Abdominal Adhesion

What is Abdominal Adhesion, and Who Gets It?

Abdominal adhesion is a band of scar tissue that forms inside the abdomen as part of the healing process, after surgery, infection, bleeding, or endometriosis involving the abdominal or pelvic cavity. 

You can think of an adhesion as you would scar tissue that remains on the skin after a wound heals. 

The difference is that an abdominal adhesion tends to form into cord-like structures that can wrap around bowels or other abdominal organs, causing them to stick together, or stick to the abdominal wall itself.

When this happens, an adhesion can cause chronic abdominal or pelvic pain and other complications such as female infertility, difficulties voiding urine, and intestinal obstruction (Obstetrics and Gynecology International).

Do you suffer with central or lower abdominal pain of many months or years duration?

Have you had surgery to your abdomen or pelvis before the onset of this chronic pain?

There is a very high chance that your chronic abdominal or pelvic pain is caused by abdominal adhesion. 

Let's examine how common this condition is, what causes it, available treatment options and what can be done to prevent abdominal adhesions after surgery. 

How Common is Abdominal Adhesion?

Adhesion is relatively common, showing up in about 93% of patients who undergo some form of abdominal surgery, and affecting 1 in 10 patients who have never had any surgery or abdominal procedure.

Abdominal adhesion is more common in patients who have had appendectomy, bowel surgery, hysterectomy or cesarean section.

Adhesion formation following surgery is also referred to as postoperative peritoneal adhesions (PPAs) or postsurgical intra-abdominal adhesion.

It is the most common cause of bowel obstruction in the developed world. 

Every abdominal or pelvic surgery carries a 90 to 100% risk of adhesion occurring and it is increasingly necessary for doctors to warn patients of this risk and the subsequent complications of developing adhesions before any such surgery is undertaken. Let's examine a few conditions and procedures that are more associated with the development of adhesion. 

Conditions and Procedures that Increase Your Chances of Developing Abdominal Adhesions

Surgical procedures that cause abdominal adhesion.Surgical procedures that cause abdominal adhesion.

An abdominal adhesion is usually the result of some form of trauma to the abdomen. Such trauma could result from external injuries or intra-abdominal or pelvic surgery.

In rare cases, abdominal adhesions can be congenital (present at birth) or occur as the result of a non-invasive procedure like radiotherapy.

As well, traits such as a patient’s genetic predisposition to adhesion formation, age, the presence of infection of an operated site, and other factors can also contribute to a patient’s likelihood of developing abdominal adhesions.

In most people, an abdominal adhesion will be caused by one or more of the following: 

The risk of adhesion is higher for open abdominal or pelvic surgery than it is for laparoscopic surgery.

If you have had any of the above listed procedure and suffer with chronic abdominal or pelvic pain, speak with your healthcare provider about the possibility of abdominal adhesion as the cause of your pain. 

Symptoms of Abdominal Adhesion

It is possible to have abdominal adhesions and have no symptoms at all.

In fact, only about one-third of people with adhesion eventually develop symptoms. While pelvic adhesions form 4 to 6 weeks after abdominal trauma or surgery, it can take several months to years before symptoms manifest.

Symptoms of pelvic adhesions can include:

Abdominal Pain

Abdominal pain is the most common symptom of pelvic adhesion.

In a recent study, abdominal or pelvic adhesion were found at laparoscopy in more than 25% of women suffering from chronic pelvic pain. Only 10% of women without chronic abdominal or pelvic pain were found to have abdominal adhesion.

The pain in the abdomen occurs because over time, adhesion bands can develop their own nerve fibres and blood vessels, which cause pain when these nerves are stretched by bowel movements or other factors inside the abdominal cavity. This pain can be sharp and intermittent or dull and more persistent.

Bowel or Intestinal Obstruction

The October 2012 issue of Frontiers in Medicine, reports that adhesive small bowel obstruction is a frequent cause of hospital admission. More recent studies show that postoperative abdominal adhesion is the most common cause of bowel obstruction in the Western world.

Adhesions can spread in a spider web-like formation inside the abdominal cavity and restrict the normal movement of the bowels or intestines, trapping and entangling loops of bowel and causing obstruction. 

Symptoms of bowel obstruction include colicky abdominal pain, feeling bloated, nausea, vomiting and constipation or inability to empty your bowels. Occasionally, the bowel is able to "free" itself from the grip of adhesions and symptoms may resolve on their own.


Infertility can be the result of abdominal adhesion in those who have had a major abdominal operation, who suffer with endometriosis, or who are known to have had an abdominal or pelvic infection like PID, salpingitis, or peritonitis. The bands form by abdominal adhesions an affect the architecture of the abdomen, interfering with the release of eggs from the ovary, or the migration of a fertilized ovum into the fallopian tubes and womb (uterine adhesions).

Pain During Intercourse

Pain during intercourse, also called dyspareunia is another common symptoms resulting from  abdominal adhesions. 

Treatment for Abdominal Adhesion

There is no definite cure for adhesion.

The best available treatment for repair abdominal adhesion is by keyhole surgery or laparoscopy to break and remove pelvic adhesions in a procedure called adhesiolysis.

Many patients report significant improvement in their overall health, as well as a very low incidence of recurrence.

There are risks, however. Since abdominal surgery is one of the primary causes of pelvic adhesions, it is possible for patients who have adhesiolysis to need more procedures in the future, sometimes as often as every two years. This occurs in few than 2 in 10 cases.

Some adhesiolysis surgeons will opt to delay the surgery 12 to 24 hours to inject the abdominal cavity with liquids containing carboxymethylcellulose (CMC), hyaluronic acid, or icodextrin ahead of surgery in hopes of reducing the chances of the abdominal adhesions forming after the corrective surgeries.

Because of the risk and uncertainty of cure with adhesiolysis, it is not a procedure that is recommended for everyone who suffers with symptoms of abdominal adhesion.

The following are conditions in patients that would make them more likely to qualify for surgery for removal of postoperative adhesions:

  • Chronic abdominal or pelvic pain that is affecting their quality of life in home it makes sense to take the added risk of more adhesions forming, as this would probably not worsen their symptoms, but offers a possibility of main control
  • Women with infertility, where adhesion is suspected as a possible cause. 
  • Patients with intestinal obstruction.

Does any of the above describe you? If so, you can look for doctors who specialise in the removal of postoperative intra-abdominal adhesions for a consultation. 

Alternative, NonSurgical Treatments and Prevention Of Abdominal Adhesion

A recent study finds that taking a fish oil supplement may be an effective adjuvant therapy to reduce the development of postsurgical adhesions related to endometriosis. This is according to Fertility and sterility, (25 October 2012, 1556-5653).

Unless patients have congenital adhesions, the formation of adhesions can be controlled, or minimized to some extent, if patients are willing to take certain measures before, during, and after a surgical procedure.

Preventative measures include:

  •  Preemptively assess the likelihood of adhesion in a procedure and take steps to reduce its occurrence
  • Opting for laparoscopic surgery when possible rather than open abdominal or pelvic surgery
  • Avoiding the use of starch- or talc-containing surgical operating gloves
  • Avoiding the use of mesh intra-abdominally, if possible
  • Careful surgery with reduced bowel handling
  • Using carboxymethylcellulose (CMC) and hyaluronic acid intra-operatively inside the abdominal cavity to create viscosity
  • Intra-operative use of antibiotics
  • Preventing bleeding into the bowel, or loss of blood supply for any extended length of time.

Patients who are preparing for abdominal surgery should discuss what measures are being taken to minimize the chance of an abdominal adhesion forming after surgery.


  • Shichao Jiang,  Wei Wang,  Hede Yan, and Cunyi Fan.  Prevention of Intra-Abdominal Adhesion by Bi-Layer Electrospun Membrane. Int J Mol Sci. 2013 June; 14(6): 11861–11870. Published online 2013 June 4. doi:  10.3390/ijms140611861
  • Herington JL,Glore DR,Lucas JA,Osteen KG,Bruner-Tran KL. Dietary fish oil supplementation inhibits formation of endometriosis-associated adhesions in a chimeric mouse model. Fertility and sterility, 25 October 2012, 1556-5653
  • Erhan Aysan et al. New and Simple Approach for Preventing Postoperative Peritoneal Adhesions: Do not Touch the Peritoneum without Viscous Liquid—A Multivariate Analysis. Obstet Gynecol Int. 2012; 2012: 368924. Published online 2012 January 26. doi: 10.1155/2012/368924
  • Liakakos T et al. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg. 2001; 18(4):260-73.
  • Pelvic Pain: Diagnosis and Management. By Fred M. Howard, Paul Perry, James Carter, Ahmed M. El-Minawi (2000).
  • Holmdahl L, et al. Adhesions: pathogenesis and prevention-panel discussion and summary.Eur J Surg Suppl. 1997 ;(577):56-62.
  • Risberg B. Adhesions: preventive strategies.Eur J Surg Suppl. 1997 ;(577):32-9.
  • Matter I, et al. (1997) Does the index operation influence the course and outcome of adhesive intestinal obstruction?Eur J Surg 163(10): 767–72
  • Monk BJ et al. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynecol. 1994 May; 170(5 Pt 1):1396-403.

Last updated on the 25th of February 2018. 

Abdominal Adhesions - Share Your Experience

Do you have a story about abdominal adhesions? Any question or comment? Share it!

Please feel free to contribute your thoughts here if you read postings by others, and you want to say something.

All postings are read by the abdominal pain team, and we shall respond to some queries directly on this page too.

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