Bowel adhesions. Symptoms and Treatment, photos than dangerous. Folk remedies, medications, diet, exercise

intestinal adhesions - a frequent postoperative complication. They can also result from congenital malformations. The main symptom of this disease at an early stage is pain. Lack of prompt treatment can result in the formation of extensive fibrotic process in which internal organs disrupted.

What is bowel adhesions?

intestinal adhesions are abnormal fusion of its portions other abdominal organs or between its own loops. Leading mechanism in their formation is an inflammation as a result of which violated local metabolism in tissues, their oxygen supply.

A damaged epithelium lining the peritoneal organs, produces an exudate which has agglutinative properties. This kind of protective reaction of the organism to inflammatory processes caused by various causes. Formulation exudate leads to degeneration of connective tissue.

Normally, fibrin, which is formed from collagen and elastic fibers must dissolve in inflammatory process with time. When exposed to adverse external or internal factors, this mechanism breaks down and a high thread protein remained in the abdominal cavity.

As a result, deteriorating the function of internal organs formed adhesive disease that can lead to serious complications. The most common form adhesions between loops of bowel, between the scars and loops between individual sections of the intestines and the serous membrane that lines the inside of the cavity of the peritoneum, between the intestine and other authorities.

Causes

intestinal adhesions, symptoms and treatments which are considered later in this article may be caused by:

• The operations on the abdominal organs, accompanied by trauma and drying it: appendectomy; elimination of acute intestinal obstruction; gynecological diseases, caesarean section; gastric ulcer and 12 duodenal ulcer and other diseases.
• Hemorrhage.
• The presence of foreign bodies.
• Closed and open abdominal trauma history.
• Local deterioration of blood supply to tissues as a result of narrowing of the blood vessels.
• Congenital malformations of the abdominal cavity.
• Inflammatory processes: acute appendicitis; in inflammation of the ovaries or fallopian tubes of women; in peritonitis and other pathologies of the abdominal cavity.

After hemorrhage or during inflammatory blood (exudate) starts to thicken and germinate connective tissue. Initially, it is still quite loose and soft, but eventually impregnated with calcium salts and become stronger. Inside it there nerves and blood vessels.

In the postoperative period, adhesions are formed very quickly - within 3 days.

After 2 weeks, they become dense. Almost half of the patients who underwent surgery on the abdomen, during the year there are adhesions. After repeated operations, this figure reaches 93%. One-third of patients adhesions observed over the next 10 years. The most serious cords are formed in people with reduced immunity.

The most common cause of this phenomenon is inappropriate surgical technique:

• direct tissue damage during surgery;
• clamping supplying blood vessels, which leads to local ischemia;
• rough incision;
• leaving foreign material in the surgical field;
• intra-abdominal hematoma.

Symptoms of uncomplicated form Pathology

The main symptoms of intestinal adhesions are the following:

• pain in the lower abdomen and side of different nature and intensity;
• symptoms of enterocolitis (inflammation of the colon and small intestine);
• anorexia, weight loss;
• partial bowel obstruction (recurrent or persistent).

Adhesions can develop for a long time without causing any discomfort to the patient, and then appear in the form of acute intestinal obstruction.

Enterocolitis symptoms are as follows:

• Pain in the umbilicus and the side intestine (most often it is a dull character);
• nausea, vomiting;
• flatulence, rumbling in the abdomen;
• spotting of the anus;
• a feeling of fullness even after eating small amounts of food;
• frequent diarrhea, upset his chair, alternating constipation and diarrhea;
• general weakness.

Symptoms of intestinal obstruction

intestinal adhesions, symptoms and treatment of which are nonspecific, can lead to partial or complete obstruction. This occurs because an intestinal tube kinks, its infringement in the "window" formed adnations and also due to the formation of nodes and bloat.

Signs of this phenomenon, depending on the stage of pathology, have the following nature:

• Traffic violation bolus through the intestines - cramping pain, flatulence, fermentation in the stomach, belching, hiccups. Soreness occurs suddenly, regardless of the meal, at any time of the day. Its amplification takes place with an increase in intestinal peristalsis. It may subside in 2-3 days by reducing the activity of the intestine, but it is often a symptom of a bad prognostic.
• Poor circulation in the intestinal wall. Pain is not so strong, but constant. Other symptoms observed asymmetric bloating, fecal delay and gases, dehydration (dry mucous membranes, sunken eyes, pale skin color, decreased urine output), and nausea. It begins vomiting - first gastric contents, and then with feces due to breeding of Escherichia coli in the upper GIT.
• Step peritonitis. The almost complete absence of peristalsis, severe bloating, symptoms of intoxication (weakness, decreased temperature, tachycardia, dry tongue with a dirty patina). The last stage may lead to death.

intestinal obstruction due to adhesions up to half of all cases in the structure of this pathology. If there is an incomplete narrowing of the lumen of the gut, then talk about a partial obstruction.

complications

Education strands of connective tissue can cause the following complications:

• deterioration motility, impaired digestion process;
• formation reflux (reverse casting food) stagnation, intestinal insufficiency;
• development of neuroses, hysteria and neurasthenia due to persistent pain;
• bowel obstruction;
• infertility in women because of the narrowing of the fallopian tubes;
• anorexia and exhaustion associated with the forced need to limit food intake;
• adhesive disease that creates a lifetime risk of bowel obstruction;
• poor circulation in the small intestine, promoting the development of its infringement and gangrene;
• when expressed fibrotic process - lethal outcome.

In people with adhesive disease, remains in operation only 22% of patients.

Diagnostics

Symptoms of bowel adhesions are common to other diseases, so you need to carry out additional inspections.

Treatment is given only after the following types of diagnosis:

• ultrasound, Which allows to identify abnormal changes in the intestinal wall in the area of ​​the previous surgery. At present, this method is less invasive and quite informative in this disease. The disadvantages of ultrasound include the inability of the meeting when it is full, intestinal gases, hindering visualization. Sonographic study also allows to identify points for subsequent laparoscopy.
• Radiography with barium. It is used in cases where the difficult diagnosis of intestinal obstruction. Pre-patient needs to drink a small amount of barium suspension and then make a series of radiographs bowel determining a displacement of the substance of the gastrointestinal tract. When barium delayed for more than 12 hours in the small intestine it is diagnosed obstruction.
• colonoscopy It serves to define the passage of the colon. It is not only diagnostic but also therapeutic method, which allows to establish a special tube to ensure that this part of the bowel obstruction. Pre-patient make a series of cleansing enemas and then injected through the anus endoscope.
• Laparoscopic exploration. It is made in cases of doubt, for the differential diagnosis. In the abdominal cavity through small punctures special tube is inserted - trocars, which may be optical devices or surgical instruments for simultaneous excision of adhesions.
• MRI - a relatively new kind of research in the diagnosis of intestinal adhesions. It is based on the impact on the patient's body intense magnetic field, wherein the hydrogen atoms emit a response signal. This method makes it possible to accurately determine the condition of the colon in the form of several thousand consecutive shots-sections.

Treatment without surgery

Conservative therapy is the basis of the treatment of adhesions. By surgery for excision of the bands of last resort, since it itself is a precipitating factor for this disease.

Adhesions some patients develop almost immediately after surgery, and the 5th day after the formation of strands to restore the function of the epithelium is almost impossible. The main therapeutic measures aimed at maintaining the normal operation of the gastrointestinal tract and the prevention of acute intestinal obstruction.

They include the following recommendations:

• dieting;
• performing gymnastics;
• physiotherapy;
• reception of drugs.

Complex conservative treatment to avoid surgery in patients with ¾.

Diet

Diet for intestinal adhesions helps reduce its air content, at which the hyperextension pinching its walls and in tyazhah, and also reduces the likelihood of inflammation and enhances motility GIT. The table below provides guidance on the use of foods for this group of patients.

Product group	illicit	Allowed
First and second courses	Fatty, rich broth and meat acute smoked Salt Rice, millet porridge (they have to constipation)	Vegetable Soup on weak broth from chicken or turkey Rabbit meat, turkey, chicken and fish (lean), steamed Buckwheat, oatmeal on the water
Bakery products	Fresh yeast dough pastries Cakes with fat cream Black bread	yesterday's bread Cracker
seasonings	Hot sauces, mayonnaise, spices	A small amount of common salt
Vegetables and fruits	Fresh fruits and vegetables with sour or spicy taste (tomatoes, hot peppers, radishes, radish, all kinds of cabbage and other) Vegetables with coarse fiber structure, cucumber, bean	Potatoes, carrots, beets boiled bananas Sweet fruit peeled, pureed
Beverages	Whole fat milk Carbonated drinks Alcohol Coffee	diluted juices Tea Fresh yogurt, fermented baked milk Compote of dried fruits, jelly, juice
Other products	animal fats soybean nuts mushrooms Fast food, semi-finished products	Low-fat cottage cheese Vegetable fats jujube

The following rules must be observed in the diet:

• food to take small fractional portions of 5-8 times a day, without overloading the digestive tract;
• drink plenty of fluids to prevent constipation;
• after a meal is better to walk on foot to enhance the intestinal motility;
• last meal - not later than 2 hours before bedtime;
• in the presence of chronic constipation, you need to take laxatives;
• food should be warm, because too hot irritate the gastrointestinal tract, and the cold quickly evacuated from the stomach, creating an additional burden on the intestine.

medicine

The most effective in the prevention of adhesions is the correct surgical technique, and the introduction into the abdominal cavity (during operation) the following medications:

• Mitomycin-C;
• phosphatidylcholine;
• Mezogel;
• carboxymethylcellulose;
• hyaluronic acid;
• Chondroitin sulfate.

Difficulties in treating adhesions are in the presence of the following factors:

• stimulation of regenerative processes in mechanical damage and inflammation of the peritoneum activation promotes fibrotic process;
• limited ability to influence the administration of drugs in the area due to a violation in her microcirculation;
• inability to reverse the process (resorption) of adhesions already formed.

Specific drugs to combat this disease does not exist.

A number of medical experts recommends that the following groups of products:

• NSAIDsWhich suspend the production of prostaglandin and thromboxane.
• antibioticsBecause on the development of adhesions affect local intestinal flora. According to studies, the incidence of adhesions in patients receiving these drugs is 50% vs 92% of patients in the control group.
• Products containing enzymes - Phlogenzym (6-9 dragees in 3 divided doses a day, 2 weeks.) Vobenzim (15-21 dragees in 3 divided doses a day, 2-4 weeks.).
• antispasmodic drugs (No-Spa, papaverine) to reduce pain.

Gymnastics

Moderate physical activities help to better operate all systems of the body, including the gastrointestinal tract. Patients with a history of surgery on the abdominal or intestinal adhesions diagnosed recommended every The morning begins with exercises to develop "abdominal" type of breathing, take a contrast shower to improve the local and general circulation. Useful as walking, aerobics and swimming.

Therapeutic exercises aimed at strengthening the muscles of the abdominal wall, and includes the following exercises:

In the standing position:

1. torso left and right turns. It is necessary to try to touch the one hand the floor (the second - on the belt).
2. Leaning forward, hands stretch out to the socks.
3. Alternately raise the left and right leg, bending the knee.

In a sitting position on the floor:

1. Dilute a little leg. Alternately pull them to your chest, bending at the knee. Hands pull back, using them as a support.
2. "Scissors" - lifting the legs to perform their vertical movement.
3. Torso turns to one leg and the other (they should be separated).

In supine position:

1. Put your hands behind your head at the castle. Raise the torso in a vertical position, straining the muscles of the abdomen.
2. Legs raised together, bent at the knee, then straighten and drop.
3. Hands take the head, alternately lift the torso and bent leg, trying to touch the knee with his elbow.

Lying on his stomach: take your hands behind your head in the lock, lift the torso, arching back. Exercise "cat" - standing on all fours, bend your back up and down. Each exercise is performed 4-6 times.

Physiotherapy

intestinal adhesions, symptoms and treatment of that previously considered to be partially eliminated with the following physical therapy:

• Hydro massage colon. This method is used for those patients who have intestinal motility is disrupted periodically. At the same time attempting to clean it improves blood circulation in the walls of the body. The procedure is performed every 3 months, at least 6 for 1 course sessions.
• electrophoresis (Phonophoresis) trypsin, hydrocortisone, hyaluronidase to the anterior abdominal wall. Through this method, exposure is performed a direct effect on the lesion. The above-mentioned drugs do not destroy the adhesions, and help to reduce the density of collagen and improve the elasticity of the strands.
• sonication to stimulate bowel motility.
• Paraffin or ozokerite applications on the projection area of ​​adhesions.
• abdominal massage. It can be carried out independently by stroking clockwise. This procedure improves the motility of the gastrointestinal tract.

Surgery

When expressed pain syndrome, failure of conservative therapy or acute ileus surgery is indicated. Surgery for adhesions is a last resort treatment, as this creates an unfavorable conditions conducive to the re-activation of fibrotic process, especially when it was preceded by a long period of inflammation.

At laparotomy performed excision of adhesions, bowel removed necrotic areas if necessary, intubation - restoring its permeability using a special installation tube. The most preferred methods are minimally invasive surgical techniques (laparoscopy).

Tactics of treatment during pregnancy and lactation

During pregnancy the uterus increases may lead to hyperinflation adhesions that causes severe pain.

Treatment strategy during gestation and lactation is as follows:

• enzyme therapy;
• dietetics;
• performing therapeutic exercises;
• electrophoresis and massage.

In extreme cases, the absence of effect of these techniques is performed surgical excision of adhesions. The operation and administration of drugs is carried out based on the smallest possible risk to the fetus and mother.

Folk remedies

intestinal adhesions, symptoms and treatment of which are given in this article are amenable to treatment folk remedies. In the event of signs of intestinal obstruction should immediately seek medical attention, as this is a life-threatening condition.

The basis of the treatment of adhesions folk recipes make herb with antibacterial, anti-inflammatory and regenerative effect. The complex reception medicinal drugs, adherence to diet and other recommendations listed above, helps to improve patients' quality of life and avoid the recurrence of adhesive disease.

Fruit and herbal teas

The most effective fruit and herbal, their reception circuit and duration of treatment is given in the table below.

Components	Max mixture, Art. l.	Method of preparation	Quantity per single dose, Art.	Number of administrations per day	The total duration of the course, d.
raspberry	4	2 tbsp. l. Pour mixture 1 tablespoon. boiling water, stand in a water bath for 10 minutes. insist in a dark place for 2 hours.	½	2	30
black currant berries	4
Dog-rose fruit	4
berries cranberries	1	2 tbsp. l. Pour mixture 1 tablespoon. boiling water for 3 hours in a thermos.	¼	4	30
Dog-rose fruit	2
leaves of nettle	2
leaves clover	2	Similarly to the above recipe	¼	4	30
The leaves and flowers of yarrow	2
Flowers mother and stepmother	2

Medicinal teas and infusions

Formulation decoctions and infusions used in folk medicine for spikes, shown in the table below.

The main component	Cooking method	Quantity per single dose	Number of times per day	Duration of the course, d.
The root of Bergenia	1 tbsp. l. Pour 1 st., then on a steam bath for half an hour, brew 4 hr., filter.	1/3 Art.	3	14
The herb St. John's wort	1 tbsp. l. pour 1 tbsp. boiling water, hold water bath for 10 min., insist 2 h., filter.	2 tbsp. l.	2	10
peony root deviating	½ st. the processed raw sugar and ½ st. vodka, insist in a dark place 1 week.	30 drops	3	30

Compresses with castor oil

Besides paraffin and ozocerite baths, on the abdomen can make compresses with castor oil. As part of this substance contains fatty acids that contribute to the elasticity of adhesive strands.

To treat this tool proceed as follows:

1. Apply to the adhesion projection of oil massage in a circular motion.
2. Close cheesecloth, folded in several layers.
3. On top of gauze put a warm cloth.
4. Sustain a compress for 2-3 hours (if there is a possibility - then leave it overnight).

Massage oil from calendula and comfrey

Oil from comfrey and calendula has a regenerating, antiseptic and soothing effect.

It is prepared by the following recipe:

1. A mixture of 1 tbsp. calendula flowers and 1 tbsp. comfrey leaves pour castor and olive oil (1 tbsp. each of them).
2. Bank tightly sealed and insist in a dark place means 5 days.
3. Filtered to obtain a homogeneous composition.

The resulting oil was rubbed into the abdominal wall in a circular motion. This procedure must be performed on a daily basis for a long time (2-3 months).

Formed bowel adhesions difficult to treat.

The best way to prevent them in the postoperative period is to comply with the doctor's recommendations, diet, improves intestinal motility, and physical activity. When ileus symptoms (gas delay and stool, vomiting, and others) should seek immediate medical assistance.

Helpful videos about the causes and cures for intestinal adhesions

Recommendations for adhesive disease:

Symptoms of bowel disease: