Worried about abdominal pains after operation
Q
I had surgery to remove an ovarian cyst three months ago. I was told that it was benign, so I didn’t need any follow-up. But in the last few weeks I’ve had pain in the same area of my lower tummy. My GP says it’s most likely just deep scar tissue and it should settle down. Could the cyst have come back? And if it is scar tissue, can anything be done about it?
A
It sounds as if you may have developed adhesions. These are bands of scar tissue that connect parts of the body that are not normally joined together, such as between loops of the bowel, or between the ovaries and the womb or the side wall of the pelvis.
They occur as part of the body’s repair mechanism after surgery and are common, occurring in over 90 per cent of people who have abdominal or pelvic surgery.
They can look like fine bands of cling film or may be thicker, fibrous bands. They typically begin to form in the first few days after surgery, but may not produce any symptoms for months or years, or not at all.
Adhesions between the bowel can cause obstruction while those in the pelvis can lead to fertility problems.
They can be difficult to diagnose with scans, but if you are very worried about the cause of your pain it may be worth having one. If nothing else, it would confirm that your cyst has not returned.
Pain from adhesions often does settle down, so taking painkillers short term is often a reasonable course of action.
But if you have severe pain then you may benefit from a laparoscopy, where a surgeon can look directly at your pelvic organs via a camera while you are under general anaesthetic, to trim away any adhesions. Unfortunately, this can result in more forming, but with luck they won’t be as troublesome as the original ones.
Q
My 14-year-old daughter is a bit of an eco-warrior and wants to use a menstrual cup rather than sanitary towels. Is this safe for someone of her age? Is there a risk of infection?
A
A menstrual cup is a small funnel shaped device made of either silicone or rubber that is inserted into the vagina to catch and collect menstrual blood. They can hold more than a tampon and some can be left in place for up to 12 hours, depending on period flow, though many cups recommend changing every four to eight hours.
The cups can be washed and then re-used, making them more ecofriendly than disposable sanitary pads or tampons. If cared for properly they can last for 10 years, making them more economical than pads as well.
Unlike tampons, they do not dry the vagina, so they do not interfere with the balance of healthy bacteria, which help protect against vaginal infections and they are not associated with toxic shock syndrome. However, like tampons, women who have never had sex may find them difficult and painful to insert, especially at first, and if this is the case, it may be helpful to start by trying out a very small tampon.
It can be hard to get a cup that is the right fit, and your daughter may need to try several before she finds one that is suitable.
Inserting and removing them is a skill which can take time to learn and so is best done at home, over the course of a weekend. Removing a full cup can also be a bit messy, so she will also need to think about where she can do this at school and it may be that on her heavier days a pad or tampon would be an easier option.
Like tampons, cups can be worn while swimming, but to reduce the chance of leaks it’s better to empty them before entering the pool.
Q
I’ve been feeling anxious and a bit low recently so my GP recommended counselling. After waiting several months, I’ve finally had a few sessions, which are done over the phone, but I feel like the counsellor is just reading from a standard script, telling me what to do. There is no discussion or interaction and I don’t feel it’s any help, which is really disappointing. Is this how all counselling is done now, or should I ask to see someone else?
A
I suspect you may be having cognitive behavioural therapy (CBT) which does not involve talking freely about what has gone on in the past. Rather it concentrates on the difficulties you are having now, how your thought processes may be contributing to making you feel low and anxious and does not involve trying to resolve historical issues.
Unlike many other forms of therapy, CBT is very structured and involves the therapist asking specific questions about the problems you are having now and then setting you goals to try and achieve, which usually involves challenging your thinking patterns.
However, as with any form of therapy this should be a collaborative process, so your therapist should discuss with you ways to find solutions to your current difficulties.
Most CBT offered on the NHS is for a limited number of sessions and this too can add to the feeling that you are doing a set course.
I would encourage you to try and continue, but do tell the therapist how you are feeling and ask if there is any room to change her approach.
Many people do find CBT very helpful, but it’s not suitable for everyone and it may be that you would do better with a different form of therapy.
Your current therapist should be able to refer you on if this is not something she can offer. Alternatively, do go back to your GP for further advice.