What are the other Names for this Condition? (Also known as/Synonyms)

• Adhesion

What are Adhesions? (Definition/Background Information)

• Adhesions are bands of scar tissue that connect two internal body surfaces that are normally separate. They occur as the body attempts to repair itself after surgery, infection, injury, radiation, or inflammation in the abdomen or pelvis
• Adhesions can cause a range of problems, including infertility, pain during intercourse, pelvic pain, bowel obstruction, and Adhesion-Related Disorder (ARD)
• There are many forms of Adhesions, depending on their location in the body, and some of these include:
  • Abdominal Adhesions
  • Pelvic Adhesions
  • Pericardial Adhesions
  • Peridural Adhesions
  • Peritendinous Adhesions
• Adhesions may also cause higher post-operative complications, including leaks, wound infections, hemorrhages, small bowel obstructions, infertility, and chronic pelvic pain, and increase the risk, complexity, and complications during subsequent surgery
• Adhesions are generally treated through a surgical procedure, termed adhesiolysis, which may be open or laparoscopic. The outcomes are generally good with early intervention and appropriate treatment

Who gets Adhesions? (Age and Sex Distribution)

• Individuals of any age group may develop Adhesions. Both males and females are affected
• The incidence of Adhesions has increased with the rise in gynecological procedures, with up to 93% of people who have abdominal surgery developing Adhesions, and up to 90% of women getting affected by post-operative Adhesions following major gynecological surgery

What are the Risk Factors for Adhesions? (Predisposing Factors)

• Individuals who have major or multiple surgical procedures are at a higher risk for developing Adhesions
• The prevalence of Adhesions has gone up significantly as a result of the rise in gynecological procedures

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Adhesions? (Etiology)

• Adhesions develop as the body attempts to repair itself after surgery, infection, injury, radiation, or inflammation in the abdomen or pelvis
• The formation of scar tissue is the body’s repair mechanism in response to tissue disturbance caused by surgery, infection, injury, or radiation

What are the Signs and Symptoms of Adhesions?

The signs and symptoms of Adhesions can vary widely depending on the individual case and location of the Adhesion. These may be mild or severe.

• Adhesions can be painless and asymptomatic too, but they cause 60 to 70% of small bowel obstructions in adults and contribute to the development of chronic pelvic pain
• Adhesions can affect the female reproductive organs, the bowel, the area around the heart, the spine, and the hand

Adhesion-Related Disorder (ARD):

• ARD is a group of symptoms that may occur as a result of Adhesions, including chronic abdominal pain, infertility, bowel obstruction, urinary bladder dysfunction, and emotional disorders such as depression
• The disorder usually causes chronic abdominal pain, and symptoms may also include infertility, an inability to pass gas, pain during bowel movements, pain while walking, sitting, or lying in certain positions, and depression

How are Adhesions Diagnosed?

Diagnosing Adhesions is difficult and can be mistaken for other conditions. Blood tests, X-rays, CT scans, MRI scans, and ultrasounds generally do not help in diagnosing Adhesions.

• According to one’s signs and symptoms, the healthcare provider will order the appropriate diagnostic tests to rule out other medical conditions that may have similar symptoms, and if the results are normal or negative for abnormal pathology, a diagnostic laparoscopy may be appropriate
• Hysterosalpingography (X-ray of the uterus and fallopian tubes) may help diagnose Adhesions inside the uterus or fallopian tubes. If the results of these tests are normal or negative, a diagnostic laparoscopy may be appropriate, as it is the only test that can confirm the presence of Adhesions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Adhesions?

• Adhesions may cause significantly higher post-operative complications, including leaks, wound infections, hemorrhages, small bowel obstructions, infertility, and chronic pelvic pain
• Adhesions may also increase the risk, complexity, and complications during subsequent surgeries

How are Adhesions Treated?

The treatment of Adhesions generally involves surgery. Adhesiolysis is a surgical procedure that involves the separation of Adhesions that have formed between the tissues/organs. The goal of the procedure is to restore the normal anatomy and function of the affected area. Adhesiolysis is typically performed using laparoscopic or open surgical techniques, depending on the location and severity of the Adhesions.

• Open adhesiolysis may not be helpful, except to remedy serious medical issues, such as bowel obstruction, as the operation to remove the adhesions will cause more adhesions to form in around 70% of cases
• Laparoscopic adhesiolysis is preferred for infertility surgery, as it reduces the risk of new Adhesions forming. Laparoscopic adhesiolysis can significantly improve the quality of life among women with chronic pelvic pain due to Adhesions, but it can be time-consuming, technically difficult, and involve some risk

The non-surgical treatments for Adhesions may include medication, exercise, physical therapy, lifestyle changes, and soft tissue mobilization. These are usually helpful in addressing the associated signs and symptoms.

How can Adhesions be Prevented?

• Adhesion barriers can be placed at the time of surgery to reduce the risk of Adhesion formations
• Adjuvant treatment after adhesiolysis with commercially available products, such as topical gels or creams, oral medications, or other therapeutic forms, can help prevent the development of intrauterine Adhesions

What is the Prognosis of Adhesions? (Outcomes/Resolutions)

• The prognosis for adhesions varies depending on the severity of the condition, but adhesiolysis can significantly improve the quality of life for those with chronic pelvic pain due to Adhesions.
• Most women who choose laparoscopic adhesiolysis are discharged on the same day of the procedure, experience minimal complications, and return to full activity within one week of the procedure

Additional and Relevant Useful Information for Adhesions:

The following link is a useful resource for information on adhesiolysis, the surgical procedure to address Adhesions:

https://www.dovemed.com/common-procedures/procedures-surgical/separation-of-lysis-of-adhesions/