Q: Hi good folks. Several years ago I had emergency surgery for diverticulitus (I was 44, now 48). Afterward I lived with a colostomy bag for six months and then had a colon resection. During the second surgery it was discovered that I had extensive scar tissue. I am assuming that there is even more scar tissue now resulting from the second surgery. Since then I have experienced some occasional intense short blasts of pain when doing asanas (parsvottanasana and prasarita padottanasan in particular). I know I have to be careful of causing hernias and have worked to increase abdominal strength. I have two questions: What about the forward bends is causing the pain and how do I correct myself to prevent the pain? Will stretching (twists and backbends) aggravate the creation of scar tissue or can it help to keep my abdominal area more supple? Thank you in advance for any information and/or advice you can provide.
A: Thanks for writing in! Your question is challenging for several reasons. The most obvious one is that without a longer interview about your recent and past history and without an actual physical exam, it is really hard to know what is the source of your abdominal pain. As we have advised students in the past, make sure to get a good check up soon with your surgeon and family MD if you have not do so yet. Secondly, you could assume, and maybe rightly so, that your pain is coming from scar tissue that formed as part of the healing process from your two surgeries. It would be helpful to know if you had similar pains between the two surgeries, or only since the second one, when you have been able, I would imagine, to be more physically active. But—and the big but—there could be a completely different source of your pain that is as yet undiagnosed! Ergo the need to see your docs for a check up to rule out some other source of abdominal pain.
Finally, I am not sure, but must assume, that the abundant scar tissue seen during the second surgery may have been a result of a ruptured diverticuli, that ruptured into your abdominal cavity. This could explain the need for a temporary colostomy bag. When you have a rupture of this sort, the contents of your large intestines, stool, can escape into the belly cavity. This can result in an infection and inflammation situation in the belly, often treated with strong antibiotics. A side effect of such a situation is that the tissues of the belly can end up sticking to one another and adhesions (like the word adhesive) form between these tissues, and they are often referred to as “scar tissue.” Sometimes these adhesions don’t cause any trouble, sometimes they cause pain or pulling, and in rare instances, they could block to gut and cause a serious back up.
I would also assume that during the second surgery, they probably cleaned up the scarred areas while they re-connected the two ends of your large intestine. If everything was clean and no infection happened after the second surgery, you could expect little or no new scar tissue or adhesions. This is good news, and your assumption about more scar tissue after the second surgery may not be true.
But even with an uncomplicated surgery, healing tissue forms a scar as part of healing process and this is an expected and normal situation. However, the areas of scar on the surface of the body and even inside the body could lead to some tightness and restriction of movement in the affected area. I know this first hand, as I had a double groin hernia repair about ten years ago, and after the initial pain subsided, I definitely had tightness and mild discomfort for months if not a year afterwards. A patient yoga practice gradually got me back to a full experience of yoga.
Backing up a moment, clean wounds seal up pretty fast, with in a few weeks, but they continue to get stronger for a while longer, at least six weeks. In fact, a common warning after surgery is to limit activity for about six weeks after surgery to give the body enough to form a strong scar. Usually, after that, you can gradually resume your pre-surgery activity.
So if we assume you have been to the doctor and have a clean bill of health, how do you approach the pain you are having? If it is exclusively happening in forward bends, is it in all forward bends, or only the two standing ones you mention above? The fact that it happens in forward bends makes me suspicious that the action of “compressing” the abdominal contents is the trigger for the pain, especially if twists and backbends don’t cause pain. If the source of the pain is fascia or connective tissue in the belly, you can cautiously and safely do backbends and twists as a way of releasing some of that tension, which could lead to lessening of pain on forward bends.
If you love forward bends and want to keep them in your practice, consider tipping from the hip joints and avoid rounding the spine and don’t bring the lower belly in contact with your thighs. In other words, stay a little higher up in the forward bends and see if you can avoid triggering the pain. You can still feel a nice stretch in the back of the legs and torso with this modified way of doing forward bends. Also, for seated forward bends like Upavista Konasana (Wide Angle Forward Bend), where the legs are wide apart and the belly is not so compressed, I’d hope you would have less chance of triggering pain, even though the standing version was a trigger. You will have to do some experimenting in your home practice and have an experienced teacher observe you in your forward bends to begin to get more details on what poses seem good to do and others that might be best avoided. If I have a pose that I avoid because it triggers pain, I like to have one that I can substitute in when I am in a public class and don’t want to miss out.
Hope these thoughts are helpful in you yoga explorations!