Doctors language?

[Hriverson]

Hi!

I'm due to have my first laparoscopy next thursday which I'm more excited about than nervous luckily! however I just got a letter from my gyno which basically described what he thinks is wrong but I don't actually understand any of it wondered if anyone could help?! It says that apon examination my left adnexum was very tender (?!) and that my uterus was fixed to my abdomen (might sound stupid but is it supposed to be like that?) and that he suspects endometriosis or possible adhesions (not sure what adhesions are). I've already had my pre op so havent got a chance to ask but just want to know just so i understand really! Hope someone can help!

[Impatient]

Adnexa -- basically means the extra bits (in this case to the uterus- so adnexa includes fallopian tubes ovaries, ligaments etc the smaller parts of the baby making set up or organs.) It's a general term in this case you reported that the left side (referring to where the left ovary is) is sore when examined by the doc.

The uterus is not supposed to be fixed by anything except for the uterine ligaments on either side. It should be flexible and floppy and able to tilt back and forth and grow when you are pregnant.

When it is reported that it is attached to the abdomen - this means it is glued tilted forwards and won't flop back. This is less common with endo. Most endo ladies have the opposite problem - glued retroverted or tilting back and stuck to the bowel.

What causes the sticking is adhesions. When your stomach has a trauma - it can be an external hit, or a surgery or from internal diseases like STIs, PID Ovarian Cysts that leak, or Endometriosis..... the damage caused to the internal tissue can trigger the body to respond to that injury by growing scar tissue as a cushion of protection from future harm... Adhesions are very sticky - super glue strong strands and they can grow across the surface and grow outwards till they hit a neighbouring organ or ligament and stick to it.

They keep on growing once they have been triggered they just cannot be stopped.

This can cause a lot of problems inside as you grow older resulting in all the organs in the pelvis getting stuck to each other and the phrase frozen pelvis applies when this has happened over many years.

The ONLY way to control adhesion growth is periodically having surgery to cut back the adhesions, but each surgery will encourage more to grow. So its not an ideal solution, but at the same time this stuff is protecting our bodies so we don't want to stop it completely It would be nice to find away to have controlled growth so it doesn't get out of control.

Adhesions can and do cause a lot more problems than endo. Adhesions can grow round tubes like the vagina and cervix and bowel and intestines and ureters and squash them like a tightening corset making it increasingly difficult and painful to pass a poo, have a wee, have sex etc.

They can make a pregnancy very painful too because they are not stretchy. instead of stretching they tear at the weakest point which is where they are attached to your body organs and tissue - and each time it tears you have created a new wound which can be the new starting point for more adhesions and scarring to grow.

Adhesions can also form inside organs - inside the bowel, the vagina and the cervix too.

If you have adhesions inside and outside the vagina for example and then need a speculum expanded inside for a smear test to be done - then that rips and tears adhesions causing excruciating pain...and even having sex can cause this pain and bleeding where it tears adhesions so once you start finding sex painful - by carrying on injuring yourself inside by continuing to have sex - you are making the problem worse in the long run.

Adhesiology is the op to cut or burn back adhesions. They are like a mighty thick entanglement of cobweb like strands all over the place.

Advanced and long standing adhesions can grow their own blood supply and nerves making them very prone to causing a lot of pain as the years go by.

They can grow around the ovaries and fallopian tubes preventing a released egg from getting to the uterus.

They are so sticky that they can stick the uterus to nearby organs very firmly. They can stick ovaries to the front or back of the uterus and away from the fallopian tubes making a natural conceiving of pregnancy extremely unlikely without help.

Each month when endo cells bleed, that blood is trapped in side you, can't escape -it lands on things lower down - if you re standing up or sitting up, and the two lowest places for gravity to drag those blood drops down to are the front and back of the uterus.

The pocket at the back of the uterus between it and the bowels is called the Pouch of Douglas or POD for short.

The pocket to the front of the uterus between it and the bladder is the uterovesical pouch.

These two tend to be where the blood from endo ends up. In your case probably that front one.

When the blood and endo cells fall there they irritate the tissue they have landed on causing sores, these sores heal after the bleeding is stopped and scar up like any wound scars up. They can also over time of repeat irritation start to build up adhesions as a cushion of protection from future harm to the underlying cells. Adhesions being sticky can grow up from the uterovesical pouch and any previous surgery holes in the stomach skin and if one day you lie on your tummy or some one or thing presses on your tummy the super sticky adhesions growing there may just catch enough of the uterus to form a bond sticking the two together.

They can get stuck surface to surface - or can get stuck with strands of adhesions...either way the uterus ends up unable to flop back and forward which would be its normal range of flexibility.

Surgery to break through the adhesions and unstick organs and free them up can be very helpful.

Buffers or barriers (there are many types) can be placed inside the body to slow down the speed at which adhesions can re-stick things together. The buffers won't stop adhesion growth but will delay the harm they do elsewhere.

So you can free up an ovary and apply a barrier to prevent it resticking to the back of the uterus. Or between the uterus and abdominal wall to slow down a repeat of the uterus getting stuck again too soon.

This is why endo ladies are advised the best time to try for a pregnancy if after a surgery as most of the critical adhesions will be cut back meaning getting pregnant should be easier, and the growing baby bump less painful too.

It's only to give you a laymans idea about adhesions - hopefully it kind of makes sense to you now.

They are wretchedly annoying things because they can cause lot of pain and discomfort...even when endo is entirely removed or even for people who don't have endo. Anyone male, female, children to pensioners can develop adhesions in the tummy from tummy traumas.

They really can complicate surgery for surgeons and compromise how well our organs can do their job.

So if you are found to have them they can be a sign of having endo as well as other things that have happened in the past. They can be cut back in a surgery to free up organs, and if they are found the hunt is on to find endo lesions hidden behind adhesions. Best of luck for the op. Whether endo is found or not - you can still have the adhesions seen to, on this op which should give you some level of relief from discomfort once you are recovered from the op.

[Hriverson in reply to Impatient]

That was such a helpful reply thank you so so much I understand so much better now!! Xx

[Hriverson in reply to Impatient]

That was such a helpful reply thank you so so much I understand so much better now!! Xx

[Mcfw in reply to Impatient]

Wow - thank you.

I've spent the last 3 weeks laid up and rapidly getting up to speed on any information. This is the best and most detailed explanation yet. My post op chat might be a bit longer than my consultant he anticipated and I can cut out some of my silly queries.

Thank you again

[Shehulk]

Hi, I'm not a doctor so I might have this wrong but as I understand it from deciphering my own reports, adnexum refers to the area where your ovaries are so the left, will be the area where your left ovary is. Also your uterus is supposed to be mobile so during an examination the gynaecologist should be able to manipulate it and move it but endometriosis and adhesions can fix it into one place, I think is called frozen uterus. Mine is fixed to the bowel apparently!

best of luck for your op next week x

[Mammoth]

Fantastic, comprehensive reply. Just in case anyone else is searching the questions and trying to make sense of similar problems, I just wanted to add that adhesions can be thought of as scar tissue, where the body is trying to heal itself. It tightens as it heals, just as other scar tissue does, for example on the skin's surface. I have adhesions that pinned my left ovary and tube to the rear of my uterus and bowel and caused a hydrosalpinx (fluid-filled tube). My left ureter is also caught up in the jungle of adhesions. Surgery managed to unpin the left ovary and tube from the bowel, but couldn't safely separate out the ureter without causing it damage. My uterus and bowel are also adhered together. They could not be separated without causing structural damage to one organ or another. This has caused me bowel pain and diarrhoea during menstruation and is starting to cause me bother in the final few weeks of pregnancy. (Now 35 weeks.)