Abdominal and pelvic adhesions
Your health expert: Mr Christian Macutkiewicz, Consultant General & Hepatobiliary Surgeon
Content editor review by Victoria Goldman, January 2022
Next review due January 2025
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 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
You’re more likely to get adhesions after open surgery than after laparoscopic (keyhole) surgery.
Most adhesions don’t cause any symptoms, so you may not know you have them. But sometimes, they can cause some problems – for more information, see our section on symptoms of adhesions.
Symptoms of adhesions
Adhesions affect everyone differently. Many people don’t have any symptoms at all. Some people have a few symptoms that don’t bother them too much. Others have symptoms that affect their daily life. If you do get symptoms, you may not notice these for a few months or even years after your adhesions form.
You may start noticing symptoms if your adhesions are causing the following problems.
- A blocked bowel (bowel obstruction) may happen if different parts of your bowel stick together. Your bowel can get partly or completely blocked. This can cause cramping pains in your tummy, bloating, feeling sick and being sick. You may also have constipation – that is when you find it hard to poo. A complete obstruction is a medical emergency. For more information, see our section on complications of adhesions.
- Ongoing pain in your tummy or pelvis.
- Problems getting pregnant may happen if your adhesions affect your ovaries or fallopian tubes.
These problems aren’t always caused by adhesions. So, if pain in your tummy or pelvis isn’t 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 tummy pain, you should seek urgent medical advice.
Diagnosis of adhesions
Adhesions can be hard to diagnose because they don’t cause any specific symptoms. And there are no specific tests to show you have adhesions.
If you have tummy pain, your doctor will ask you about:
- your symptoms
- 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
They’ll usually do several checks, including taking 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 don’t always show up in tests and scans – but having these 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 to a doctor who specialises in reproductive health or fertility problems. They may suggest tests to check whether you’re having problems getting pregnant because you’ve got adhesions.
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Self-help for adhesions
If your adhesions are causing 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, make an appointment to see your GP.
Your GP may advise you to make some changes to your diet. This may help food pass through your bowels more easily. It may also ease the pain. You may be advised to:
- eat softer foods
- eat foods low in fibre
- drink more fluids
If you’re finding it hard to poo, your GP may prescribe a laxative 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 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, the hospital will keep an eye on you until the blockage clears. They’ll usually suggest you don’t eat or drink anything for a day or two. This will give your bowel a rest, so it hopefully won’t get completely blocked. 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. This will release gas and fluid from your stomach.
You’ll be offered pain relief with a stronger painkiller (such as morphine) while you’re in hospital. Gradually, you’ll be able to start having sips of drinks, followed by soft food and then more solid food.
These measures will usually be enough to clear a partially blocked bowel. But if you’re not getting better after a few days, your doctor may advise you to have surgery.
Surgery
Surgery for adhesions is called adhesiolysis. This cuts through and separates the adhesions. Your doctor may suggest you have surgery for several reasons.
- You have signs of a complete bowel blockage. In this case, the surgery may be done as 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 or pelvic pain, thought to be caused by adhesions.
Having any type of surgery may mean you get more adhesions afterwards. So, your surgeon will talk through the risks, benefits and possible alternatives. 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 putting surgical tools and instruments through small cuts into your tummy to see inside and cut the scar tissue. You’re less likely to get new adhesions after keyhole surgery than after open surgery. But if you have certain complications or a lot of your bowel is blocked, you may need open surgery instead. Open surgery is when a surgeon makes a single large cut into your tummy.
Causes of adhesions
You can get adhesions after any type of surgery in your tummy 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, such as 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
Complications of adhesions
Complete bowel obstruction
A partial bowel obstruction may be treated without surgery. But a complete bowel obstruction is a medical emergency because it 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
- bleeding from your bottom
- a fever (high temperature)
If you have these symptoms, call for an ambulance or go to your nearest accident and emergency department.
Prevention of adhesions
Adhesions may form if you have an operation. This is how your body sometimes reacts to surgery on your tummy and isn’t due to the skill of your surgeon. If you have lots of operations, you’re more likely to have more adhesions.
Scientists are trying to make substances and fluids that can be used during surgery to stop adhesions forming. But these products don’t prevent adhesions completely, 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.
You may not know you have adhesions, because adhesions don’t always cause problems. They also don’t show up easily in imaging tests. But sometimes you may get some symptoms, such as pain in your tummy, a blocked bowel or fertility problems. For more information, see our sections on symptoms of adhesions and diagnosis of adhesions.
Your bowel can get blocked (obstructed) again if you have adhesions. This can happen even if you’ve already had surgery to treat them. You may be less likely to get a bowel obstruction again if you have keyhole surgery rather than open surgery. For more information, see our section on treatment of adhesions
Adhesions don’t always cause symptoms so you may not feel anything. Or you may notice some ongoing pain in your tummy. You may also feel sick or bloated or find it hard to poo. If you have any of these symptoms and they’re not going away, speak to your GP. For more information, see our section on symptoms of adhesions.
Gynaecological laparoscopy
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