Abdominal and pelvic adhesions

Adhesions are bands of scar tissue that can make body tissues and organs stick together. They often form after you’ve had an operation inside your tummy (abdomen) or pelvis.

Your body makes scar tissue when it heals. Scar tissue can happen if the tissues inside your tummy or pelvis get damaged.

Adhesions are bands of scar tissue that form between different organs or tissues. They can make your organs or tissues stick together. You may get adhesions:

• after any type of surgery in your tummy or pelvis – for example, bowel surgery
• after an infection in your tummy
• if you have an ongoing inflammatory condition such as endometriosis

Keyhole (laparoscopic) surgery is less likely to cause adhesions than open surgery.

Most adhesions don’t cause any symptoms, so you may not know you have them. But sometimes, they can cause some problems.

Symptoms of adhesions

Many people don’t have any abdominal or pelvic adhesion symptoms at all. But others can have severe symptoms that affect their daily life. Symptoms from adhesions can start months or even years after the adhesions first formed.

You may start noticing symptoms if your adhesions are causing the following problems.

• A blocked bowel (bowel obstruction) – this is when different parts of your bowel stick together.
• Ongoing pain in your tummy or pelvis.
• Problems getting pregnant, if your adhesions affect your ovaries or fallopian tubes.

Your bowel can get partly or completely blocked. This can cause:

• cramping pains in your tummy
• bloating
• feeling or being sick
• watery diarrhoea (with partial obstruction)

But obstruction can also cause constipation (finding it hard to poo). A complete obstruction is a medical emergency. For more information, see our section on complications of adhesions.

These problems aren’t always caused by adhesions. So if pain in your tummy or pelvis isn’t getting any better, see a GP. Or if you’ve recently had an operation, contact the hospital where you had it. If you have sudden tummy pain, you should seek urgent medical advice.

Causes of adhesions

You can get adhesions after any type of surgery in your tummy (abdomen) or pelvis, including:

• operations to remove parts of your digestive system
• appendix removal (appendicectomy)
• gallbladder removal (cholecystectomy)
• hysterectomy
• surgery for ectopic pregnancy

You may also get adhesions:

• after an infection in your tummy - for example, pelvic inflammatory disease or diverticulitis
• if you have an ongoing inflammatory condition such as endometriosis
• if you have inflammatory bowel disease such as Crohn’s disease
• after treatment with radiotherapy

Diagnosis of adhesions

Diagnosing abdominal or pelvic adhesions can be difficult. There are no specific tests.

If you have tummy pain, your doctor will ask you about:

• any symptoms you do have
• your medical history
• any medicines you’re taking
• any surgery you’ve had in the past

They may also:

• examine you – using their hands to feel around your tummy and pelvis
• use a stethoscope to listen for sounds in your bowel

Your doctor is likely to take your temperature, pulse rate and blood pressure. They may also ask you for a urine sample and suggest you have some blood tests.

Imaging tests

You may need to have some imaging tests. Adhesions may not show up in scans. But having these tests may help to rule out other conditions. These tests may include:

• a CT scan – often with a contrast dye, which your doctor can see going through your bowel
• an X-ray
• an ultrasound
• an MRI scan

Fertility tests

If you haven’t been able to get pregnant after trying for a year or more, your GP may refer you for tests to see if adhesions are causing your fertility issues. You will see a doctor who specialises in reproductive health or fertility problems.

Self-help for adhesions

If you have any pain, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice. If over-the-counter painkillers aren’t helping, it’s important to see a doctor because you may need more specialist help.

Your doctor may suggest making some changes to your diet. This may help food to pass through your bowel more easily. It may also ease the pain. Changes that may help include:

• eating softer foods
• eating foods low in fibre
• drinking more fluids

If you’re finding it hard to poo, your GP may prescribe a laxative or stool softener for a short while. This will help to soften your poo so it’s easier to pass. Your GP may also prescribe some medicines to ease your tummy pain.

Treatment of adhesions

Adhesions don’t usually cause problems, and most people don’t need any specific treatment. But some people may need surgery. You may need to go into hospital if:

• your doctor thinks you have a blocked (obstructed) bowel
• you have severe pain because of an adhesion

Non-surgical treatment for an obstructed bowel

If you have a blocked bowel, you’ll need to stay in hospital until the blockage clears. Your doctors will ask you not to eat or drink anything for a day or two. This will help to prevent a complete blockage.

You’ll have an intravenous infusion (IVI) – also known as a drip – to make sure you get enough fluids and salts. You’ll also have a tube into your nose to drain gas and fluid from your stomach. This will relieve any pressure and make you more comfortable.

You may need pain relief with a stronger painkiller (such as morphine) while you’re in hospital. If your blockage resolves, you’ll gradually be able to start having sips of drinks, followed by soft food and then more solid food.

These measures are often enough to clear a partially blocked bowel. But if you’re not getting better after a few days, your doctor will recommend surgery.

Surgery

Surgery for adhesions is called adhesiolysis (pronounced ad-hee-see-oh-ly-sis). This cuts through and separates the adhesions. Your doctor may suggest you have surgery for reasons such as the following.

• You have signs of a complete bowel blockage and need an emergency procedure to clear your bowel.
• You’ve been having treatment for a partly blocked bowel for a couple of days but aren’t getting better.
• You’re having ongoing tummy (abdominal) or pelvic pain, thought to be caused by adhesions.

Having any type of surgery may mean you get more adhesions afterwards. So, it’s really important to talk through the risks, benefits and possible alternatives with your surgeon. They’ll only advise you to have an operation if they think it’ll help you.

Your surgeon may be able to do the operation using keyhole surgery. This means making several small cuts into your tummy. The surgeon will then use surgical tools and instruments to look inside and cut the scar tissue.

You’re less likely to get new adhesions after keyhole surgery than after open surgery. But some complications, such as a blocked bowel or fertility issues, may mean you need open surgery instead. Open surgery means the surgeon makes a single large cut instead of several small ones.

Complications of adhesions

Complete bowel obstruction

You can have a partial bowel obstruction treated without surgery. But a complete bowel obstruction is a medical emergency and can be life-threatening.

If your bowel is completely blocked, your bowels will stop working. You may:

• have a lot of pain
• not be able to pass wind or poo

Seek urgent medical attention if you have these symptoms.

Strangulated bowel

If part of your bowel gets twisted tightly around a band of adhesions, this can cut off the blood supply. This is called a strangulated bowel. It’s life-threatening if you don’t get treatment – so it’s vital to get help.

Symptoms of bowel strangulation include:

• severe and constant pain in your tummy
• a fever (high temperature)
• bleeding from your bottom (this is uncommon)

If you have these symptoms, call an ambulance or go to your nearest accident and emergency department.

Prevention of adhesions

Adhesions commonly form if you have an operation. Some people are more prone to developing adhesions than others. It isn’t due to the skill of your surgeon. Some types of surgery are more likely to cause adhesions than others.

Scientists are working on substances that can stop adhesions forming during surgery. These substances form a barrier between healing tissues, so they don’t stick together. But there is currently no evidence that they prevent adhesions, so most surgeons don’t use them.

Keyhole surgery usually leads to fewer adhesions than open surgery. So, if you’re having an operation, ask your surgeon if keyhole surgery is an option for you.