abnormal position? (in other words, the adhesions reformed) I posted on a gi forum and the doctor said that with adequate medication and a doctor with good skill I should have no problem. I have also read that nighttime attacks of diarrhea/pain are not part of IBS and if they occur, would indicate a different problem. Did you work for a gi doctor? Or was your experience part of an endoscopy unit where these procedures were done? The reason I ask because I am wondering if you have ever heard of an unusual presentation of crohn's disease where there is no diarrhea/cramps etc. but just pain. I know of one case like this.(although the patient did have occult bleeding) The doctor on the gi forum also said it was possible.

Chris S.

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