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Abdominal and pelvic adhesions

An adhesion is scar tissue that can make your tissues or organs inside your body stick together. They often form after you have an operation on your tummy (abdomen) or pelvis. Most of the time, adhesions don’t cause problems, so you may not even know you have them.

The tissues and organs inside your body normally have slippery surfaces, which prevent them from sticking together. If the tissues inside your body are irritated, for example during surgery or following an infection such as appendicitis, your body’s healing process triggers a response. This response creates scar tissue called adhesions. Scars are a natural part of the healing process and the scar tissue that forms changes over many months. All types of surgery result in some scar tissue.

Sometimes scar tissue can cause your bowel to stick together, particularly if you have had an operation on your abdomen. This can partially or completely block your bowel and is known as bowel obstruction. If you’re a woman and have an infection or surgery in your pelvic area, adhesions can affect your fallopian tubes. This can in turn affect your fertility.

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  • Symptoms Symptoms of adhesions

    You may not have any symptoms from adhesions unless they cause problems, such as abdominal pain, bowel obstruction or infertility. But there are also lots of other reasons why you may have abdominal pain. See a doctor or surgeon if you have pain that lasts for a long time.

  • Diagnosis Diagnosis of adhesions

    Your GP (or doctor at a hospital if you go to accident and emergency) will ask about your symptoms and examine you. He or she will also ask you about your medical history.

    If you’re seen by your GP, they may refer you to a surgeon who specialises in laparoscopic (keyhole) gastrointestinal surgery. If you’re having fertility problems, your GP will refer you to a gynaecologist (a doctor who specialises in women’s reproductive health).

    Sometimes, the only way to tell for certain whether you have an adhesion is to look inside your body. It may be possible for this to be done with keyhole surgery. It’s important to remember that surgery carries some risks and may lead to more adhesions forming, but this is less common with keyhole surgery.

    If your doctor suspects an adhesion is obstructing your bowel, he or she may:

    • examine your tummy to check for tenderness
    • take your temperature
    • check your heart rate
    • do some blood tests
    • order an X-ray or other tests that show the inside of your body, such as a barium swallow and meal, CT or MRI scan

    Your doctor may refer you to a surgeon to have a laparoscopy. This is a keyhole procedure that enables your surgeon to look inside your abdomen or pelvis.

  • Treatment Treatment of adhesions

    Most people who have adhesions don’t need treatment for them as they don’t often cause problems. But if your doctor thinks that you have a bowel obstruction or pain because of an adhesion, you may be referred to hospital for treatment. If you have fertility problems caused by adhesions, your doctor will discuss your options with you.

    Non-surgical treatment

    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    If you have an obstructed bowel, you may need to go into hospital so your doctor can keep an eye on you until it clears. If you have a partial obstruction, your doctor may advise you to just have sips of water and not eat. This rests your bowel and may prevent it from becoming completely obstructed. You may have a drip put into a vein in your arm (to make sure you get enough fluids and salts) and also a tube into your nose. This releases gas and fluid from your stomach and stops you from being sick.

    Your doctor may suggest that you eat foods that are low in fibre so they can pass through your bowel more easily. This can help to relieve the obstruction. If your obstruction doesn’t clear after a few days, your doctor may advise you to have surgery.

    Surgery

    Surgery to disconnect adhesions is called adhesiolysis and is currently the only way to treat them. All surgery however, carries a risk of creating further adhesions. Your surgeon will only advise you to have an operation if they think it will be beneficial for you. For instance, if you have a complete bowel obstruction or a strangulated bowel (causing the blood supply to your bowel to be cut off, you might need an emergency procedure. You may also be offered this treatment if you’re having fertility problems caused by adhesions.

    Your surgeon may do the adhesiolysis operation using keyhole surgery. They will make a few small cuts in your tummy rather than one large one as in traditional open surgery. They will insert instruments through these to cut through the scar tissue.

    Your doctor may also give you the option of having surgery if you have ongoing pelvic or abdominal pain. You will have the opportunity to discuss the risks, benefits and possible alternatives of the procedure.

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  • Causes Causes of adhesions

    The main cause of adhesions is surgery within your abdomen or pelvis.

    However, adhesions can also form because of inflammation caused by:

    You can also be born with problems that cause adhesions, such as a ruptured (torn) bowel.

  • Complications Complications of adhesions

    Bowel obstruction

    Symptoms of bowel obstruction include:

    • severe cramping pain in your tummy (abdomen) that may come and go
    • feeling bloated
    • feeling sick or vomiting
    • constipation – or you may have diarrhoea

    A complete bowel obstruction is a medical emergency. It causes severe pain and your bowels stop working so you don’t pass wind or feel able to go to the toilet. Seek urgent medical attention if you have these symptoms.

    If a part of your bowel becomes twisted tightly around a band of adhesions, it can cut off the blood supply to your bowel. It’s then said to be ‘strangulated’. This is life-threatening if left untreated so you will need immediate treatment.

    Symptoms of bowel strangulation include:

    • severe constant pain in your abdomen
    • a fever
    • a fast heartbeat

    If you have these symptoms in addition to those above, call for emergency help.

    Fertility problems

    If you’re a woman and having difficulty getting pregnant, you may have adhesions your fallopian tubes. If you have been trying to get pregnant for at least a year without success, see your GP.

  • Prevention Prevention of adhesions

    Adhesions always form if you have surgery. Scientists are currently trying to develop special substances and fluids that can be used during surgery to prevent them forming. More studies on these products are needed before doctors will be able to tell how well they work. Keyhole surgery generally leads to fewer adhesions than conventional open surgery but it may not always be an option.

  • FAQs FAQs

    How long after my operation will it be until I know whether I have developed adhesions?

    Answer

    You can only tell whether you have developed an adhesion if it causes problems for which you need treatment. These problems might be a bowel obstruction, tummy (abdominal) pain or infertility, for example. They may become apparent shortly after your surgery or not until decades later.

    Explanation

    Most of the time, adhesions don’t cause problems, so you may not know if you have them. You’ll usually only find out you have adhesions if they start to cause symptoms, such as pain in your tummy. If adhesions cause complications, such as a bowel obstruction or fertility problems, these may cause symptoms.

    An adhesion could cause an obstruction in your bowel within weeks of your operation, or many years afterwards. This can make it difficult to associate any symptoms with surgery that you may have had many years earlier. It’s always important that you tell your doctor about your medical history including any previous operations you’ve had.

    If I've developed a bowel obstruction as a result of adhesions, how likely am I to get another one?

    Answer

    The complications from adhesions are unpredictable. Some patients never have symptoms and others may require several operations over time.

    Explanation

    Bowel obstruction can be a persistent problem for some people with adhesions. But you may not have any further problems if your original obstruction is dealt with effectively. Bowel obstruction caused by adhesions is unpredictable, but there are some factors that may affect your risk.

    The risk of further bowel obstruction is higher during the first five years after surgery for adhesions. However, it’s still possible to develop another obstruction many years later. Your risk may also increase with the number of previous obstructions you’ve had. This is especially so if your operation didn’t remove all the adhesions.

    If you’re worried about your risk of having another bowel obstruction, please talk to your doctor.

    I've heard that a type of massage therapy may be able to help treat infertility caused by adhesions. Is this true?

    Answer

    There isn’t any strong evidence to show that massage therapy is an effective treatment for infertility caused by pelvic adhesions.

    Explanation

    There have been reports that a type of physical therapy involving massaging specific areas of a woman’s body may treat infertility related to adhesions.

    But the research that has been carried out hasn’t been of good enough quality to prove whether the technique really works. It has only involved small numbers of women and was carried out by the people who developed the technique.

    If you plan to try massage, or any other type of complementary therapy, talk to your doctor first. The therapy could affect other medical treatments you’re having and there may be other treatments for infertility that you could try. Talk to your doctor to discuss your options.

    Is there anything I can do to reduce my risk of bowel obstruction, such as change my diet?

    Answer

    Once adhesions have formed, the only way to reduce their number or position is to have further surgery. But if your doctor thinks you’re at risk of a bowel obstruction, they may suggest you try a fluid-only or low-fibre diet.

    Explanation

    Symptoms of a partial bowel obstruction include cramp in your tummy and feeling sick. If your doctor suspects you have a partial bowel obstruction, they may advise you to change your diet. You may need to not eat solid food for a day or two and just drink fluids. This will help your bowel to rest.

    If you keep having problems with adhesions, your doctor may recommend that you follow a low-fibre diet. This is because bulky, high-fibre foods are more likely to get stuck in any parts of your bowel that are particularly narrow because of adhesions. This can lead to bowel obstruction, pain and bloating. A low-fibre diet involves cutting down on wholemeal bread, pasta, rice, wholegrain cereals, pulses and fruit and vegetables.

    It’s important however, to have a chat with your doctor or a dietitian first before you make changes to your diet.

  • Resources Resources

    Further information

    Sources

    • Abdominal adhesions. National Digestive Diseases Information Clearinghouse (NDDIC). www.digestive.niddk.nih.gov, published September 2013
    • Small-bowel obstruction. Medscape. www.emedicine.medscape.com, published 28 April 2014
    • Wound healing and repair. Medscape. www.emedicine.medscape.com, published 3 April 2013
    • Laparoscopic adhesiolysis. Medscape. www.emedicine.medscape.com, published 23 April 2013
    • ten Broek RPG, Issa Y, van Santbrink EJP, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ 2013; 347:f5588. doi:http://dx.doi.org/10.1136/bmj.f5588
    • Open adhesiolysis. Medscape. www.emedicine.medscape.com, published 10 July 2013
    • Catena F, di Saverio S, Kelly MD, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2010 evidence-based guidelines of the World Society of Emergency Surgery. World J Emerg Surg 2011; 6:5. doi:10.1186/1749-7922-6-5
    • Map of Medicine. Intestinal obstruction. International View. London: Map of Medicine; 2012 (Issue 2)
    • Pelvic pain. PatientPlus. www.patient.co.uk/patientplus, reviewed 19 July 2012
    • Intestinal obstruction and ileus. PatientPlus. www.patient.co.uk/patientplus, reviewed 23 April 2014
    • Intestinal obstruction. The Merck Manuals. www.merckmanuals.com, published June 2014
    • Low fibre diet for the prevention of bowel obstruction. Queensland Government. www.health.qld.gov.au, published April 2014
    • Endometriosis. Medscape. www.emedicine.medscape.com, published 21 April 2014
    • Suo T, Gu X, Andersson R, et al. Oral traditional Chinese medication for adhesive small bowel obstruction. Cochrane Database of Systematic Reviews 2012, Issue 5. doi:10.1002/14651858.CD008836.pub2
    • Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Care Excellence (NICE), February 2013. www.nice.org.uk
    • Ahmad G, Mackie FL, Iles DA, et al. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database of Systematic Reviews 2014, Issue 7. doi:10.1002/14651858.CD001298.pub4
    • Kumar S, Wong PF, Leaper DJ. Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological abdominal surgery. Cochrane Database of Systematic Reviews 2009, Issue 1. doi:10.1002/14651858.CD005080.pub2
    • Wurn BF, Wurn LJ, Roscow AS, et al., Treating female infertility and improving IVF pregnancy rates with a manual physical therapy technique. Medscape Gen Med 2004; 6(2):51. www.medscape.com
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