When the Pain Just Won’t Go Away
Better awareness of scar tissue trouble can mean better treatment options
It’s been nearly five years now of intense pain for Amy Smith (not her real name). The 44-year-old mother of two from rural Wisconsin had been incredibly active, vibrant and athletic until recent years.
She would golf weekly with her friends, practice yoga, get out in the yard and play football with her husband and two sons, and help care for the couple’s aging parents as best she could.
She now does what she can to get through the day to simply take care of herself.
Over the past several years, the pain in Smith’s lower abdomen, around the area of her two C-sections, has become debilitating. Until recently, she wasn’t sure where to turn for a proper diagnosis or what might help the pain.
“Dealing with it sucks. I now go to physical therapy. The diagnosis is scar tissue surrounding my kidneys,” she said.
She said that during the physical therapy, “it feels like your insides are being torn apart, which is really what is happening.”
Smith has sought help from her doctor, physical therapists, and massage therapists, but found little relief other than from painkillers. She would prefer, especially because she leads such an active work, family and social life, that there be another way. She’s not alone.
Internal scar tissue is common after any sort of surgery, according to Lauren Schiff, assistant professor in the division of Minimally Invasive Gynecologic Surgery at the University of North Carolina Department of Obstetrics and Gynecology.
Ninety-three percent of patients who have abdominal surgeries develop adhesions, and according to Schiff, a majority of those people will never experience complications. But for those who suffer from binding internal scar tissue, the problems can be devastating. What’s most important, Schiff said, is that the root cause of the tissue build-up is identified before any additional action is taken — especially another surgery.
"Prior surgery is often blamed for problems with scar tissue. But there are oftentimes another underlying problem."
“There is relatively good evidence that shows even after removing adhesions, pain does not improve. The reason for that is more surgery causes more scar tissue. We expect scar tissue to re-form," said Schiff. "So unless there is a specific physiologic hampering, something that’s supposed to work in a particular way but doesn’t because of the scar tissue, removing scar tissue isn’t typically an objective any surgeon has.”
Schiff recommends that any patient with pain post-op get a good clinical exam, in which both surgical history and symptoms are thoroughly considered. She says identifying the true source of the pain is critical, because there may be other reasons — and there are often other reasons — for the developing scar tissue and pain.
“Unfortunately, prior surgery is often blamed for problems with scar tissue. But there are oftentimes another underlying problem, such as pelvic floor tension myalgia, a muscle spasm specific to gynecologic patients is the problem. It’s pain that can be felt abdominally, in the back, or in the legs and can be related to a spasm of the pelvic muscles. This is not uncommon after patients have had multiple abdominal surgeries. Oftentimes treating the muscle spasms ends up relieving the pain and these are things that are not necessarily widely either treated or known about.”
Schiff added that pain itself can become a disease, which is something physicians see a lot of and have to focus on. The challenge there becomes re-educating a patient’s body and brain about how to interpret pain signals from the body.
Any patient with pain post-op should get a good clinical exam.
“I tell my patients that chronic pain takes a lot time to develop and it takes a long time to treat. We address it through multi-modal approaches, and it’s really important we have good brain health. That involves healthy sleep habits, meditation, addressing coping mechanisms for pain. These things all have been significant shown to improve pain outcomes in combination — if necessary — with a surgical approach.”
Dr. Meagan Costedio, a surgeon in the department of Colorectal Surgery with the Cleveland Clinic, offers those suffering from debilitating internal adhesions this advice:
- Always ask for minimally invasive surgery when possible.
- Don’t put off surgery. The longer you wait to have a health care issue addressed, the more likely it is the problem will trigger its own internal scar tissue.
- Try a liquid diet for a day if you have any bloating or cramping. That can be all it takes sometimes to get symptoms under control, especially if the scar tissue causes a blockage.
- If symptoms worsen, get to a hospital.
- Listen to your body so you might recognize problems early.
Once you know what you’re dealing with, you can minimize your discomfort and regain some control over your health and your life, Costedio said.
Controlling the pain and regaining her life is something that Amy Smith, and tens of thousands of others like her every year, are working toward. Helping them is an increased awareness that binding scar tissue has very real side effects and are a complication of abdominal surgery. The diagnosis allows for earlier treatment and a search for alternative solutions when nothing else seems to work.