Scar adhesions

About adhesions

If the tissues inside your body become injured, such as during surgery, your immune system triggers a response that involves forming bands of scar tissue, called adhesions.

Scars are a natural part of all healing processes, and the scar tissue that is formed changes and adapts for many months. All types of surgery result in scar tissue being formed.

Most of the time, adhesions don't cause any problems, so you may not even know you have them. However, in some people who have had abdominal surgery, the scar tissue can cause the bowel to stick together. This can cause your bowel to become partially or completely blocked (obstructed). Partial bowel obstructions can cause reoccurring abdominal discomfort, which can make you feel sick and vomit. A complete bowel obstruction is a medical emergency. It causes severe pain, which initially comes on in waves before becoming constant.

If you’re a woman, adhesions caused by surgery in your pelvic area can pull your fallopian tubes out of place, which can lead to infertility.

Symptoms of adhesions

You may not have any symptoms at all unless your adhesions start to cause further problems such as a bowel obstruction or infertility.

You may, however, have ongoing pain in your abdomen or pelvis. This won't always be a symptom of adhesions, but you should see your GP if you have pain or bloating that lasts for a long time.

Complications of adhesions

Bowel obstruction

If you have a bowel obstruction, you may:

  • have severe cramping pain in your abdomen that comes and goes (as a result of a partial bowel obstruction)
  • have a bloated abdomen
  • feel sick or vomit
  • be constipated or have diarrhoea

You should seek urgent medical attention if you have these symptoms and they are severe, or if you have had previous problems with bowel obstructions.

Occasionally, a part of your bowel may become twisted tightly around a band of adhesions, cutting off the blood supply to your bowel. This is often referred to as strangulation of the bowel. It’s life-threatening and you will need immediate treatment. Symptoms of bowel strangulation can include:

  • a tender abdomen
  • a fever
  • a fast heartbeat

If you have these symptoms in addition to those above, you should call for emergency help.

Fertility problems

If you’re a woman and adhesions are affecting your fallopian tubes, you may find you have trouble getting pregnant. It's important to remember, however, that for any fertile couple it can take up to a year or more of having regular, unprotected sex to become pregnant. If you’re worried about your fertility, see your GP.

Causes of adhesions

The main cause of adhesions developing is from having surgery on your abdomen or pelvis.

However, adhesions can also form as a result of inflammation caused by:

  • appendicitis, especially if your appendix ruptures
  • ulcerative colitis
  • endometriosis
  • an infection, such as gastroenteritis
  • a congenital band, which means you were born with it
  • a sexually transmitted disease (if you’re a woman)

Diagnosis of adhesions

If you see your GP because you have pain in your abdomen or pelvis, he or she will ask about your symptoms and examine you. Your GP will also ask you about your medical history. He or she may refer you to a general surgeon who specialises in laparoscopic (keyhole) gastrointestinal surgery.

If you’re having fertility problems, your GP will refer you to a gynaecologist (a doctor who specialises in women's reproductive health).

The only way of being able to tell for certain whether you have an adhesion is to look inside your body. This can be done with keyhole surgery. However, surgery always carries some risks and may lead to further adhesion formation.

Your doctor may carry out the following tests to confirm whether you have a bowel obstruction and if so, how serious it is. He or she may:

  • feel your abdomen to check for any tenderness
  • take your temperature
  • check your heart rate
  • do some blood tests
  • take an X-ray or do other imaging tests, such as a barium swallow and meal, CT or MRI scan
  • carry out a laparoscopy (a keyhole procedure that allows a surgeon to look inside your abdomen or pelvis)

Treatment of adhesions

Most people who have adhesions will not need any treatment for them as they don't usually cause any problems. However, if your doctor thinks you have a possible bowel obstruction or adhesion-related pain, you may be referred to hospital for treatment. If you have fertility problems caused by adhesions, your gynaecologist will be able to discuss your options with you.

Non-surgical treatment

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

In the early stages, if you restrict your fluid intake to sips of non-fizzy drinks and don’t eat for 24 hours, this can treat the problem by preventing it from developing into a full bowel obstruction. Even if a bowel obstruction has fully developed, it will usually get better with time. However, you may need to be admitted to hospital for treatment, so your doctor can monitor you until your bowel obstruction clears. In hospital, you will have a drip put into your vein in your arm to make sure you get enough fluids and salts. You may also have a tube put into your nose to release gas and fluid from your bowel.

Your doctor may suggest you have a liquid diet, or a diet low in fibre, so your food 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 advise you to have surgery.

Surgery

Surgery to break up adhesions is called adhesiolysis and is currently the only way to treat adhesions. However, as any operation carries a risk of creating further adhesions, you will only be advised to have adhesiolysis if your surgeon thinks it will be beneficial for you. For instance, if you have a complete bowel obstruction or strangulated bowel that is life-threatening, you might need adhesiolysis as an emergency procedure. You can also have the procedure if you’re having fertility problems caused by adhesions.

Adhesiolysis can be carried out using keyhole surgery. This involves your surgeon making several small cuts in your abdomen or pelvis to cut through the scar tissue, rather than making one large cut on your skin as in traditional open surgery.

Your doctor may also give you the option of having surgery if you have ongoing pelvic or abdominal pains or bloating. However, it's important to remember that surgery may not improve your pain, and there is a risk it could make your pain worse. You will have an opportunity to discuss the risks, benefits and possible alternatives of the procedure with your surgeon, before you give your consent for the procedure to go ahead.

Prevention of adhesions

Adhesions are difficult to prevent if you need to have surgery. Scientists are currently trying to develop special films and fluids, which can be used during surgery, to prevent adhesions forming. However, more studies on these products are needed before doctors will be able to tell how well they work.

How long after my operation will it be until I know whether I have developed an adhesion?

Answer

You will only be able to tell whether you have developed an adhesion if it causes complications that you need treatment for, such as a bowel obstruction, abdominal (tummy) pain or infertility. These problems may become apparent shortly after your surgery or even decades later.

Explanation

Most of the time, adhesions don't cause any problems, so you may not even know if you have them. You will usually only find out you have adhesions if they start to cause you symptoms, such as abdominal pain, or lead to complications such as a bowel obstruction or fertility problems. 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 you may get with an operation that you may have had years earlier. For this reason, it's always important that you tell your doctor about your medical history and any previous operations you have had.

If I've developed a bowel obstruction as a result of adhesions, how likely am I to get another one?

Answer

Everyone is different, and while you may go through life without having another bowel obstruction, it’s possible you could develop another one.

Explanation

Bowel obstructions can be a reoccurring problem for some people with adhesions. However, most people don't have any further problems if their original obstruction is dealt with effectively. It's hard to tell exactly what your chance of developing another bowel obstruction is, but there are some factors that could affect your risk.

For example, your risk of having another bowel obstruction is greater during the first five years after your previous one. However, it's still possible to develop another obstruction many years later. Your risk may also increase with the number of previous obstructions you have had. This is also the case if you didn't have surgery to break up your adhesions when you were previously treated.

If you’re worried about your risk of having another bowel obstruction, talk to your doctor.

I've heard that a type of massage therapy may be able to help treat infertility caused by adhesions. Is this true?

Answer

There isn’t any strong enough evidence to show that massage therapy is an effective treatment for infertility caused by pelvic adhesions.

Explanation

There have been reports that a type of physical therapy involving massaging specific areas of a woman's body may be effective at treating infertility related to adhesions.

However, the research that has been carried out hasn't been of good enough quality to prove whether the technique really works. It has only involved small numbers of women and has been carried out by the people who developed the technique.

If you intend to try massage, or any other type of complementary therapy, talk to your doctor first as this may have an impact on other medical treatments you’re receiving. There may be other treatments for infertility that you can try. Talk to your doctor if you’re having fertility problems caused by adhesions to discuss your options.

Is there anything I can do to reduce my risk of bowel obstruction, such as change my diet?

Answer

Once adhesions have formed, the only way to get rid of them or change their position is to have further surgery. However, if your doctor thinks you’re at risk of a bowel obstruction in the immediate or short term, he or she may suggest you try a fluid-only or low-fibre diet.

Explanation

If your doctor suspects you have symptoms of a partial bowel obstruction (such as cramping in your abdomen or feeling sick), he or she may suggest not having solid food for a day or two and only drinking fluids. This will help your bowel to rest for a couple of days.

Similarly, if you have reoccurring problems with adhesions, your doctor may recommend that you follow a low-fibre diet. This is because bulky high-fibre foods are more likely to get stuck in any bowel narrowings caused by adhesions and this can lead to bowel obstruction, pain and bloating. A low-fibre diet may mean cutting down on wholemeal bread, pasta and rice, wholegrain cereals, pulses such as baked beans and kidney beans, and fruits and vegetables.

You should only consider making changes to your diet following discussions with your doctor or a dietitian.