Abdominal Adhesions - 
Causes, Diagnosis And Treatment

Apart from causing organs or bowels stick to one another, pelvic adhesions are one of the most common causes of chronic abdominal pain and infertility adhesions can cause dangerous bowel obstruction if it twists around the bowel in a condition known as strangulation.

Strangulation cuts off the blood supply to the bowel and requires surgery to repair. Strangulation is a serious problem, and can result in death in up to 37% of cases.

What Are The Causes of Abdominal Adhesions?

Abdominal adhesions are the result of excessive scar tissue forming as part of the normal healing process after any form of injury within the abdomen. This may include infections, Caesarean sections, appendicitis (and subsequent surgery to remove the appendix), or other conditions affecting the lower pelvis.

When abdominal adhesions occur, scar tissues lengthen and web inside the abdomen, leading to the formation of hard fibrous bands upon which the bowels could strangulate themselves, or stick, causing a kink or outright blockade of their lumen.

The most common causes of abdominal adhesions are:

Post-Surgical Abdominal Adhesions

It is common for abdominal adhesions to form after undergoing any type of pelvic surgery. The surgery itself can be a success, and a patient can heal without incident. In some cases, however, excessive scar tissue forms, either as the result of having the surgery (tissue damage, excessive tissue handling, use of gloves or chemical agents during the surgery that stimulate excessive scar tissue) or simply due to a patient having a genetic predisposition to scarring.

Studies estimate that anywhere from 75% to 93% of patients undergoing any form of abdominal surgery would develop adhesions. 

Common surgical procedures that cause abdominal adhesions include:

• Appendicectomy
• Hysterectomy
• Caesarean section
• Gallbladder surgery (Cholecystectomy)
• Bowel surgery
• Kidney surgery
• Pancreatic surgery

Patients who experience abdominal pain, bloating, bleeding, or cramping in the weeks following any of these procedures may be demonstrating symptoms of pelvic adhesions. 

Endometriosis

Endometriosis is a condition whereby the normal lining of the womb is also found outside the womb as well. Endometriosis is a very common cause of abdominal pain, and it is believed that more than 15% of women with chronic abdominal pain, heavy menstrual flow, or deep-seated pelvic pain during intercourse could be suffering from endometriosis.

Endometriosis leads to the formation of scar tissues and fibrous bands as well, causing abdominal and or pelvic adhesions.

Abdominal Infection

Abdominal infections such as peritonitis can also be a cause of abdominal adhesions. Peritonitis is an infection inside the abdominal cavity. After such an infection, the body normally heals by clearing any pus or bleeding that formed during the infection.

Scar tissue and fibrous bands may also form during the healing process, leading to adhesions. Infections that could lead to abdominal adhesions include:

• Peritonitis
• Ruptured appendicitis
• Ruptured infected gallbladder
• Caecitis
• Typhoid infection

Massive Bleed Into Abdomen

Massive bleeds in the abdomen are often the result of trauma, for instance, a car accident where the liver or spleen is ruptured, causing internal bleeding. Bleeding into the abdomen could also follow a ruptured abdominal aortic aneurysm or ruptured ectopic pregnancy.

As the blood is cleared in any of the above conditions, scar tissue forms and adhesions can develop to cause chronic abdominal pain in the future. 

Radiotherapy

Radiotherapy is the use of x-ray energy in the treatment of certain conditions, especially cancer.

After extensive treatment with radiotherapy, good tissues could be damaged in addition to the bad tissue for which the treatment was intended. During the normal healing process, scar tissues could form, causing abdominal adhesions.

Congenital Adhesions

Abdominal adhesions can also be present at birth. People who are genetically predisposed to scarring can have congenital adhesions.

Symptoms of Abdominal Adhesions

The symptoms of abdominal adhesions could mimic those of other conditions like irritable bowel syndrome, trapped wind, constipation, or celiac disease. Typically the key indicator that a person may be suffering from something more than a common digestive ailment is persistence and having experienced one of the six causes for abdominal adhesions mentioned in the previous section. For anyone who has experienced one of the common causes of abdominal adhesions, he or she should consult their doctor if they also experience one of the following:

• Abdominal pain
• Bloating and distension
• Inability to open your bowel
• Passage of very little or no flatus
• Nausea or vomiting

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.

If you have suffered with an abdominal adhesion in the past, please help the other members of this community by offering your valuable advice and insights. 

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