International Adhesions Society





Links - Adhesion Related Disorders (ARD) & CAPPS

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Resources with Links relative to helping to prevent chronic pain caused by post-surgical adhesions.
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Somewhere in the late 1990’s, shortly after its inception, the International Adhesions Society coined the term “Adhesion Related Disorder” (ARD) as a result of its research it had started into the nature of the problems of adhesions, from the perspective of the patient. Having adhesions is about much more than bowel obstruction, pelvic or abdominal pain, and that’s why we starting calling this ARD:

“Adhesion Related Disorder” (ARD): a constellation of recurrent bowel obstruction, chronic abdominal or pelvic pain, chronic diarrhea or constipation. Patients often develop a variety of psychosocial issues, and have undergone a number of procedures in an attempt to diagnose and/or correct a sometimes unidentifiable underlying problem.

It's not just....
Pelvic Pain
Interstitial cystitis
Irritable bowel syndrome


Complex Abdomino-Pelvic & Pain Syndrome

Going beyond ARD, the IAS’s own research revealed the ARD patient is a member of a much larger group of patients who, in varying degrees, combinations and sequences experience a range of overlapping and coalescing symptoms and conditions including endometriosis, interstitial cystitis (IC), irritable bowel syndrome (IBS), bowel obstruction, chronic abdominal and/or pelvic pain and even fibromyalgia.

Although ‘‘adhesions’’ may start out as a single, stand-alone entity, an adhesions patient may develop a number of related conditions rendering the severe ARD patient practically indistinguishable from patients with multiple symptoms originating from other abdominal or pelvic conditions. Similarly, a patient starting out with say chronic pelvic pain, may very well have, or develop bowel and bladder problems, as well as psycho-social issues that develop as a result of their condition.
Attempting to treat these conditions as separate entities for the most part is an exercise in frustration. Although they may start out as separate conditions, they end up as essentially one condition - CAPPS. What is needed is a multi-disciplinary and integrated or holistic approach. And to start we need to understand these individual conditions in the context of a family of conditions to which they belong.

Once we understand the disease we can begin on its prevention and treatment.

Accordingly we coined the term:
Complex Abdomino-Pelvic & Pain Syndrome

to describe this huge population of patients. We define CAPPS as:

“a syndrome of nonmalignant origin consisting of a complex of symptoms of the abdomen or pelvis that includes pain, bowel, or bladder dysfunction of at least 6 months duration.”
Read more about our research and why it was important to coin the term CAPPS.

This page goes beyond the standard descriptions of adhesions and their prevention, and discusses the wider problem of ARD and CAPPS.

CAPPS - General
- Disorders of adhesions or adhesion-related disorder: monolithic entities or part of something bigger--CAPPS? This is the landmark paper produced as a result of IAS research. Click here for the full text article and here for a lay summary and here for the PubMed abstract.
- Surgical treatment for chronic pelvic pain.
- Diagnostic laparoscopy and adhesiolysis: does it help with complex abdominal and pelvic pain syndrome (CAPPS) in general surgery? A paper coming from the Adhesions (CAPPS) clinic set up by the IAS with Dr. Redan and McCarus.
- "A Patient's Guide to Adhesions and Related Pain", Dr. Wiseman’s original paper describing adhesions, their treatment and their relationship to pain and bowel obstruction. In addition, stories from patients are featured to illustrate how adhesions (or suspected adhesions) affect their daily lives and how they cope with a sometimes-insurmountable problem. This was the paper that led to the terms ARD, CAPPS and their descriptions.
- Adhesion Related Disorder by Dr. Clark Gerhart, another doctor experienced in ARD.
- Evidence for overlap between urological and nonurological unexplained clinical conditions.
- IAS Research on Severe Adhesion Related Disorder (ARD); Pattern of Bowel Dysfunction and Obstruction, Social and Physician Issues: an Internet Survey
- IAS Research on Adhesions Related Deaths

IAS Sister Organization -ISCAPPS
- International Society for Complex Abdomino-Pelvic & Pain Syndrome

- Chronic Pain Research Alliance (CPRA), formerly the Overlapping Conditions Alliance.
- Campaign to End Chronic Pain in Women


Components of CAPPS

Chronic Fatigue Syndrome
- Chronic Fatigue and Immune Dysfunction Syndrome Association of America.

Dyspareunia (Painful Sexual Intercouse)
- Why does it hurt when I have sex? – ASRM.
- Sexual intercourse – painful.

See our endometriosis page here.

- Fibromyalgia – National Library of Medicine.
- Fibromyalgia – WebMD
- Fibromylagia Network

IBS – Irritable Bowel Syndrome
- Irritable Bowel Syndrome – National Library of Medicine
- National Digestive Diseases Information Clearinghouse (NDDIC)
- WebMed
- Irritable bowel syndrome and chronic pelvic pain: a singular or two different clinical syndrome?
- Defining and diagnosing irritable bowel syndrome

IBS Organizations
- Irritable Bowel Syndrome Self Help and Support Group
- International Foundation for Functional Gastrointestinal Disorders (IFFGD).

Interstitial Cystitis (IC), Painful Bladder, Overactive Bladder
- Interstitial Cystitis from National Library of Medicine
- Interstitial cystitis/bladder pain syndrome fact sheet
- Interstitial Cystitis/Painful Bladder Syndrome - NIDDK
- Patients with chronic pelvic pain: endometriosis or interstitial cystitis/painful bladder syndrome?
- Interstitial cystitis and endometriosis in patients with chronic pelvic pain: The "Evil Twins" syndrome.

IC Organizations
- Interstitial Cystitis Association
- International Painful Bladder Foundation
- Interstitial Cystitis Network and Overactive Bladder Network

Chronic Pelvic Pain (CPP)

- What is Chronic Pelvic Pain? – International Pelvic Pain Society
- Chronic Pelvic Pain and the Overlap of Pelvic Pain Disorders by Michael Pezzone MD.
Dr. Pezzone is the principal investigator of an NIH study that looked at the pathways of neurogenic cross-sensitization of pelvic viscera and its implications for the overlap of irritable bowel syndrome, interstitial cystitis, and other chronic pelvic pain disorders.
- Managing Pelvic Pain – ASRM
- Current concepts of pelvic congestion and chronic pelvic pain. An excellent review by the late Dr. Perry, founder of the International Pelvic Pain Society.

Research Articles
- Chronic pelvic pain in the community--symptoms, investigations, and diagnoses
- Hormone suppression in differential diagnosis of chronic pain

CPP Organizations
- International Pelvic Pain Society – has searchable database for physicians and other providers.
- Pelvic Pain Support Network – UK

Pain and Chronic Pain, General Resources
Please refer to our page containing resources concerning pain and chronic pain in general.

Complex regional pain syndrome, CRPS; RSDS; Causalgia - RSD; Reflex sympathetic dystrophy (RSD) syndrome

- CRPS information from the National Library of Medicine
- Global approach to chronic pelvic and perineal pain: from the concept of organ pain to that of dysfunction of visceral pain regulation systems

CRPS Organizations
- Reflex Sympathetic Dystrophy Association

Please see our Vulvodynia page here.

Conditions/ Procedures that may lead to adhesions

- Endometriosis. Please see our Endometriosis page here.
- Uterine Fibroids, Myoma, Myomectomy. Please see our fibroids page here.
- Hysterectomy. Although ANY surgical procedure has the potential to result in adhesions, we have highlighted hysterectomy because of its particular prevalence an ability to result in problems from adhesions.

Library & Resources >Links

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