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Every time your body heals from an injury, it leaves a mark. On your skin, you get a visible scar. Inside your abdomen and pelvis, that same healing process happens, but the tissue behaves a bit differently. Your internal organs are normally covered in a smooth, slick lining that allows them to glide past each other effortlessly as you move, breathe, and digest food. Your intestines are in continuous motion and move to help push food through. When those tissues get inflamed or injured, for example from a surgery, your body’s immune system sends out fibrin, which acts like a natural sticky glue to seal off the damaged area. Over time, that sticky layer turns into tough bands of fibrous internal scar tissue. Usually over time these soften, but they never fully go away. These are what surgeons refer to as adhesions. They can tether your intestines to your abdominal wall, bind your ovaries to your uterus, or glue loops of bowel together in tight webbed knots.
What causes adhesions?
Abdominal or pelvic operations like C-sections, appendectomies, gallbladder removals, and pelvic surgeries for fibroids or endometriosis are common causes for developing adhesions. But not everyone who has surgery will develop a significant degree of internal scarring. And if you do, it does not mean your surgeon did anything wrong, because it is simply the body’s natural mechanism for repair. Other common triggers of adhesions include endometriosis, pelvic inflammatory disease, ruptured cysts, a burst appendix, or even localized infections can cause enough internal inflammation to leave behind significant scarring.
What are signs and symptoms of adhesions?
For many women, small adhesions never cause a single issue, and they might live their whole lives without knowing they have them. But because our abdominal organs need freedom of movement to function properly, adhesions can sometimes act like internal ropes pulling tight on sensitive nerves and delicate structures.
One of the most frequent presentations where adhesions should be considered is chronic, deep abdominal or pelvic pain. It often feels like a pulling or tugging sensation, especially when stretching, twisting, or exercising. Sometimes women notice that their pain gets worse during certain times of their menstrual cycle or during deep intercourse because the internal organs can’t slide out of the way like they are supposed to. Because adhesions do not show up on standard ultrasounds, CT scans, or MRIs, women are often told their scans look completely normal, which can leave them feeling frustrated and unheard for months or years.
The more critical complication of adhesions is a small bowel obstruction. Your intestines are constantly moving food and liquid through a rhythmic muscular squeezing called peristalsis. If a loop of bowel gets caught under a tight band of scar tissue, or gets twisted around an adhesion like a garden hose with a kink in it, everything stops.
Knowing when an adhesion issue is becoming an emergency can save your life. A bowel obstruction usually starts with sudden, severe abdominal cramping that comes in waves. This is often followed by intense bloating, an inability to pass gas or have a bowel movement, and persistent vomiting that quickly leads to severe dehydration. If you ever experience this combination of symptoms, especially if you have a history of prior abdominal or pelvic surgery, you should go straight to the nearest emergency room. Delaying care can cause the trapped bowel to lose its blood supply, which is a life-threatening situation that requires immediate surgical intervention. Of note, there are other causes of bowel obstructions as well so you should always seek medical care if these symptoms develop.
Management for adhesions
If you suspect you have adhesions that are causing mild or moderate pain, you do have options that don’t immediately require going back into the operating room. In fact, we try to avoid operating for pain alone whenever possible, because every new surgery carries a risk of creating even more scar tissue. Many women find tremendous relief working with a specialized pelvic floor physical therapist who uses targeted visceral manipulation techniques to help mobilize tight internal tissues. Working with a pain specialist who understands pelvic nerve pathways can also make a huge difference. It’s always important to speak with your doctor about these symptoms.
About the Author:
Dr. Stephanie Joyce is a board certified and fellowship trained general surgeon, who specializes in trauma and critical care. She is known for her minimally invasive techniques and is a trailblazer in the research and application of robotics for emergency surgery.
