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Lower abdomen pain after c-section and tubectomy. Cause and cure?

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Dr. Aarti Abraham

OBGYN

Practicing since :1998

Answered : 6000 Questions

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Posted on Wed, 6 Feb 2013 in Vaginal and Uterus Health
Question: Lower Abdomen Pain after C Section (11 years ago) and Tubectomy (11 years ago). The pain always existed for the past 11 years and has aggravated now. Got a Scan done and report was clear. What are the reasons and solution?
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Answered by Dr. Aarti Abraham 10 hours later
Hello,
Thanks for writing to us.

There could be two clear cut reasons for the problems that you describe.

1. Because of adhesions following the surgery. An adhesion is a band of scar tissue that binds 2 parts of your tissue together. They should remain separate. Adhesions may appear as thin sheets of tissue similar to plastic wrap or as thick fibrous bands.
Abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery. Most adhesions are painless and do not cause complications. However, they are known to cause chronic pelvic pain. Adhesions typically begin to form within the first few days after surgery, but they may not produce symptoms for months or even years. Adhesions develop as the body attempts to repair itself. This normal response can occur after surgery, infection, trauma, or radiation. Repair cells within the body cannot tell the difference between one organ and another. If an organ undergoes repair and comes into contact with another part of itself, or another organ, scar tissue may form to connect the 2 surfaces. Doctors typically diagnose adhesions during a surgical procedure such as laparoscopy (putting a camera through a small hole into the stomach to visualize the organs). If they find adhesions, doctors usually can release them during the same surgery.

Studies such as blood tests, x-rays, and CT scans may be useful to determine the extent of an adhesion-related problem. However, a diagnosis of adhesions usually is made only during surgery. Treatment varies depending on the location, extent of adhesion formation, and problems the adhesion is causing. Adhesions frequently improve without surgery. Therefore, unless a surgical emergency becomes evident, a doctor may treat symptoms rather than perform surgery, because further surgery itself might lead to more adhesions !

With a normal scan report, chances are high that this is adhesive pathology, and if not severe, it does not require surgery.

2. The post hormonal changes in the woman’s body. More specifically, the post tubal ligation syndrome (PTLS) is often referred to the different side effects that the woman experiences after the tubal ligation was done. Most women complain that the effects are negative ones causing them pain, discomfort and stress.

Most women complain of increased menstrual bleeding, vaginal dryness and itching. There are also symptoms of bloating, cramps, insomnia and weight gain. They seem to have symptoms of menopause like sweats, hot flushes and mood swings. They also complain of increased feelings of stress and anxiety, depression and some memory lapses. There is loss of sexual appetite since the woman experiences painful sex due to vaginal dryness. Chronic pelvic pain might be one manifestation. If you are having any of the other symptoms alongwith pain, chances of this condition are high.
Treatment is with psychological counselling, anti stress and anti depressant medications and hormonal replacement if indicated.

3. There may be other varied causes of chronic pelvic pain . You need to see a specialist who will elicit a complete history and perform a detailed review of systems, including reproductive, GI, musculoskeletal, urologic, and neuropsychiatric. A detailed gynecological examination is a must. There are varied causes of this condition such as Endometriosis ( also diagnosed often only by laparoscopy and might not show on an ultrasound ), Adnexal cysts, Chronic ectopic pregnancy, Chlamydial infection, Pelvic congestion syndrome, Adenomyosis, fibroids etc. Some of these might not be explained by a normal scan, and a detailed gynecological evaluation would highlight these.

Certain Urologic disorders, Musculoskeletal disorders, low back pain, chronic pain in the coccyx, pelvic floor myalgia, subtle hernias could cause these. Gastrointestinal diseases ( eg chronic constipation, irritable bowel syndrome ) , neurological disorders, and psychological upheavals also lead to chronic pelvic pain.

Since these causes are varied, treatment depends on exact diagnosis , which requires a thorough check up and appropriate referrral based on the findings.

Meanwhile, a healthy lifestyle, nutritious diet, a positive outlook and relaxation techniques like yoga/meditation and regular exercise can significantly alleviate the severity of chronic pelvic pain.

Take care and feel free to ask for further clarifications.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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