After major surgery on the uterus or ovaries, the belly can act up out of nowhere, often long after the operation. You feel fine, and then suddenly you are bloated, swinging between constipation and diarrhea, and once in a while you end up in the emergency room. When doctors look inside, they often find loops of bowel stuck together. This is called a bowel adhesion.
Why does it happen? Once we open the abdomen and handle the organs, the body tries to heal the area by laying down a sticky, fibrous kind of tissue. That helps recovery, but the trouble is that this tissue can fuse bowel to bowel, or bowel to the abdominal wall, in places it shouldn't. The deeper into the pelvis a surgery reaches, as in gynecologic cancer, the higher the odds. And if you have been on chemotherapy for a long time, the bowel itself tends to be sluggish, which gives you even more to keep an eye on.
The scary part is how quietly it announces itself. Mild indigestion and trouble passing gas are easy to wave off as just another side effect of chemo. But if it builds into a complete blockage, what we call a bowel obstruction, that is an emergency. If your abdomen swells up tight, you are vomiting, and absolutely no gas or stool is passing, do not hesitate to go to the hospital. This is not the kind of thing that gets better by waiting it out.
That said, there is no way to prevent every adhesion. There is genuinely a part of this that no one can predict before opening the body. Still, there are things you can do day to day. Eat small amounts often rather than one big meal, drink plenty of water, and walk a little and often, as much as your body allows. It doesn't have to be real exercise; even one loop around the hospital ward hallway helps get the bowel moving.
I'd also like to add a word for the family members doing the caregiving. Please don't blame yourself for not noticing sooner, or for giving in when your loved one said they wanted to eat. Adhesions are not something a caregiver can prevent. There may be days when a thoughtless remark from someone stings, but that is not the fault of the person hearing it; it is a lack of care from the person who said it. When it gets heavy, find someone to talk to. Just putting it into words can make it feel a good deal lighter.
What is written here is general information, and if you have symptoms, please discuss them directly with your own medical team.