Adhesions: Abdominal, Bowel, Pelvic – Symptoms, Treatment, Pictures

What Are Adhesions?

This article describes abdominal adhesions, bowel (intestinal) adhesions and pelvic adhesions.

Adhesions (Latin adhere= to stick, to hold tight) are abnormal bands of scar tissue that form between internal organs and glue them together. Normally, scar tissue is formed only within an injured area, as part of a healing process, but in case of adhesions, it also appears on adjacent surfaces and can connect them.

Abdominal adhesions mostly appear after abdominal surgery or inflammation, and pelvic adhesions after gynecological operations or pelvic inflammatory disease (PID), mostly resulting from sexually transmitted diseases (STDs).

Abdominal or pelvic adhesions may develop inside the intestine and uterus, or between surfaces of organs and abdominal membrane (peritoneum), thus pulling organs from their original positions, obstructing passage of food and blood supply, causing abdominal or pelvic pain, bloating, constipation, urinary retention, irregular menstrual bleeding or infertility.

Pictures of abdominal adhesions

What Causes Abdominal or Pelvic Adhesions?

1. Abdominal or Pelvic Surgery

Surgical removal of the appendix, gallbladder, any operation on the bowel, resolving ectopic pregnancy, cesarean section or any major abdominal or pelvic surgery may result in adhesions formation. Surgery inside the uterus, like “dilatation and curettage”, may result in intrauterine adhesions (Asherman’s syndrome) (1).

2. Inflammation

Inflammation, like appendicitis, pelvic inflammatory disease (PID), Crohn’s disease or ulcerative colitis may all result in adhesions.

3. Infection

  • In Crohn’s disease, bacterial infection can result in abscesses formation in or around the bowel wall, especially around the rectum and anus. Abscess healing can result in intestinal adhesions.
  • Sexually transmitted diseases (STDs), like chlamydia or gonorrhea, may result in adhesions within the uterus, Fallopian tubes and around ovaries and cause chronic pelvic pain, irregular menstrual bleeding, infertility or ectopic pregnancy. Bacteria can travel up to the liver and cause the so called “violin string adhesions” between the liver and diaphragm (2).
  • Intestinal tuberculosis (3)
  • Infection of a surgical wound

4. Other Causes

  • Internal abdominal bleeding due to perforation of the bowel
  • Endometriosis
  • Cancer in the abdominal or pelvic cavity
  • Radiation therapy or chemotherapy of abdominal or pelvic cancer
  • Foreign body, like a piece of gauze or a part of surgical equipment remained in the abdominal cavity after surgery
  • Adhesions can be, rarely, present at birth from various causes

What Are Symptoms of Adhesions?

Symptoms caused by adhesions depend on adhesion location and complications, and include:

  • Abdominal pain: sudden or chronic, occasional or constant, cramping or pulling; adhesions above the liver may cause pain with deep breathing; intestinal adhesions may cause pain during stretching or reaching an object above your head. Pain is caused by bowel obstruction.
  • Pelvic pain: acute or chronic; adhesions near the vagina can cause painful intercourse. Pain is caused by pulling nerves in displaced organs.
  • Poor appetite and nausea are common.
  • Occasionally, pain is followed by vomiting, which relieves the pain.
  • Other symptoms are mentioned under complications (see below).

Adhesions Related Disorder (ARD)

Sometimes, adhesions may result in the following combination of problems:

  • Chronic abdominal or pelvic pain
  • Infertility
  • Gastro-esophageal reflux disease (GERD)
  • Frequent urination or urine retention
  • Painful bowel movement
  • Pain on walking, sitting or laying in certain positions.
  • Anemia and nutrient deficiencies due to poor eating habits or loss of appetite
  • Loss of employment due to lost work days
  • Loss of family and social life
  • Depression, suicidal thoughts

Complications of Adhesions

1. Intestinal Obstruction

Fibrous tissue can obstruct the intestinal lumen or pull intestinal loops in the way that blocks passage of food. Obstruction may cause poor appetite, dry skin and mouth, severe thirst, infrequent urination (from dehydration), nausea, vomiting, abdominal cramps, constipation, inability to pass gas, abdominal swelling  (from collection of food, fluid and gas in the bowel) and fever (from intestinal inflammation).

2. Strangulation

Adhesion may cause twisting of the bowel along its axis thus affecting blood supply and eventual death (gangrene) of the affected part of the bowel in as few as 6 hours. Symptoms of this disorder, known as strangulation, include sudden, severe, crampy or steady abdominal pain, nausea, vomiting and rectal bleeding.

3. Vaginal and Labial Adhesions

Bacterial vaginosis, diaper rash or irritation by clothes may cause vaginal or labial adhesion in infants, girls or adult women. Adhesion is usually mild and is resolved spontaneously or by minor intervention by a doctor.

4. Infertility

Adhesions in the uterus or Fallopian tubes can result in infertility (which can be sometimes successfully treated) (1).

5. Ectopic Pregnancy

Adhesions in Fallopian tubes increase the risk of ectopic (tubal) pregnancy.

How Can Be Adhesions Diagnosed?

1. Symptoms

Your doctor may not be always aware of adhesions as a possible cause of chronic abdominal pain, constipation, bloating or infertility; so you can remind him/her and also provide your complete medical history, including eventual surgeries, injuries, radiation treatment, and any abdominal inflammation or infection at any time of your life.

2. Signs

During physical examination, doctor may find distended abdomen, tender spots, unusual mass, loud (or absent) abdominal sounds due to intestinal obstruction, pale or dry skin due to anemia or dehydration.

3. Investigations

Ultrasound and X-ray usually can not reveal abdominal adhesions. X-ray after barium swallow (upper GI) can reveal adhesions within the small intestine (strictures), and barium enema (lower GI), adhesions within the colon. Unusual course of intestinal loops revealed by these investigations may raise suspicion for adhesions outside the intestine.

CTcan sometimes reveal adhesions outside the small bowel (4). MRI can sometimes reveal adhesions inside and outside the small and large intestine and uterus (5). Laparoscopy can often reveal abdominal adhesions outside the bowel. Any of these investigations can fail to reveal adhesions, so often an exploratory surgery is needed for diagnosis.

Histeroscopy (uterine endoscopy) can reveal uterine adhesions and hysterosalpingography (contrast X-ray of uterus and tubes) adhesions in the uterus and Fallopian tubes.

Treatment with Adhesion Lysis (Adhesiolysis)

In general, adhesions can be successfully removed by operation called adhesion lysis or adhesiolysis. This can be performed during laparoscopy or during open surgery – laparotomy. In both cases, scissors, harmonic scalpels, laser or electrosurgery can be used; operation can last from 2-4 hours. Adhesiolysis is usually successful, but every adhesion-removing procedure may result in new adhesions, so this operation should be done only in severe and debilitating symptoms, and to resolve intestinal obstruction, infertility or other complications. Read more about adhesiolysis (professional level article).

Adhesion Prevention

Adhesion creation can be prevented to some extent by (6):

  • Performing minimally invasive surgical techniques, like gasless laparoscopy (without inflating carbon dioxide) instead of open surgery (what is not always possible), minimal handling of tissues, using non-reactive sutures, avoiding gloves containing starch or talc, preventing desiccation of organ surfaces by using moist sponges, etc.
  • Inserting adhesion barriers (SprayGel™, sheets made of oxidized cellulose, etc.) that separate organ surfaces during and after operation thus preventing adhesion formation. SprayGel™ stays on surfaces of organs for 5-7 days and prevents adhesion formation, then is naturally cleared from the body in 7-14 days.
  • Administering of intra-abdominal steroids to prevent inflammation.
  • Avoiding repeated surgical adhesion removal, since each operation raises a risk for new adhesions

Adhesions Formation Pathophysiology and Prognosis

Within few hours after a surgical procedure (or other cause of tissue injury), inflammatory cells and fibrin from the blood are attracted to the site of injury; the end result is a scar formed between two cut surfaces. The same scaring process can start to develop adjacent to the site of injury because of mechanical irritation, drying, foreign bodies (piece of gauze, talc from surgical gloves) or lack of oxygen in peritoneum – abdominal membrane. In first days, fibrionous adhesions made of fibrin (clotting substance derived from the blood), may appear and cause temporary bowel obstruction with abdominal pain and constipation. These fibrionous adhesions may disappear or develop into permanent fibrous adhesions, made of fibrous tissue from collagen,produced by fibroblasts, which may start to trigger symptoms months or years after surgery. Permanent fibrous adhesions do not likely resolve spontaneously.

How to Find a Doctor for Adhesiolysis

If you plan to have adhesiolysis, find a doctor who takes abdominal/pelvic pain seriously, is experienced in adhesion treatment and has necessary equipment available. Maybe someone on an online adhesion message forum can help you find appropriate doctor in your area.

Related Articles:

References:

  1. Asherman’s syndrome caused by intrauterine adhesions  (nwh.org)
  2. Adhesions between the liver and diaphragm in STD  (emedicine.medscape.com)
  3. Adhesions in intestinal tuberculosis can be shown by CT or investigations with barium  (saudijgastro.com)
  4. CT can reveal small bowel adhesions  (ncbi.nlm.nih.gov)
  5. Cine-MRI can reveal abdominal adhesions  (ingentaconnect.com)
  6. Laparoscopic surgery for adhesions: techniques, prevention of adhesions  (obgyn.net)
About Jan Modric (249 Articles)
Health writer
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  • amichelle0415

    I’m 21 years old. I’ve had a Mirena IUD since January 2010. Since then I’ve had sudden pelvic pain normally on the right side. Sometimes it’s a sharp pain and sometimes it’s a dull ache. I’ve had BV twice since I’ve gotten the IUD and now I think I have it again. The antibiotics never work; it always comes back within 2-3 weeks. I’m worried my recurrent BV infections may be causing me to develop PID. I plan on going to the doctor as soon as I can but I just moved to a new city and haven’t found an OB/GYN yet.

    Also, I’ve noticed my strings are not as long as they used to be. When I check for them, I can usually feel them around my cervix and now I can barely feel the string coming out at all.

  • Jan Modric

    amichelle0415,

    women often report various symptoms after getting Mirena IUD. I strongly recommend you to find a gynecologist soon.

  • Frankie feathers

    I have had lower left flank pain with vomiting forever and sometimes right flank pain also with no luck of a diagnosis it can last any where from a few days to a few weeks I am 30,000 in debt with no idea of a cause

  • Hi Frankie. Pain and vomiting can occur for a number of reasons. Gastrointestinal diseases are the more obvious causes, but it can also occur with certain kidney diseases. It is difficult to say with any certainty, especially on an online platform. If you are not satisfied with the current medical attention you are receiving then you should consult with another doctor/medical specialist. A gastroenterologist or internist may be a good place to start.

  • Tim Plyler

    My friend is experiencing a sharp pain just left and down from her naval. She says its just under the surface of the skin, in her fat. Ideas? She says it hurts to bend over or to push something like a chair or box. Is this dangerous? No sign of a bruise.

  • Hi Tim. Pain on its own is difficult to assess without further symptoms (example diarrhea) or knowing the medical history. It would be irresponsible to say if it is anything dangerous or serious. She should seek medical attention. You can read this article on lower left abdominal pain (http://www.healthhype.com/acute-and-chronic-left-lower-llq-abdominal-pain-diagnosis.html) and as you can see there are so many possible causes. It may be nothing serious but this could also be the early symptom of many serious diseases. It’s better to be safe than sorry.

  • Jennifer

    No doctor will listen to me but I am convinced I have a nerve attached to adhesions after four bowel operations many years ago.My leg hurts below the knee down to my ankle all day and all night…lying down makes no difference atall.I amlimping quite badly and going upstairs and uphill is extremely painful.There is no nerve compression in my spine,I;ve had MRI,hip xrays,CT scans,,40+physio sessions,been treated by chiropracters,examined by 4 neurosurgeons,countless orthopedic surgeons,had epidural injection in my spine at grreat cost but with absolutely NO result.I am thoroughly fed up with it…I tend to stay in every day rather than be in pain walking…I have spent more than £3000 trying to find out WHAT is wrong..Have you any suggestions please?Thankyou so much.

  • Dorita Sanders Kesley

    This is long but i did get help. I do the same way, it was my right foot and ankle, pain nearly to knee most often. I was told blood lots, NO testing did not support, no ankle injury etc… years later displayed food allergies. Foot worsened to daily pain, pain more extreme w/swelling daily. I was told authritious. Exrays showed yes some. They wanted surgery. I said no, my left foot had an injury once. Authritious was in it. They checked left was worse and had NO PAIN! So I chanel doctors.I finally gave up and at 63 was using a Walker just to move around. Then I had to have Hysterectomy, bladder sling, rectocel and another procedure in same area. 3 weeks later my bad foot was pretty good. I was off the walker and feeling great. THEN IT HIT. Other foot starting to hurt, wrist on left hurring, then back pain, R wrist and forearm…progressed in 4 short days to total wracking pain in every joint except hips and knees. In a wheelchair I could not even push with my hands, I was sent to a Rhumatologist. I was sent to the very best in my area. Yes my problem was RA. I was told had they gotten to me when it was “just” that one foot they could have helped me not go downhill that way. Short term I was given shots and meds. Then they started me on long term meds which keep it from spreading and remove symptoms. I hurt pretty bad for another maybe two weeks (bedridden and wheelchair) then another week on walker, some arm hand pain.. f
    Beginning if the fourth week I was back at work, NO WALKER… NO CANE… still had bad days but mostly just pain or two here or there. If it bothers me now it is in my right hand. What worked for me was the doctor who specialized in RA. But diet eliminating gluten helps and I eliminated dairy too. I was told that was the reason I reached 64 before having it so bad. And the diet helped me not to have bone damage. So think about diet changes but deffinately see RA specialist doctor asap. (I will pray you get a good one like I d I d)