Abdominal adhesions are fibrous strands or scar tissue that may commonly form following abdominal or pelvic surgery. Pelvic adhesions may involve any organ within the pelvis, such as the uterus, ovaries, fallopian tubes, or bladder. They may be caused by surgery, infection, inflammation or endometriosis. They may lead to multiple conditions such as chronic pelvic pain and infertility.
Adhesion may be asymptomatic or they may cause debilitating symptoms:
- Pain - by restricting mobility of mobile organs in the abdomen or pelvic cavity, eg. bowel and ovaries. Furthermore, nerve endings may become entrapped within developing adhesions. The pain can be local or deep in the pelvis.
- Bowel obstruction - dense adhesions can cause a narrowing of the bowel known as a stricture, leading to a condition known as bowel obstruction.
- Bladder problems - adhesions can reduce the capacity and proper emptying of the bladder causing pain and frequency, which can be mistaken for cystitis.
- Dyspareunia [pain during sex] - when the ovaries become stuck down by scar tissue and can result in pain during deep penetration.
- Infertility - scar tissue can result in the ovaries being displaced from their normal position, or in the blockage of the Fallopian tubes interfering with the process of egg production [ovulation] and egg transport through the Fallopian tubes.
Adhesions may be removed by laparoscopic [keyhole] surgery although adhesion reformation is still a significant problem. Research is currently ongoing in this controversial area with some studies suggesting the removal of adhesions is unhelpful whilst others suggest it to be helpful.
Use of Adhesion Prevention Products
Some anti-adhesive agents were shown to prevent adhesion formation after gynaecological surgery compared to placebo but there is no evidence that they improve fertility outcome or prevent pelvic pain.