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Lower Right Abdominal Pain, Back Pain and Nausea. Adhesions?
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Lower Right Abdominal Pain, Back Pain and Nausea. Adhesions?

Hello, I am a 41 year old female and I am looking and searching for answers and came across this forum that I am hoping someone can help or provide advice.  

I have had several surgeries over the past few years - c-section (1997), gallbladder removal and hysterectomy (2008)and then last year (Dec 2010) a resection rectopexy for rectal prolapse.  

Over the last few months, I have been developing pain in my right lower abdomen.  Over the last two months, it has become extremely severe and debilitating.  It also goes around to my lower back.  I have urine retention problems (I am seeing an urologist and until my urodynamics test, have to self cather myself 4-6X/day).  But, this does NOT relieve the pain - unusually, it seems to bring it on more.

I believe that my pain is due to scar tissue build up and adhesions.  

When I first had the pain, I went to my OB and he did a pelvic exam and ultrasound and said all was good with my ovaries.  Then, I went to my internist who thought it might be appendicitis so took a trip to the ER to find it was not appendicitis.  The cat scan showed some minor cysts on my kidneys, but then also a "mixed density bilobed structure in the right lower quadrant) - my internist said that basically means an unidentifiable mass or blur of "something".  After talking further, he referred me to a general surgeon.  I saw the surgen today to discuss laparoscopic surgery, but he seems very hesitant.  

I am in such pain and distress that I have not been able to work (I am now out on disability as of this week).  I cannot eat (causes too much pain and I have lost over 15 pounds over the past month) and I was in the ER last week because the pain was so bad.  I am also very nauseous.

How can I convince the surgeon to do the laparoscopic - I am certain it is scar tissue (when I had my hysterectomy, my gynecologist saw a lot of scar tissue that he says he removed some from my c-section with my first child).

I have had issues (digestive) for the last 5 years where doctors told me I had IBS, eat more fiber, etc., and that I would be okay to find out that I had a gallbladder disfunction and then the prolapse.  I have had every test known to man (cat scan, mri, ultrasound, xray, bloodwork, urinalysis, proctogram, cystoscopy, small bowel series) and cannot go on like this.  

The surgeon seemed hesitant because he said that if I had scar tissue or adhesions, that my intestines would be blocked, but from what I have read, that is not necessarily the case.  Adhesions can cause intenstinal blockage, but not in all cases, correct?  My other symptoms seem to point me back to scar tissue buildup and adhesions from my rectopexy (it was done robotically, but the surgical incisions are quite large and my pain is where the incisions are).

Your advice or suggestions are appreciated very much!
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Avatar_n_tn
You should also look into endometiosis (it causes adhesions as well and many of your symptoms sound like endo because it can be anywhere I have it on my ureter, bowel, bladder, ovaries, etc. If you think this is the case you need to find an endo specialists (a general ob/gyn does not know enough). To find one in your area contact the endometriosis association:
http://www.endometriosisassn.org/

Just because you have had a hysterectomy does not mean that you do not have any endo:
http://www.vitalhealth.com/patient-physician-resources/dr-cook/recurrent-endometriosis-after-TAH.php

Also if you are in Illinois I recommend going to
http://www.surgery4women.com/home

Also if you are anywhere near these doctors they are excellent:

http://www.nezhat.com/patients_myths.html
(laparoscopy myths this should help you with your argument)
http://www.nezhat.com/about_us_farr.html
http://www.nezhat.org/who/drs_cam_nezhat.html
http://www.nezhat.com/about_us_ceana.html

(They are all in different states)

I hope this helps,
achilles2
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1340994_tn?1374197577
Have you had a colonoscopy?  Could they get the scope through?  Did you have relief of pain with the prep?  Do you think the pain is coming from constipation, probably of an obstructive cause from scar tissue?  

http://www.emedicinehealth.com/script/main/art.asp?articlekey=58785&pf=3&page=1

If you have adhesions, it is true that doctors will be hesitant to cut you further for fear you will just get more adhesions, and now these will be his fault.  The above article is good.  It says some adhesions go away on their own.  
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1804836_tn?1318539183
Yes, I have had a colonoscopy (done by the colon rectal surgeon who did the rectopexy) and he said everything looked fine.  I have constipation but the pain did not go away with the prep and he did not find scar tissue in my colon (he thought that maybe I had scar tissue buildup in my colon rectal area from the surgery, but did not find any).  I will check out the link above.  Thank you!
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Avatar_f_tn
My sister in law was told her pain wasn't her appendix and it was.You might get a second opinion on the appendix. But alternatively, later she had many surgeries too and lots of adhesions. She had peripheral neruopathy from it and coudln't eat got depressed etc. She was on morphine. Finally, they put her on antidepressants plus a couple of nerve drugs. Have you tried things like Lyrica and such? As perhaps you have similar symptoms. Have you been to a pain doc? You need to get relief and eat. So, you need something now. Getting diagnosed is important if you can too. I wouldn't go for more surgery unless they know for sure that is what is going on.
hope you get relief soon. Try Ensure to help get some nutrients if you can keep it down.
mkh9
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Avatar_n_tn
You should also look into endometiosis (it causes adhesions as well and many of your symptoms sound like endo because it can be anywhere I have it on my ureter, bowel, bladder, ovaries, etc. If you think this is the case you need to find an endo specialists (a general ob/gyn does not know enough). To find one in your area contact the endometriosis association:
http://www.endometriosisassn.org/

Just because you have had a hysterectomy does not mean that you do not have any endo:
http://www.vitalhealth.com/patient-physician-resources/dr-cook/recurrent-endometriosis-after-TAH.php

Also if you are in Illinois I recommend going to
http://www.surgery4women.com/home

Also if you are anywhere near these doctors they are excellent:

http://www.nezhat.com/patients_myths.html
(laparoscopy myths this should help you with your argument)
http://www.nezhat.com/about_us_farr.html
http://www.nezhat.org/who/drs_cam_nezhat.html
http://www.nezhat.com/about_us_ceana.html

(They are all in different states)

I hope this helps,
achilles2
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1804836_tn?1318539183
Hello, thank you - yes, it could be my appendix.  I will discuss with my doctor.  I read another thread where someone said that they were told it was not their appendix, but when they had the laparoscopic surgery, they found it was an issue with their appendix.

I have been on antidepressants before when I had abdominal pain because they told me that 80% of your nerve receptors are in your abdominal area; however, it did not help at all.  I am on pain medication and am on pretty much a liquid diet (Ensure is great for nutrition - I used that last time and it helped - I will get more).

I appreciate your advice (and everyone else) who takes their time to read my story!

I have never been in this much pain before and just need relief...
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1804836_tn?1318539183
THANK YOU!!  I do have bladder wall irregular thickening which I think can also be a sign of endo??  I am in Michigan, but will definitely check out the links you sent!
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Avatar_n_tn
You're welcome,
I forgot to add I also had endo all over my apendix (it was infested and huge) so when I had my laparoscopy  my doctor also ended up removing my appendix.
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1804836_tn?1318539183
Did the endo on your appendix show up on any tests (i.e. cat scan?).  How did you get your endo diagnosed?  It seems that either scar tissue, adhesions or endo can only be truly diagnosed by laparoscopy - did it take a lot for you to get the surgeon to do the laparoscopy?  I am in so much pain (I go back to him on 9/26) that I am literally going to get on my knees and beg him to do it because I am 100% sure that he will find something.

Thank you Again!
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Avatar_n_tn
I sent you a message.
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Avatar_f_tn
You are quite welcome. We are all glad to help. I hope you find the problem and get relief soon.
mkh9
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Avatar_f_tn
Blockage from the adhesions is quite possible. Ive had 3 stomach surgeries, the first leaving major scar, looked liked frankenstien stomach, and of course developed masive amts of adhesions at incision site that did have my..., just asked my husband, we both cant recall, been so long ago, im sorry sweetie, but we r thinkin they hd my sml intestine bound up and had attached themselves to , hubby jst said sml intestine as well as binding it up, then i got sepsis & dam* near died, not a good time in my life, in ccu for almost 3 weeks. Do be dilligent about this and get some answers. If u hv to change drs, then do so & take your records with you! Feel better and dont give up! Adhesions can cause many problems and pain!
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Avatar_f_tn
Blockage from the adhesions is quite possible. Ive had 3 stomach surgeries, the first leaving major scar, looked liked frankenstien stomach, and of course developed masive amts of adhesions at incision site that did have my..., just asked my husband, we both cant recall, been so long ago, im sorry sweetie, but we r thinkin they hd my sml intestine bound up and had attached themselves to , hubby jst said sml intestine as well as binding it up, then i got sepsis & dam* near died, not a good time in my life, in ccu for almost 3 weeks. Do be dilligent about this and get some answers. If u hv to change drs, then do so & take your records with you! Feel better and dont give up! Adhesions can cause many problems and pain!
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Avatar_f_tn
Dont understand this double post issue im hving, must be my cell, 4gv please, goina try to figure out wht the deal is. Sorry
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1804836_tn?1318539183
Thank you - and NO worries about the double posting at all.  Your information is SO MUCH appreciated.
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1804836_tn?1318539183
Hello all.  An update.  I had laparascopic exploratory surgery this past Monday and the surgeon DID find an issue with my appendix and my intestine.  My appendix was being elongated by scar tissue and my intestines were kinked up so she removed my appendix and cut out and reattached a section of my intestines.  Recovering now so don't know for sure if this will alleviate my pain but keeping my fingers crossed.  Thank you all for your advice and kind words!
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Avatar_n_tn
Thanks for the update. I am glad that you have such a good surgeon. Get well soon.


achilles2
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Avatar_f_tn
I am 46 and have had 5 surgeries starting at the age of 12 exploratory and they cut me from my belly button down. At 18 I had PID. Then at 21 I had an ectopic pregnancy that ruptured and was cut through the scar they did the surgery on when I was 12. 6 months later I had another ectopic pregnancy that ruptured and they took out everything but my ovaries. They cut me through that same scar that formed kiloids. Well in 2010 I was in so much pain that my OB did laproscopic surgery and took out my right ovary that was buried in adhesions. This past July 2011 he took out my right ovary due to adhesions and informed me I have adhesions on my right intestine he cannot get to. I am in so much pain and I do not know where to go from here, I was told I would be in pain the rest of my life but they don't want to help me with the pain. I live in Independence, Mo and do not know where to go for help. Any ideas?
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Avatar_n_tn
I am sorry you are in so much pain. When they did your surgeries did you ever have a bowel prep? If not that is why they have not touched your intestines. Can you go to another state for help if so I recommend that you try
http://www.surgery4women.com/home

I hope you get the help you need,
achilles2
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Avatar_n_tn
Also has anyone every looked at endometriosis, just because they did not "see" endo during surgery does not mean it is not there there must be a biopsy done to look for microscopic endo.

Also are you getting your hormones replaced w/bio-indentical hormones? This is very important here is a link to tell you about them. Maybe you can contact them and find someone near you.
http://diplomatpharmacy.com/patient_services/bio_identical_hormone_therapy/

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1804836_tn?1318539183
For your intestinal adhesions, your OB would not have had the expertise to do surgery on that area.  I would recommend going to a colon-rectal surgeon as they specialize in this area and can do surgery.  Any doctor who tells you that you would be in pain the rest of your life and that they don't want to help you does not have  your best interest at heart.  I would continue to search for another doctor.  I had to go through several different doctors and specialists before I found one who cared enough to push other doctors to help me.  I REALLY hope that you find some help soon!
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82861_tn?1333457511
I have lived with abdominal adhesions and partial bowel obstruction since 1998.  Went on the surgical merry-go-round for years.  Each surgery resulted in less and less time without symptoms.  The last one some 6+ years ago gave me all of two weeks of relief.  That's when my doctors and I decided surgery was only causing more problems and I'd have to learn to live with it unless I was fully obstructed and about to die.

Pain management helps but it's about more than throwing meds at the pain and nausea.  Living with adhesions requires a strong commitment to alternative nutrition - think smoothies - and a big dose of psychotherapy to learn relaxation and meditation techniques.  Once you accept that your life won't ever be what it once was, you can start to build a new life that has joy and meaning in spite of the medical problems.
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Avatar_m_tn
I am currently sat in hospital in the UK waiting for my scan with many of your symptoms. Came in for appendicitis but also have rectal prolapse. I can only offer my support of your frustrations. I have been waiting over two years to have rectal problems sorted out. It's nice to know that I am not alone.

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1804836_tn?1318539183
How did your tests go?  So I am better (no more pain) since my surgery last year, but still have constipation issues (even though the surgeon told me that after my rectopexy surgery for the rectal prolapse that I should have no problems).  Now, I am dealing with the fact that my bladder is not working - I have to do self catheterization daily.  

Hope all goes well for you!
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Avatar_f_tn
I wonder if anyone can help me, Im pulling my hair out with frustration and pain. FOUR weeks ago I went to the ER with low right abdo pain and they kept me in. Told me my ovaries are fine, the CT scan found nothing and my bloods were normal, my blood pressure was so low that they wouldnt let me home for a couple of days. I was told it wasnt my appendix even though I was indicating to them that this was where the pain was, they scanned my gallbladder (upper right) but not my lower right, I was so frustrated. Apparently being 46 pointed towards my gallbladder, how silly is that. to cut a long story short, Ive been back to my gp twice, telling them that the pain is constantly there, and varies in severity throughout the day and night. Ive lost my appetite, feel sick and shaky all the time and no one can tell me what it is. In 3 days Ive eaten 4 slices of toast, thats all. Today Im sitting here and the pain is at its worst yet but I dont know what to do, the ER found nothing, my GP told me to take painkillers and because my blood results are all showing as normal, they seem to imply its in my head!! Help me someone, I cant stand this pain.
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Avatar_f_tn
I wonder if anyone can help me, Im pulling my hair out with frustration and pain. FOUR weeks ago I went to the ER with low right abdo pain and they kept me in. Told me my ovaries are fine, the CT scan found nothing and my bloods were normal, my blood pressure was so low that they wouldnt let me home for a couple of days. I was told it wasnt my appendix even though I was indicating to them that this was where the pain was, they scanned my gallbladder (upper right) but not my lower right, I was so frustrated. Apparently being 46 pointed towards my gallbladder, how silly is that. to cut a long story short, Ive been back to my gp twice, telling them that the pain is constantly there, and varies in severity throughout the day and night. Ive lost my appetite, feel sick and shaky all the time and no one can tell me what it is. In 3 days Ive eaten 4 slices of toast, thats all. Today Im sitting here and the pain is at its worst yet but I dont know what to do, the ER found nothing, my GP told me to take painkillers and because my blood results are all showing as normal, they seem to imply its in my head!! Help me someone, I cant stand this pain.
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