Adhesions

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who have adhesions, or who would like information about them.

An adhesion is a band of scar tissue that may cause tissues or organs inside the body to stick together. They commonly form after surgery in the abdomen (tummy) or pelvis and may cause abdominal pain.

About adhesions

If the tissues inside your body are disturbed in any way, for example, during surgery, your body's immune system will launch an inflammatory response. The inflammation triggers your body to produce bands of scar tissue, called adhesions.

Scars are a natural part of all healing processes, and the scar tissue that is formed changes and adapts for many months after the original cause has stopped. All types of surgery result in scar tissue being formed, although keyhole surgery is associated with less scarring and a lower risk of adhesions.

Most of the time, adhesions don't cause any problems, so you may not even know if you have them. However, in some people, the scar tissue can stick to your bowel, or if you are a woman, your fallopian tubes, and pull them out of place, leading to an obstruction. Bowel obstructions caused by adhesions are usually partial, which can be associated with long-term abdominal discomfort. A complete bowel obstruction is a medical emergency. Adhesions in the fallopian tubes may lead to infertility.

Symptoms of adhesions

You may have ongoing pain in your abdomen or pelvis if you have an adhesion. This won't always be a symptom of adhesions, but you should see your GP if you have pain or bloating that lasts for a long time.

However, you may not have any symptoms at all unless your adhesions start to cause further problems such as a bowel obstruction or infertility.

Complications of adhesions

Bowel obstruction

If you have a bowel obstruction, you may:

• have severe cramping pain in your abdomen that may come and go
  
• have a bloated or distended abdomen
  
• feel sick or vomit
  
• be unable to pass wind
  
• be constipated

You should seek urgent medical attention if you have these symptoms and they are severe, or if you have had previous problems with obstructions.

Occasionally, a part of your bowel may become twisted tightly around a band of adhesions, cutting off the blood supply to your bowel. This is sometimes called strangulation of the bowel. This is life-threatening and you will need immediate treatment. If you develop any of the following symptoms in addition to those above, it may be a sign of bowel strangulation and you should call for emergency help:

• your pain is replaced with a continuous dull ache or a constant background pain
  
• you have a fever
  
• you have a fast heartbeat

Fertility problems

If you are a woman with adhesions in your fallopian tubes, you may find that you have trouble getting pregnant.

It's important to remember however, that for any woman, it can take up to a year or more of having regular, unprotected sex to become pregnant. If you are worried about your fertility, see your GP.

Causes of adhesions

The main cause of adhesions is surgery. Any type of surgery that involves opening up your abdomen or pelvis carries a risk of adhesions.

However, adhesions can also form as a result of inflammation caused by:

• appendicitis, especially if your appendix ruptures
  
• radiotherapy for cancer
  
• a disease causing inflammation of the bowel, such as Crohn's disease
  
• endometriosis
  
• infection, such as gastroenteritis.

Diagnosis of adhesions

If you see your GP because you have pain in your abdomen or pelvis, he or she will ask about your symptoms and examine you. Your GP will also ask you about your medical history. He or she may refer you to a colorectal surgeon (a doctor who specialises in conditions affecting the bowel) or a gynaecologist (a doctor who specialises in women's reproductive health), depending on your symptoms and medical history.

The only way of being able to tell for certain whether you have an adhesion is to look inside your body. This can be done with keyhole surgery. However, surgery always carries some risks and may lead to further scarring.

Your doctor can carry out the following tests to confirm whether you have a bowel obstruction and if so, how serious it is (if it is a partial or complete obstruction, and whether you have a strangulated bowel):

• feeling your abdomen to check for any tenderness
  
• taking your temperature
  
• checking your heart rate
  
• blood tests to check your white cell count
  
• an X-ray or other imaging studies, such as a CT or MRI scan.

Treatment of adhesions

Most people who have adhesions will not need any treatment for them, as they don't usually cause any problems. However, if your doctor thinks you have a possible bowel obstruction or adhesion-related pain, you may be referred to hospital for treatment.

Non-surgical treatment

If you have adhesion-related pain, your doctor may prescribe you painkillers to take.

Bowel obstructions usually clear by themselves with time. However, you may need to be admitted to hospital for treatment and so your doctor can monitor you until your bowel obstruction clears. This will usually be for at least two to three days.

In hospital, you will be put on an intravenous drip (a drip into your vein) to make sure that you get enough fluid and salts. You may also have a tube put into your nose to release gas and fluid from your bowel (intestinal decompression). Your doctor may give you a liquid diet or a diet low in fibre so that your food can pass through any narrowings in your bowel. This can help to relieve the obstruction. If your obstruction doesn't clear after a few days, your doctor may advise that you have surgery.

Surgery

Surgery to break up adhesions is called adhesiolysis and is currently the only way to treat adhesions. However, as any operation carries a risk of creating further adhesions, you will only be advised to have adhesiolysis if your surgeon thinks it will be beneficial for you. For instance, if you have a complete bowel obstruction or strangulated bowel that is life-threatening, you might need adhesiolysis as an emergency procedure. You can also have the procedure if you are having fertility problems caused by adhesions.

Adhesiolysis is now usually carried out using keyhole surgery - this means your surgeon will insert small instruments to cut the scar tissue through small cuts in your abdomen or pelvis, rather than making one large cut as in traditional open surgery. There is a lower risk of complications such as infection after keyhole surgery, and you are likely to recover faster and be in less pain than after open surgery.

Your doctor may also give you the option of having surgery if you have ongoing pelvic or abdominal pains or bloating. However, it's important to note that surgery may not improve your pain, and there is a risk that it could make your pain worse. You will have an opportunity to discuss the risks, benefits and possible alternatives of the procedure with your surgeon, before you give your consent for the procedure to go ahead.

Prevention of adhesions

Adhesions are difficult to prevent if you need to have surgery. However, there is some evidence to suggest that they may be less likely to form with keyhole surgery than with open surgery. Scientists are also trying to develop products such as films and fluids, which can be used during surgery to prevent adhesions forming. However, more studies on these products are needed before doctors will be able to tell how well they work.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.