Adhesions are a widespread problem with over 90% of people who have had abdominal surgery going on to develop adhesions. Although adhesions are usually the result of previous surgery, some can occur following pelvic infection, and in many instances, they accompany more severe stages of endometriosis.
Adhesions can affect the female reproductive organs and cause a range of problems including infertility, painful sex, pelvic pain and bowel obstruction or blockage. Adhesions, especially when occurring together with conditions such as irritable bowel syndrome or endometriosis, commonly cause chronic pelvic pain.
A laparoscopy, which is a minimally invasive procedure, is usually performed to confirm the presence of adhesions. If adhesions are found, your doctor can usually release them during the same surgery.
What Causes Adhesions?
An adhesion is a band of scar tissue that joins two internal body surfaces or organs together. Adhesions develop as the body attempts to repair itself. This normal bodily response results in organs, or tissues within the body sticking to other internal surfaces. Adhesions vary in size - some are thin sheets of tissue while others are thick fibrous bands.
Pelvic adhesions often form after a pelvic surgery, such as a Cesarean section (C-section), surgery for endometriosis, removal of an ovarian cyst or in response to an infection (such as pelvic inflammatory disease) or another condition like endometriosis or appendicitis.
How Are Adhesions Diagnosed?
Diagnosing the cause of chronic pelvic pain can be difficult. According to your symptoms, your doctor may refer you for one or more diagnostic tests to rule out any abnormal pathology or medical condition. These tests may include blood tests, x-rays, CT scans, MRIs or ultrasound.
If the results of these tests are normal or negative, a diagnostic laparoscopy may be necessary as these tests cannot diagnose adhesions. A diagnostic laparoscopy is the only procedure that can conclusively diagnose adhesions. During this procedure, your surgeon uses a laparoscope to clearly view your reproductive and pelvic organs. If adhesions are found, your doctor will usually release them while performing the laparoscopy.
Symptoms Of Adhesions
Although most adhesions are painless and do not cause complications, adhesions are believed to contribute to the development of chronic pelvic pain. Adhesions can affect the ovaries, fallopian tubes, bladder, and the bowel. They can cause a range of problems including infertility, painful intercourse, pelvic pain, urinary tract infections and bowel obstruction. These symptoms significantly disturb daily activities and impair quality of life.
Adhesions can also lead to a complex set of problems called adhesion-related disorder (ARD). ARD causes chronic abdominal pain. It can be difficult to diagnose, presenting as a vague or 'crampy' pain. Symptoms of ARD can be mistaken for a host of other possible diagnoses such as chronic fatigue syndrome, endometriosis, irritable bowel syndrome, fibromyalgia, depression, and anxiety.
Symptoms of ARD May Include:
- Chronic pain
- Bowel obstruction and an inability to pass wind
- Urinary bladder dysfunction
- Pain and difficulty having a bowel movement
- Pain on movement such as walking, sitting or lying in certain positions
- Emotional disorders such as depression
- Intestinal problems such as constipation, obstruction, or alternating constipation with diarrhoea
How Are Adhesions Treated?
Treatment choices depend on symptoms and severity of disease. Non-invasive treatments include oral medications such as NSAIDs (Nonsteroidal anti-inflammatory drugs) to relieve abdominal pain or cramps, or hormonal drugs to regulate your menstrual cycle and alleviate abdominal pain. Although medication is often the first treatment choice for adhesions, it is not always effective.
Open adhesiolysis is mostly used to remedy serious problems such as bowel obstruction. Where possible, laparoscopic adhesiolysis is preferred as it is a minimally invasive (keyhole) surgery that decreases the risk of new adhesions forming after surgery.
During a laparoscopy, your surgeon operates through 3-4 small incisions on your abdomen. The laparoscope is a small lighted tube that enables your surgeon to clearly view your pelvic tissues and organs. Guided by this camera, the surgeon inserts tiny instruments through the incisions to release any adhesions. The adhesions are cut by a scalpel or electrical current.
Occasionally, adhesion barriers may be placed at the time of surgery to reduce future adhesion formations. This treatment is known as adjuvant treatment – it uses either pharmacological agents or mechanical barriers to inhibit the formation of adhesions after surgery.
What Are The Benefits Of Laparoscopic Surgery?
For women who are suffering from chronic pelvic pain due to adhesions, laparoscopic adhesiolysis can significantly improve their quality of life. This procedure produces similar results to open adhesiolysis when it comes to managing extensive adhesions.
The benefits of this procedure include being discharged from the hospital on the same day, not needing major abdominal cuts, experiencing minimal complications and being able to return to your normal routine within one week.