Peritoneal Adhesions - Mothering Forums

 
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#1 of 4 Old 03-24-2008, 06:18 PM - Thread Starter
 
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OK, I get that this means I have adhesions connecting my stomach lining (right?) and uterus. (Worth noting they say it is on the "lower uterine segment.")

Can anyone forsee and explain complications to birth this could present?

TIA!

~Marie: Mom to DS(17), DS(16), DD(14), DD(10), DD(8) & someone new on the way.
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#2 of 4 Old 03-24-2008, 08:30 PM
 
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First, since adhesions can happen from any number of things (such as endometriosis) I truly don't see how it would affect labor/delivery. Last I checked they don't c-section for that particular problem.

here are some interesting articles on peritoneal adhesions

http://www.greenjournal.org/cgi/content/full/106/2/275

http://www.mdconsult.com/das/article...9/1.html?issn=
(I don't have the funds to access, but if someone did....)

http://www.emedicine.com/MED/topic3283.htm

Quote:
Bowel injury: Bowel injuries occur in less than 0.1% of all cesarean deliveries. The most common risk factor for bowel injury at the time of cesarean delivery is adhesions from prior cesarean deliveries or prior bowel surgery. If the bowel is adherent to the lower portion of the uterus, dissect it sharply. Injuries to the serosa can be repaired with interrupted silk sutures. If the injury is into the lumen, perform a 2-layer closure. The mucosa can be closed with interrupted 3-0 absorbable sutures placed in a transverse fashion for a longitudinal injury. For multiple injuries and injury to the large intestine, consider intraoperative consultation with a general surgeon or gynecologic oncologist.
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#3 of 4 Old 03-24-2008, 08:39 PM - Thread Starter
 
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Thanks so much for that info.!

~Marie: Mom to DS(17), DS(16), DD(14), DD(10), DD(8) & someone new on the way.
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#4 of 4 Old 04-02-2008, 12:48 PM
 
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Hi,

Sorry to hear that you are dealing with this. I understand it can be quite painful.

I'm a massage therapist and adhesions are something we routinely encounter and try to address. So I come to your question from that perspective. I'm sure that the midwives on this board will have other information to add.

Adhesions form between two layers of fascia. Fascia is a type of very thin connective tissue surrounding every structure in our body from the smallest capillary to the biggest organ. Think of the thin filmy layer you sometimes see between two layers of an onion. Within the peritoneum (the fascial "sac" that contains the abdominal contents) each organ has its own layer of surrounding fascia. Adhesions are areas where inflammation or injury has caused the fascia of two different organs to stick to one another. Over the long term these sticky spots can thicken into fibrous scar tissue. This is a problem because in order to function normally, each organ must be able to move freely on its own.

So it doesn't sound right to me that there could be an adhesion between your uterus and your stomach lining, as the lining is inside the stomach. So if there were such an adhesion, it would be between the uterus and the fascial layer surrounding the stomach. But even that doesn't seem likely unless your stomach is somehow out of place. More likely the adhesion is between your uterus and the peritoneum itself . But what I most commonly come across is women who have had c-sections who develop adhesions between the uterus and the fascia of the intestines. I could guess better if I knew whether it was the posterior or the anterior lower segment and whether you have any history of organ prolapse. The best thing would be for you to get a clarification on this.

Regardless, any adhesion involving the uterus can restrict to some degree the free movement of the uterus during labor. So I think the biggest concern would be that it would cause additional pain. However, adhesions sometimes resolve on their own and this is even more likely during pregnancy. A lot depends on why you first got the adhesion, how long you have had it, and how thick it is. Has your midwife/doctor said anything about possible complications that s/he is concerned about?

Off the top, I am aware of two different treatment options. Some surgeons will attempt to separate the adhesions surgically. Most, however, will be reticent to do so unless there is some significant restriction of function. This is because there is a strong likelihood of the adhesions reforming after surgery. Massage may help to make the area of the adhesion more supple and, in some cases, can actually resolve the adhesions entirely. If I were dealing with this during pregnancy, I would look for a therapist who is certified in prenatal massage and who is also certified in any one of the following modalities as well: visceral manipulation, mayan abdominal massage, or chi nei tsang. I have listed these in order of my own preference. The easiest way to search for qualified practitioners is through the American Massage Therapy Association or the Association of Bodywork and Massage Practitioners. Some physical therapists specialize in this area as well. One practice I can think of off the top my head is at www.clearpassage.com. Their focus is on fallopian obstructions in cases of infertility, but they would be more than qualified to address peritoneal adhesions as well. If they are not located near you, you could ask them for a referral. If you should choose to see either an MT or a PT, they should certainly give you self-massage exercises to do at home. A short time doing self massage every day in addition to your regular appointments is by far the most effective way to treat adhesions (IMHO!).

I don't check this board too often, so if you have any questions, please PM me. Best of luck!

Megan
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