An adhesion is a connection between tissues in the body that normally should not be connected to each other. It’s kind of internal scar tissue; stiff strings or membranes, which can cause intestinal loops to stick together or the intestinal wall to stick to the abdominal wall. This makes the intestine less mobile, which can cause complaints such as diarrhea, constipation, abdominal pain and a swollen abdomen. In severe cases, complete intestinal blockage may occur. An adhesion consists of connective tissue (scar tissue) and connects organs that should not be together. An adhesion can be as thin as plastic wrap or as thick as connective tissue ligaments (ankle ligaments, knee ligaments). The condition can occur throughout the abdominal cavity. They are often seen in or on the small or large intestine, but adhesions can also develop in or between the female reproductive organs (fallopian tubes, ovaries and uterus). In the latter case, they often lead to painful sexual intercourse, pelvic pain and even infertility. In about 15 to 20% of women with fertility complaints, adhesions appear to be the cause.
The development of adhesions in the abdominal cavity
Adhesions in the abdominal cavity after appendectomy / Source: Hic et nunc, Wikimedia Commons (Public domain)
Adhesions are almost always caused by damage to the tissue in the abdominal cavity and the body’s natural healing process that follows. Healthy tissue is damaged by inflammation in the abdominal cavity (e.g. peritonitis or intestinal inflammation), radiation treatment of malignant tumors in the abdominal cavity (e.g. cervical or bladder cancer) and abdominal operations on the (appendix) intestine. The body then tries to repair itself. This is a natural, healthy response. After all, the cut edges of a wound must grow back together and detached organs must grow back into the abdominal cavity. However, the repair cells in the body cannot distinguish between one organ and another. During natural repair, (parts of) organs sometimes come into contact with each other and are connected by the formation of stiff, hard connective tissue strands.
More than 90% of people who have had abdominal surgery or inflammation in the abdominal cavity develop adhesions. The vast majority of people do not suffer from this. However, about 5% of people with adhesions in the abdominal cavity develop (sometimes daily and long-term) complaints.
The complaints of adhesions in the intestines
The food we eat is transported from the stomach to the intestines. In the more than five meters long small intestine and the more than one meter long large intestine, the food remains are pushed further and further by squeezing (peristaltic) movements. In order to perform these peristaltic movements properly, the intestines must be flexible and mobile. If the intestinal loops grow together due to adhesions or if the intestine becomes fused with the abdominal wall, the intestine loses some of its mobility. Depending on the precise location, size and cause of the adhesions, this can cause complaints such as: diarrhea, constipation, flatulence, abdominal pain, abdominal distension and nausea.
In severe cases, adhesions can lead to narrowing or even complete closure (ileus) of the intestine. The food can then no longer be pushed through the intestine (normally) and a blockage occurs. The intestine expands due to an accumulation of swallowed air, saliva and gastric juice. With a complete intestinal blockage, there is no more stool. A partial intestinal blockage usually leads to diarrhea. The consequences of a blockage in the small or large intestine are sudden, severe abdominal cramps, nausea and vomiting. In the event of complete intestinal blockage, a potentially life-threatening situation – emergency medical attention must be sought. Serious intestinal blockages are caused by adhesions in 50 to 75% of cases.
The diagnosis of ‘adhesions’ is difficult to make
If abdominal complaints persist for a longer period of time, it is always wise to visit the doctor. However, the diagnosis of ‘adhesions’ is difficult to make. Based on the complaints and medical history (possible abdominal surgery or inflammation), the GP will have a suspicion. To make the diagnosis with certainty, keyhole surgery will have to be performed. However, this is not always done, because new adhesions can develop as a result of the operation. However, in the event of a (threatening) intestinal blockage, surgery is necessary. Narrowings in the intestine can be detected by means of an X-ray examination with contrast fluid or a visual examination of the large intestine (colonoscopy). However, after these examinations it is not always clear what the exact cause of the strictures is.
The treatment of adhesions in the intestine
The only way to remove adhesions is through (keyhole) surgery. The connective tissue strands are then surgically removed or loosened (adhesiolysis). However, the risk of new adhesions developing is high. An operation is usually only performed in the case of very serious complaints, such as a (threatening) intestinal blockage. In other cases, treatment often consists of painkillers and laxatives to keep the stool soft. For some people, a regular abdominal massage helps to loosen and smooth the adhesions, which reduces the symptoms.
In addition to the medication, special nutritional advice is almost always provided by a dietitian in the event of adhesions. For adhesions in the small intestine, a liquid or low-fiber diet is important. Fiber-rich food is prescribed for adhesions in the large intestine. It is therefore not wise to take fiber preparations on your own initiative. Such preparations can accumulate in the too narrow (small) intestine and therefore even lead to complete blockage.
Nutritional advice for adhesions in the intestine
In people with adhesions, gas formation in the intestines often causes painful symptoms. It is therefore better to avoid foods that (usually) lead to extra gas formation: new potatoes, leek, cabbage, onion, pepper, Brussels sprouts, garlic, plums, melon, radish, unripe or large amounts of fruit, large amounts of sugar or fat, nuts , pungent herbs and spices, beer and carbonated drinks.
Nutrition for adhesions in the small intestine
If you have been advised to eat easily digestible, low-fiber food, it is important to avoid products with kernels, seeds, threads, peels and skins. These are difficult to digest dietary fibers. So avoid eating coarse whole wheat bread, muesli, cruesli, unpeeled or fibrous fruit (pineapple, berries, blackberries, mandarin, orange), raw or fibrous vegetables (asparagus, mushrooms, broad beans, corn, bean sprouts, eggplant, sauerkraut) and legumes. Also be careful with stringy and tough meat and whole wheat pasta.
Nutrition for adhesions in the large intestine
If you need to eat fiber-rich food (because the adhesions are in the large intestine), eat plenty of vegetables, fruit and legumes. These foods contain so-called soluble fibers that are processed by intestinal bacteria in the large intestine and stimulate intestinal function. Brown bread, whole wheat bread, bran, whole wheat pasta, oatmeal and breakfast cereals are also good. These products contain grains, which contain insoluble fiber. These are fibers that are not digested in the intestine and leave the body in unchanged form with the feces. They act as a kind of sponge in the large intestine; they absorb moisture and make the stool soft and flexible.
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