Some symptoms need care right away. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, explains that adhesions are the most common cause of a blocked small intestine. If you have severe abdominal pain and can’t pass gas or stool, get medical care immediately.
In the video above, OB/GYN Dr. John Dulemba explains what adhesions are, how they can cause pain in women, especially with endometriosis, and how they are treated.
What adhesions are
Dr. Dulemba describes adhesions as part of the body’s normal healing. If you’re cut anywhere on your body, you develop scar tissue, and the same kind of scar tissue can form inside the abdomen. NIDDK describes adhesions as bands of scar-like tissue that join organs to each other or to the wall of the abdomen.
The problem, Dr. Dulemba explains, is that this scar tissue can make organs stick together. The ovaries can become stuck to the side wall of the pelvis or to the uterus, and the bowel can become stuck to the back of the uterus.
What causes them
According to NIDDK, abdominal surgery is the most common cause. Adhesions form in more than 9 out of 10 people who have open abdominal surgery, although most never have symptoms. They are less common after laparoscopic (keyhole) surgery. Inflammation and infection can also cause them, including endometriosis, pelvic inflammatory disease and Crohn’s disease.
The link with endometriosis
The American College of Obstetricians and Gynecologists (ACOG) explains that endometriosis is a long-term condition in which tissue like the lining of the uterus grows outside the uterus, usually in the pelvis. It affects about 1 in 10 women of reproductive age. This tissue responds to the monthly cycle: it can bleed and become inflamed, and over time this can form adhesions that make organs stick together.
Dr. Dulemba says that until the endometriosis is removed, the scar tissue will keep growing and interfering with normal function. He describes adhesions that start slowly, then grow thicker and develop their own blood supply and nerves, so they hurt more as the disease progresses.
Symptoms
Many people with adhesions have no symptoms. NIDDK says long-lasting abdominal pain is the most common symptom, and that adhesions in the pelvis can block or press on reproductive organs and make it harder to get pregnant.
ACOG lists these common symptoms of endometriosis:
- long-lasting pelvic pain, the most common symptom
- painful periods, which often get worse over time
- pain during sex
- pain when urinating or having a bowel movement
- constipation, bloating or other digestive problems
- trouble getting pregnant
ACOG notes that the amount of pain doesn’t always match how severe the endometriosis is.
How they’re diagnosed
Adhesions usually don’t show up on X-rays or CT scans, NIDDK explains, although these tests can show a blockage the adhesions cause. Sometimes surgery is needed to see them.
For endometriosis, ACOG says an ob-gyn starts with your history and a pelvic exam and may order a transvaginal ultrasound, or sometimes an MRI. The only way to confirm endometriosis is a laparoscopy, but ACOG notes you don’t have to have one before starting treatment for symptoms.
Treatment
Adhesions that cause no problems don’t need treatment, according to NIDDK. When they cause symptoms, they can be released with surgery.
Dr. Dulemba explains that adhesions can’t go away on their own, so when endometriosis has caused them, the adhesions have to be cut. Left untreated, he says, the pain may keep getting worse.
Endometriosis itself can be treated with medicine, surgery or both, ACOG says. Pain relievers called NSAIDs can ease pain, and hormonal medicines can slow the growth of endometriosis and help manage pain, although they don’t remove tissue that is already there. During surgery, endometriosis can be removed by cutting or with a laser.
Why adhesions can come back
Cutting adhesions leaves raw surfaces that can form new ones. Dr. Dulemba says adhesions can come back in more than 80 percent of patients who have had them before. NIDDK also notes that surgery to remove adhesions can cause new ones.
To lower the chance, Dr. Dulemba says surgeons try to limit blood loss and tissue damage, and may place barrier materials to keep raw surfaces apart while they heal. NIDDK lists similar steps, including laparoscopic surgery when possible, gentle handling of tissue and absorbable barrier films.
For endometriosis, ACOG says most people get pain relief from surgery, but up to 8 in 10 have pain again within two years. Hormonal medicine after surgery may help keep pain away longer.
Dr. Dulemba says there are few alternatives to surgery for adhesions, though approaches such as physical therapy or acupuncture may help relieve symptoms.
Questions to ask your doctor
- Could adhesions or endometriosis be causing my pain?
- What tests do I need, and will an ultrasound or MRI show the problem?
- Can I start treatment for my symptoms before having a laparoscopy?
- Which medicines could help, and what are their side effects?
- If I have surgery, how will you reduce the chance of new adhesions?
- How might treatment affect my chances of getting pregnant?
- What can I do if the pain comes back after surgery?
- Which symptoms mean I should get care right away?
Dr. Dulemba is an OB/GYN in the Dallas-Fort Worth area. See Dr. Dulemba’s Best Docs Network profile for more about the practice.
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
