Pelvic adhesions are a medical condition characterized by the formation of scar tissue within the pelvic cavity. These bands of fibrous tissue can cause organs that are typically separate to stick together. This process can impede the natural, smooth movement of structures such as the uterus, ovaries, fallopian tubes, bladder, and intestines, potentially leading to discomfort and other complications.
What Are Pelvic Adhesions
Normally, the surfaces of internal pelvic organs are smooth and slippery, allowing them to glide past each other without friction. Pelvic adhesions are fibrous bands of scar tissue that create abnormal connections, physically binding organs together.
This scar tissue can vary in thickness and density, ranging from thin, filmy strands to thick, dense bands. While scar tissue is a natural part of the body’s healing, adhesions are an abnormal formation that restricts normal organ movement and function. The presence of these adhesions can effectively “glue” structures like the fallopian tubes to the ovaries or the uterus to the bowel, disrupting their usual anatomy.
Common Causes
Pelvic adhesions frequently arise as a result of the body’s healing response to trauma or inflammation within the pelvic cavity. A primary cause is abdominal or pelvic surgery, where the surgical manipulation of tissues can trigger scar tissue formation. Procedures such as Cesarean sections, hysterectomies, appendectomies, and surgeries for endometriosis are commonly associated with their development. The body perceives surgical manipulation as an injury, initiating a healing process that can lead to these fibrous connections.
Infections are also a significant factor in adhesion formation. Pelvic inflammatory disease (PID), often a consequence of sexually transmitted infections like chlamydia or gonorrhea, can cause widespread inflammation and scarring in the reproductive organs. Similarly, ruptured appendicitis or diverticulitis, which involve infection and inflammation within the abdominal cavity, can extend to the pelvic area and result in adhesions.
Endometriosis is another common cause, where tissue similar to the uterine lining grows outside the uterus. This misplaced tissue can cause inflammation, irritation, and bleeding, leading to scar tissue and adhesions that bind organs. Other less frequent causes include severe abdominal trauma or certain inflammatory conditions like inflammatory bowel disease, which can induce pelvic inflammation and subsequent scarring.
Signs and Symptoms
Pelvic adhesions can cause various symptoms, though some individuals experience no discomfort. Chronic pelvic pain is a frequently reported symptom, which can vary in intensity from a dull ache to sharp, stabbing sensations. This pain may worsen during menstruation, physical activity, or sexual intercourse.
Painful intercourse (dyspareunia) can occur when adhesions restrict pelvic organ movement during sexual activity. Adhesions involving reproductive organs, particularly the fallopian tubes or ovaries, can interfere with egg transport or ovulation, potentially leading to infertility. In some cases, infertility may be the only noticeable symptom.
If adhesions involve the intestines, they can cause constipation, bloating, abdominal cramping, or even partial or complete bowel obstruction. Adhesions near the bladder might contribute to urinary symptoms like frequent or urgent urination. Symptoms often depend on the adhesions’ location, extent, and affected organs.
How They Are Diagnosed
Diagnosing pelvic adhesions can be challenging because their symptoms often overlap with other gynecological or gastrointestinal conditions. A thorough medical history, including previous surgeries, infections, and symptoms, is typically the first step. A physical examination may also provide initial clues, but it cannot definitively confirm the presence of adhesions.
Standard imaging tests (ultrasound, CT scans, MRI) are often used to rule out other conditions but may not clearly show adhesions. Adhesions are often too fine or indistinct for reliable visualization on these scans. The most definitive method for diagnosing pelvic adhesions is a minimally invasive surgical procedure called laparoscopy. During laparoscopy, a surgeon inserts a thin, lighted tube with a camera through a small abdominal incision to directly visualize pelvic organs and identify scar tissue.
Treatment Options
Treatment for pelvic adhesions varies based on symptom severity and impact on daily life. For mild discomfort, conservative pain management approaches may be recommended. This includes over-the-counter pain relievers, prescription medications, or physical therapy to alleviate symptoms. These non-surgical methods manage pain but do not remove adhesions.
For severe symptoms or complications like infertility or bowel obstruction, surgical intervention is often considered. The primary surgical procedure, adhesiolysis, involves cutting or releasing scar tissue bands. This is frequently performed using laparoscopic techniques (“keyhole surgery”), involving small incisions and specialized instruments. Laparoscopic adhesiolysis aims to free organs and restore their normal movement and function.
For complex cases with extensive or deeply embedded adhesions, open surgery may be necessary. Surgeons also employ strategies to minimize new adhesion formation, a common concern after adhesiolysis. These strategies include meticulous surgical techniques (gentle tissue handling, minimal bleeding) and barrier agents (films or liquids) placed between tissues to prevent sticking during healing.