The tissues and organs inside your body normally have slippery surfaces, which prevent them from sticking together. But if the tissues are irritated, because you’ve had surgery or an infection for example, 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’ve had an operation inside your tummy. This can partially or completely block your bowel and is known as a bowel obstruction.
In women, if you’ve an infection or surgery in your pelvic area, adhesions can affect your fallopian tubes. This may in turn, affect your fertility.
You might not get any symptoms from adhesions unless they cause problems, such as:
- long-lasting tummy pain
- bowel obstruction
That said, there are lots of other reasons why you might have tummy pain. But if your pain lasts for a long time, contact your GP, or surgeon if you’ve recently had an operation.
Your GP will ask about your symptoms and medical history, and will examine you.
Your GP may refer you to see a surgeon who specialises in gastrointestinal surgery. This is because sometimes, the only way to tell for certain whether you have an adhesion is to look inside your body. It might be possible to do this by keyhole (laparoscopic) surgery, as the risk of it causing more adhesions is lower compared to open surgery. Talk to your doctor or surgeon about the risks and best options for you.
If you’re having fertility problems, your GP will refer you to a gynaecologist (a doctor who specialises in women’s reproductive health). For more information about this, see our information on Female infertility.
If your doctor thinks an adhesion is obstructing your bowel, they may:
Most people who have adhesions don’t need any treatment for them as, often, they don’t cause problems. But if your doctor thinks that you have a bowel obstruction or severe pain because of an adhesion, they might suggest you go into hospital for treatment.
If you need something for the pain, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and, if you have any questions, ask your pharmacist for advice.
Non-surgical treatment for an obstructed bowel
If you have an obstructed bowel, you might 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 might suggest you don’t eat solid food for a day or two and just drink fluids. This will give your bowel a rest and may prevent it from becoming completely obstructed. Bulky, high-fibre foods are more likely to get stuck in parts of your bowel that are narrow because of adhesions. Your hospital team may put a drip into a vein in your arm 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 might need to 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 suggest you have surgery.
The only way to treat adhesions is with what’s called adhesiolysis, which is an operation to disconnect them. But it’s important to be aware that all surgery carries a risk of creating further adhesions. Your surgeon will only advise you to have an operation if they think it will help you.
Your surgeon may do the adhesiolysis operation using keyhole surgery. They’ll make a few small cuts in your tummy rather than one large one as in open surgery. They’ll then cut through the scar tissue.
Surgery for an obstructed bowel
If you have a complete bowel obstruction, you might need an emergency procedure to clear it. Your doctor and surgeon will talk you through the risks, benefits and possible alternatives of surgery.
The main cause of adhesions is having surgery in your tummy or pelvis. But adhesions can also form because of inflammation caused by:
- appendicitis, especially if your appendix ruptures
- an infection, such as pelvic inflammatory disease
You can also be born with problems that cause adhesions, such as a ruptured (torn) bowel.
Symptoms of bowel obstruction include:
- severe cramps or pain in your tummy that may come and go
- feeling bloated
- feeling sick or vomiting
- constipation – or you might have diarrhoea
A complete bowel obstruction is a medical emergency as it can be life-threatening. You’ll be in a lot of 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 its blood supply. It’s then said to be ‘strangulated’. This is also life-threatening if you don’t get treatment so it’s vital to get some help.
Symptoms of bowel strangulation include:
- severe and constant pain in your tummy
- a fever
- a fast heartbeat
If you have these symptoms, call for an ambulance or go to the accident and emergency at your local hospital.
If you’re having difficulty getting pregnant, you may have adhesions near your fallopian tubes. If you’ve been trying to get pregnant for at least a year without success, contact your GP. For more information, see our information on Female infertility.
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.
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. But while they may become apparent shortly after your surgery, it might not be until years or even decades later.
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.
The complications from adhesions are unpredictable. Some patients never have symptoms and others may need to have several operations over time. Bowel obstruction can be an ongoing problem for some people with adhesions, while others don’t have any more problems.
A bowel obstruction caused by adhesions is unpredictable, but there are some factors that may affect your risk. The risk of getting another bowel obstruction is higher during the first five years after surgery for adhesions. Yet 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, particularly if your operation didn’t remove all the adhesions.
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- Emergency presentations. OSH colorectal surgery. Oxford Medicine Online. oxfordmedicine.com, published October 2011
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- Ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ 2013; 347:f5588. doi: 10.1136/bmj.f5588
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, March 2017
Expert reviewer Mr Christopher Wong, Consultant Gastrointestinal and Endocrine Surgeon
Next review due March 2020
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