What are adhesions?
Adhesions are bands of scar tissue can bind organs to other structures that should not be connected. Adhesions may appear as thin sheets of tissue similar to plastic wrap or as thick fibrous bands.
The tissue develops when the body's repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation. Although adhesions can occur anywhere, the most common sites for adhesions are the abdominal and pelvic organs.
What causes adhesions?
Adhesion formation occurs after trauma to the tissues, and is caused by an inflammatory response due to tissue damage. As the body’s tissues heal and adhesions are formed, the tissues begin to shrink somewhat, which results in dysfunctional movement of the area. This, in turn, creates more mechanical irritation, perpetuating the cycle of adhesion formation. Adhesions tend to persist long after the original trauma has healed, attaching to organs, nerves, muscles and other neighboring structures. Adhesions tend to form following open surgery, inflammation, trauma or radiation therapy treatment.
Often, a patient will have to have additional surgeries to remove adhesions formed from their previous surgery. This can start a sort of vicious circle, with adhesions forming during surgery and then needing subsequent surgery, which in turn can cause more adhesions, to remove them.
Doctors associate signs and symptoms of adhesions with the problems an adhesion causes rather than from an adhesion directly. As a result, people experience many complaints based on where an adhesion forms and what it may disrupt. Typically, adhesions show no symptoms and go undiagnosed.
The most common symptom of pelvic adhesions is pain. The pain may present as constant pain, or it may occur sporadically. In some cases, the adhesions may cause bowel obstruction as organs are twisted and held in positions other than their usual anatomic positions.
Most commonly, adhesions cause pain by pulling nerves, either within an organ tied down by an adhesion or within the adhesion itself.
- Adhesions above the liver may cause pain with deep breathing.
- Intestinal adhesions may cause pain due to obstruction during exercise or when stretching.
- Adhesions involving the vagina or uterus may cause pain during intercourse.
- Pericardial adhesions may cause chest pain.
- It is important to note that not all pain is caused by adhesions and not all adhesions cause pain.
- Small bowel obstruction (intestinal blockage) due to adhesions is a surgical emergency.
- These adhesions trigger waves of cramp-like pain in your stomach. This pain, which can last seconds to minutes, often worsens if you eat food, which increases activity of the intestines.
- Such intestinal blockage can correct itself. However, you must see your doctor. If the blockage progresses, these conditions may develop:
- Your bowel stretches further.
- Pain becomes constant and severe.
- Bowel sounds disappear.
- Gas and bowel movements stop.
- Your belly will grow.
- Fever may increase.
- Further progression can tear your intestinal wall and contaminate your abdominal cavity with bowel contents.
To determine whether adhesions are the cause of symptoms such as pelvic pain or abdominal problems, your doctor may perform an exploratory procedure using a laparoscope, a narrow lighted tube inserted through a small incision in the abdominal area, to inspect the abdominal cavity and pelvic structures. Laparoscopy has become a standard method for diagnosing various abdominal disorders.
See a doctor any time you experience abdominal pain, pelvic pain, chest pain, or unexplained fever. If you have undergone surgery or have a history of medical illness, discuss any changes in your recovery or condition with your doctor.
Adhesion Treatment Options
The best "treatment" for adhesions is to prevent or minimize their formation. The advent of minimally invasive techniques has greatly improved the effort to achieve less tissue destruction during surgery while minimizing bleeding in an effort to decrease subsequent fibrin layering and the potential for adhesions. The use of the most acceptable minimally reactive sutures and an effort to not suture unless necessary helps avoid both tissue reaction. Unfortunately, while the use of minimally invasive techniques are important in and of themselves, they will not completely decrease the risk of adhesions.
The only way to treat adhesions is to remove or separate them through surgery. This procedure is called adhesiolysis (ad-he-ze-o-li-sis). Studies have shown that patients with pelvic pain and severe adhesions can experience a marked reduction in symptoms after laparoscopic adhesiolysis.
However, one of the reasons adhesions are so problematic is that adhesions reform more than 70 percent of the time, even following adhesiolysis. Therefore, adhesion prevention is vital.
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