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Abdominal and pelvic adhesions
Expert reviewer, Mr Christian Macutkiewicz, Consultant General and Hepato-Pancreatico-Biliary Surgeon
Next review due September 2022
Adhesions are bands of scar tissue that can make the tissues and organs inside your body stick together. They often form after you’ve had an operation inside your tummy (abdomen) or pelvis.
About adhesions
Your body produces scar tissue as part of its normal healing process. This process can be triggered if the tissues inside your abdomen or pelvis are disrupted in some way. For example, because you’ve had abdominal surgery or an infection. Adhesions are bands of scar tissue that form between different organs or tissues, causing them to stick together. This doesn’t always cause any problems, and so you might not even know you have them. But in some people, they can cause significant problems.
- Abdominal adhesions can cause different sections of your bowel to stick together, particularly if you had an operation inside your tummy. If this happens, your bowel may become partially or completely blocked. This is known as bowel obstruction.
- Pelvic adhesions can affect fallopian tubes in women. This may affect your fertility.
Adhesions can form after any type of surgery in your abdomen or pelvis. Examples include operations to remove gastrointestinal cancers, appendix removal (appendicectomy), gallbladder removal (cholecystectomy), hysterectomy and surgery for ectopic pregnancy. Adhesions are more common following open surgery, compared to laparoscopic (keyhole) surgery.
Symptoms of adhesions
Most of the time, adhesions don’t cause any symptoms at all. They can start to become apparent if they cause the following problems.
- Bowel obstruction. This can cause cramping pains in your abdomen, as well as bloating, feeling sick and vomiting. A complete obstruction is a medical emergency. See the Complications section for more information.
- Ongoing, long-term (chronic) pain in your abdomen or pelvis.
- Difficulties getting pregnant. This can happen if you have adhesions affecting your ovaries or fallopian tubes.
These problems aren’t always caused by adhesions. If you’ve been having ongoing pain in your abdomen or pelvis that doesn’t seem to be getting any better, see your GP. Or, if you’ve recently had an operation, contact the hospital where you had it. If you have sudden abdominal pain, you should seek urgent medical attention.
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Need a GP appointment? Telephone or Video GP serviceDiagnosis of adhesions
If you see a doctor with abdominal pain, they’ll ask you several questions about your symptoms and medical history, including any previous surgery you’ve had.
They may examine you – using their hands to feel around your abdomen and pelvis, and a stethoscope to listen for sounds in your bowel. They’ll usually do a number of checks, including taking your temperature, pulse rate and blood pressure. They might also ask you for a urine sample and suggest that you have some blood tests.
Imaging tests
You may need to have some imaging tests done. These don’t always show up if you have adhesions – but can rule out other conditions. They may include:
- a CT scan – often with a contrast (dye) which your doctor can monitor as it travels through your bowel
- an X-ray
- an ultrasound
- an MRI scan
Fertility tests
If you have been trying to get pregnant without success for a year or more, your GP may refer you to a fertility doctor or a gynaecologist. This is a doctor who specialises in women’s reproductive health and fertility problems. They may suggest tests that can help to identify whether the problems you’re having in getting pregnant are due to adhesions.
Self-help for adhesions
If you have pain due to adhesions, you can take over-the-counter painkillers such as paracetamol or ibuprofen to manage this. Always read the patient information leaflet that comes with your medicine and, if you have any questions, ask your pharmacist for advice. If over-the-counter painkillers aren’t helping, make an appointment to see your doctor.
Your doctor may advise you to make some changes to your diet. This might include eating softer foods and foods low in fibre, and drinking more fluids. This can help to make sure the food passes through your bowels more easily and may help to resolve the pain.
Treatment of adhesions
Most people who have adhesions don’t need any treatment for them as they don’t usually cause problems. But if your doctor thinks that you have a bowel obstruction or severe pain because of an adhesion, you might need to go into hospital for treatment.
Non-surgical treatment for an obstructed bowel
If you’re having severe symptoms due to an obstructed bowel, your doctor may suggest going into hospital so they can keep an eye on you until it clears. They’ll usually suggest not eating or drinking anything for a day or two. This will give your bowel a rest, helping to prevent it from becoming completely obstructed. In the meantime, you’ll be put on a drip to make sure you get enough fluids and salts. They’ll also put a tube into your nose, which will release gas and fluid from your stomach.
You’ll be offered pain relief with a stronger painkiller (for example, morphine) while you’re in hospital. Gradually, you’ll be able to reintroduce sips of drinks, followed by soft food and then more solid food.
These measures will usually be enough to clear a partial obstruction. But if there’s no improvement after a few days, your doctor may advise you to have surgery.
Surgery
Surgery for adhesions involves a procedure called adhesiolysis to cut through and separate the adhesions. Your doctor may advise this surgery in the following circumstances.
- You have signs of a complete bowel obstruction. In this case, surgery may be done as an emergency procedure to clear the obstruction.
- You’ve been receiving treatment for partial obstruction for a couple of days, with no improvement.
- You’re having ongoing tummy or pelvic pain, thought to be due to adhesions.
It’s important to be aware that all surgery carries a risk of creating further adhesions. Your surgeon will talk through the risks, benefits and possible alternatives. They will only advise you to have an operation if they think it will help you.
Your surgeon may be able to do the operation using keyhole surgery. This means inserting surgical tools and instruments through small cuts into your tummy to see inside and to cut the scar tissue. There is thought to be less risk of new adhesions forming after keyhole surgery than after open surgery. Open surgery is when a single large cut is made into your abdomen. But if you have certain complications or a lot of your bowel is affected, your surgeon may have to carry out the procedure through open surgery.
Causes of adhesions
The main cause of adhesions is having surgery in your tummy or pelvis. But adhesions can also form for other reasons, including:
- endometriosis
- an infection in your abdomen, such as pelvic inflammatory disease or diverticulitis
- inflammation caused by diseases such as Crohn’s disease
- treatment with radiotherapy
Complications of adhesions
Complete bowel obstruction
Although a partial bowel obstruction can usually be treated without surgery, a complete bowel obstruction is a medical emergency because it can be life-threatening. You’ll be in a lot of pain and your bowels stop working so you won’t be able to pass wind or poo. Seek urgent medical attention if you have these symptoms.
Strangulated bowel
If a part of your bowel becomes twisted tightly around a band of adhesions, it can cut off the blood supply. Your bowel is said to be ‘strangulated’. This is life-threatening if you don’t get treatment – it’s vital to get some help.
Symptoms of bowel strangulation include:
- severe and constant pain in your tummy
- bleeding from your bottom
- a fever
If you have these symptoms, call for an ambulance or go to your nearest accident and emergency department.
Prevention of adhesions
Adhesions can form if you have an operation, it’s just the way the body sometimes reacts and isn’t due to the skill of your surgeon. The more operations you have, the more likely adhesions will form. Scientists are currently trying to develop substances and fluids that can be used during surgery to prevent them forming.
Keyhole surgery usually leads to fewer adhesions than open surgery but it’s not always possible. Ask your surgeon if it’s an option for you.
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Will I know if I've got adhesions from surgery?
Most of the time, adhesions don’t cause problems so you may not know if you have them. They’ll usually only become apparent if they start to cause symptoms, such as pain in your tummy, bowel obstruction or fertility problems.
These symptoms might not happen until years or even decades after your surgery. Even then, there’s no accurate test for adhesions. The only way to be completely certain that you have them is to have surgery to look inside your body.
It’s always important that you tell your doctor about your medical history including any previous operations you’ve had. This will help your doctor to make an accurate assessment as to whether or not any symptoms you’re having might be due to adhesions.
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Can I get repeat bowel obstructions due to adhesions?
It’s not uncommon to develop repeat bowel obstructions due to adhesions. This can happen whether you previously had surgery to resolve the problem or not. Around one in five people who had non-surgical treatment for bowel obstruction are readmitted to hospital within five years. The risk of recurrence is slightly less for people who have surgery to treat bowel obstruction.
It’s impossible to predict the likelihood that you will get another bowel obstruction, but there are some factors that may affect your risk. The risk of getting another bowel obstruction is higher during the first couple of years after surgery for adhesions. Yet it’s still possible to develop another obstruction many years later. Risk of adhesion-related bowel obstruction is also higher following open surgery than keyhole (laparoscopic) surgery.
It’s important to watch out for any return in symptoms after you’ve had treatment for a bowel obstruction. Repeat symptoms include cramping pains, bloating and vomiting. You may be asked to come for regular check-ups with GP, who will monitor you and refer you for tests if your symptoms seem to be returning.
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Related information
Gynaecological laparoscopy
A gynaecological laparoscopy is a procedure where your surgeon uses a camera (laparoscope) to see inside your lower abdomen (tummy). This means they will be able to see your uterus (womb), fallopian tubes and ovaries.
Caring for surgical wounds
Taking proper care of your surgical wound can lower your risk of infection
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Other helpful websites
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Sources
- Laparoscopic adhesiolysis. Medscape. emedicine.medscape.com, updated 21 September 2017
- Ten Broek RPG, Krielen P, Di Saverio S, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 2018; 13:24. doi:10.1186/s13017-018-0185-2
- Surgery. Oxford handbook of clinical medicine. Oxford Medicine Online. oxfordmedicine.com, published online September 2017
- Tabibian N, Swehli E, Boyd A, et al. Abdominal adhesions: A practical review of an often overlooked entity. Ann Med Surg 2017; 15:9–13
- Adhesions. Guts UK! gutscharity.org.uk, accessed 11 July 2019
- Infertility in women. BMJ Best Practice. bestpractice.bmj.com, last reviewed June 2019
- Tubal dysfunction and pelvic lesions. The MSD Manuals. www.msdmanuals.com, last full review/revision January 2019
- Small bowel obstruction. BMJ Best Practice. bestpractice.bmj.com, last reviewed June 2019
- Post-operative complications (Oxford specialist handbooks). Oxford Medicine Online. oxfordmedicine.com, published online October 2011
- Colorectal surgery (Oxford specialist handbooks in surgery). Oxford Medicine Online. oxfordmedicine.com, published online September 2011
- Assessment of chronic pain. BMJ Best Practice. bestpractice.bmj.com, last reviewed June 2019
- Assessment of acute abdomen. BMJ Best Practice. bestpractice.bmj.com, last reviewed June 2019
- Abdominal pain. Patient. patient.info, last reviewed 21 May 2015
- Emergencies in general practice. Oxford handbook of general practice. Oxford Medicine Online. oxfordmedicine.com, published online April 2014
- Abdominal examination. Patient. patient.info, last reviewed 4 June 2015
- Fertility problems: assessment and treatment. National Institute for Health and Care Excellence (NICE), September 2017. www.nice.org.uk
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Author information
Reviewed by Pippa Coulter, Freelance Health Editor, Bupa Health Content Team, September 2019
Expert reviewer, Mr Christian Macutkiewicz, Consultant General and Hepato-Pancreatico-Biliary Surgeon
Next review due September 2022
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