Adhesions
Internal scar tissue that binds organs together
Quick Facts
- Type: Connective (scar) tissue condition
- Common cause: Previous abdominal or pelvic surgery
- Often: Cause no symptoms at all
- Possible problems: Pain, bowel obstruction, fertility issues
Overview
Adhesions are bands of fibrous, scar-like tissue that form between organs, tissues, or the inner wall of the abdomen or pelvis. Normally, internal surfaces are smooth and slide easily against one another. When tissue is injured or inflamed, the healing process can cause surfaces to stick together as scar tissue forms, creating an adhesion.
Adhesions are very common after abdominal or pelvic surgery and may also follow infection, inflammation, or endometriosis. Many adhesions cause no symptoms at all and are never noticed. In some people, however, they pull on or trap organs and lead to pain, bowel obstruction, or fertility difficulties.
Symptoms
Most adhesions are silent, but when they cause problems the symptoms depend on which organs are involved.
- Chronic or intermittent abdominal or pelvic pain
- Pain that worsens with movement, certain positions, or eating
- Bloating and cramping
- In the pelvis, pain during intercourse or difficulty becoming pregnant
If adhesions block the bowel, symptoms can include severe cramping abdominal pain, vomiting, swelling of the abdomen, and an inability to pass gas or have a bowel movement. A bowel obstruction is a medical emergency.
Causes
Adhesions form as part of the body's healing response to internal injury or irritation.
- Surgery: The most common cause, especially abdominal and pelvic operations, where handling of tissues triggers scarring.
- Infection: Conditions such as pelvic inflammatory disease or peritonitis.
- Inflammation: Inflammatory bowel disease and other inflammatory conditions.
- Endometriosis: Tissue similar to the uterine lining that causes irritation and scarring in the pelvis.
- Radiation: Treatment to the abdomen or pelvis.
Risk Factors
- Previous abdominal or pelvic surgery, particularly major or repeated operations
- Past abdominal or pelvic infection
- Inflammatory bowel disease
- Endometriosis
- Previous radiation therapy to the abdomen or pelvis
Diagnosis
Adhesions are difficult to detect because they usually do not show up on standard imaging.
- History: Previous surgery, infection, or other risk factors along with the symptom pattern.
- Imaging: Scans may show complications such as a bowel obstruction rather than the adhesions themselves.
- Laparoscopy: A keyhole procedure with a camera is often the only way to see adhesions directly, and it can sometimes treat them at the same time.
Because adhesions are hard to confirm without surgery, they are sometimes diagnosed after other causes of symptoms have been ruled out.
Treatment
Treatment is needed only when adhesions cause symptoms or complications.
- Watchful management: Adhesions causing no problems usually need no treatment.
- Pain management: For ongoing pain, depending on the cause and severity.
- Surgery to divide adhesions: A procedure called adhesiolysis can release adhesions causing pain or obstruction, though surgery itself can lead to new adhesions.
- Emergency surgery: Needed when adhesions cause a complete bowel obstruction.
Decisions about surgery weigh the benefits against the chance of forming further adhesions.
Prevention
- Surgeons use techniques and sometimes special barriers during operations to reduce adhesion formation
- Minimally invasive (keyhole) surgery may cause fewer adhesions than open surgery
- Prompt treatment of abdominal and pelvic infections
- Good management of conditions such as endometriosis and inflammatory bowel disease
When to See a Doctor
See a clinician for persistent or recurring abdominal or pelvic pain, especially after previous surgery. Seek emergency care immediately if you have signs of a bowel obstruction:
- Severe, cramping abdominal pain
- Vomiting
- A swollen, bloated abdomen
- Inability to pass gas or have a bowel movement
A bowel obstruction can become serious quickly and needs urgent treatment.
Frequently Asked Questions
What are adhesions?
Adhesions are bands of scar-like tissue that form between organs or tissues inside the body, often after surgery, infection, or inflammation. They can make surfaces that normally slide freely stick together. Many cause no symptoms, but some lead to pain or obstruction.
Do adhesions always cause symptoms?
No. Most adhesions are silent and are never noticed. Problems arise only when they pull on or trap organs, which can cause chronic pain, bowel obstruction, or fertility difficulties in the pelvis.
How do I know if I have adhesions?
Adhesions are hard to detect because they usually do not appear on standard scans. They are often suspected from a history of surgery or infection plus typical symptoms, and may only be confirmed during a laparoscopy, a keyhole procedure that can also treat them.
Can adhesions be removed?
Yes, a surgical procedure called adhesiolysis can divide adhesions that cause pain or obstruction. However, surgery itself can trigger new adhesions, so the decision weighs the expected benefit against the risk of forming more.
When are adhesions an emergency?
Seek emergency care if adhesions cause a bowel obstruction, with severe cramping abdominal pain, vomiting, a swollen abdomen, and inability to pass gas or stool. A bowel obstruction can become dangerous quickly and needs urgent treatment.
References
- MedlinePlus, U.S. National Library of Medicine. Adhesions.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Abdominal adhesions.
- Mayo Clinic. Small bowel obstruction.
- American College of Obstetricians and Gynecologists (ACOG). Pelvic adhesions.