Abdominal adhesions are bands of scar tissue that develop within the abdominal cavity, causing internal tissues and organs to stick. Normally, organs within the abdomen have slippery surfaces, allowing them to glide past one another without friction. Adhesions can form between organs or between organs and the abdominal wall, restricting their natural movement. They are a common outcome, particularly after abdominal surgery.
Understanding Abdominal Adhesions
Abdominal adhesions form as part of the body’s natural healing response to injury or inflammation. When tissues within the abdominal cavity are damaged, such as during surgery or infection, the body forms fibrous scar tissue. This scar tissue connects typically separate surfaces.
Bands of scar tissue vary in appearance, ranging from thin, transparent films to thick, dense fibrous cords. They can connect loops of the intestine, attach the intestines to other organs like the bladder or ovaries, or bind organs to the inner lining of the abdominal wall, known as the peritoneum.
Common Causes and Risk Factors
The most frequent cause of abdominal adhesions is prior surgery within the abdomen or pelvis. Nearly all individuals who undergo abdominal surgery develop adhesions, with risk increasing with more operations. Procedures like appendectomy, hysterectomy, C-sections, and bowel surgeries often cause adhesions.
Beyond surgery, other factors can trigger adhesion development. Inflammatory conditions, such as peritonitis (inflammation of the peritoneum), endometriosis (where uterine-like tissue grows outside the uterus), and inflammatory bowel disease, can lead to their formation. Infections within the abdomen or pelvic region, as well as physical trauma, can also cause adhesions.
Recognizing Symptoms and Potential Complications
Many individuals with abdominal adhesions experience no symptoms at all. However, when symptoms do occur, they can range from mild to severe and may appear months or even years after the adhesions initially formed. A common symptom is chronic abdominal pain, which may be described as a dull ache, cramping, or colicky pain that comes and goes. This pain can result from the adhesions pulling on organs or causing kinks in the bowel.
A serious complication of abdominal adhesions is bowel obstruction, where the adhesions cause a partial or complete blockage in the intestines. Symptoms of bowel obstruction include nausea, vomiting, abdominal bloating, and an inability to pass gas or stool. This condition can be a medical emergency requiring immediate attention. In women, adhesions affecting the reproductive organs, such as the ovaries or fallopian tubes, can contribute to difficulty conceiving or infertility.
Diagnosing and Managing Adhesions
Diagnosing abdominal adhesions can be challenging because they often do not show up on standard imaging tests like X-rays, CT scans, or MRIs, unless they are causing a complication like an obstruction. Diagnosis is often based on a patient’s medical history, particularly a history of previous abdominal surgeries, and their reported symptoms. A definitive diagnosis often requires a diagnostic laparoscopy, a minimally invasive surgical procedure where a small incision is made to insert a camera and visually inspect the abdominal cavity.
For managing adhesions, conservative approaches are often tried first, especially for mild symptoms or partial obstructions. These may include pain management with medications and dietary adjustments to help the digestive system. Surgical intervention, known as adhesiolysis, involves cutting or removing the adhesion bands. This procedure can be performed through traditional open surgery or a laparoscopic (keyhole) approach. Any surgery carries a risk of new adhesion formation.
Reducing Your Risk
While it may not be possible to completely prevent abdominal adhesions, especially after surgery, several strategies can help reduce the risk. Minimally invasive surgical techniques, such as laparoscopic surgery, are associated with fewer adhesions compared to traditional open surgery due to smaller incisions and less tissue manipulation. Surgeons also employ careful tissue handling during procedures to minimize trauma.
The use of adhesion barriers during surgery can also play a role in prevention. These barriers, which can be films or gels, are placed between healing tissues to create a physical separation, thereby discouraging them from sticking together. Modern surgical practices and adjuncts aim to significantly lower adhesion formation.