Pelvic Adhesions and C-Sections

Pelvic Adhesions and C-Section

While current day gynecologic surgeries are often routine, safe and effective, unfortunately many patients find pelvic adhesions one of the less positive results of such procedures. Predicting who is prone to adhesions, or the likelihood of one developing after a procedure, is far from an exact science, so it is imperative that the possibility is discussed with your doctor prior to your surgery. Here’s what you should know before your surgery or c-section, as well as some preventative tips and products so that pelvic adhesion doesn’t inhibit your otherwise routine post-surgery recovery.

What Are Adhesions?

Adhesions are bands or sheets of scar tissue that bind organs or tissues that are typically separated. They are often the result of surgery in the pelvic area, right where the reproductive organs are housed, including the uterus, ovaries and fallopian tubes. Adhesions can cause a variety of serious complications, such as postoperative pelvic pain, small bowel obstruction, and even infertility. While the gravity of these risks should not be overlooked, your doctor may be able to greatly reduce the risk of their occurrence with proper awareness and preventative measures.

How Common Are Adhesions?

Adhesions are fairly common, especially after pelvic or abdominal surgery, but they can also occur in women who suffer from pelvic inflammatory disease (PID), endometriosis, or certain sexually transmitted diseases. The chances of adhesion development, as well as the consequences thereof, are determined by a multitude of possible factors, including type of surgery, number of previous surgeries, surgical technique and individual patient predisposition. Studies across the board show that many women who undergo pelvic surgery will experience some degree of adhesion formation. One evaluation of multiple studies of women who underwent pelvic surgery found that adhesions develop within 5-7 days, while diagnosis or clinical issues may arise within 6 months.

Did you know? 55 – 100% of women develop adhesions following reproductive pelvic surgery, whether open or laparoscopic.

How Do Adhesions Form?

Aside from the ovaries, all the abdominal and pelvic organs are at least partially wrapped in a clear membrane called the peritoneum. Any surgery within the peritoneum, no matter how carefully performed, causes a degree of inflammation to the tissue. Inflammation is a normal part of the healing process, but it also contributes to adhesion formation by encouraging the development of band of scar tissue.

What Problems Can Adhesions Cause?

Pelvic Pain: Adhesions are commonly associated with pelvic pain. That’s because they bind organs and tissues together, essentially “tying them down,” so that the stretching and pulling of everyday movements can irritate the surrounding nerves. Adhesions can also cause pain during intercourse.

Infertility: Adhesions resulting from certain types of pelvic surgery, especially ovarian and tubal surgeries, are a common cause of infertility. Adhesions involving the ovaries or fallopian tubes can block the passage of the ovum, or egg, from the ovaries into and through the fallopian tubes. Adhesions around the fallopian tubes can also interfere with tube transport to the ovum, increasing the risk of tubal pregnancies.

Bowel Obstruction: Bowel or intestinal obstruction is one of the serious conditions that can develop as a result of adhesion. It can occur anywhere between a few days or many years after surgery. Symptoms of bowel obstruction can include pain, nausea and vomiting. Adhesion formation involving the bowel is particularly common following a hysterectomy.

What surgical procedures are likely to cause adhesions?

Caesarean Section: these adhesions typically do not cause pain. They can sometimes make subsequent caesarean sections more difficult, however, because the physician must cut through these adhesions to reach the uterus and the baby. This can increase the duration of the procedure and the amount of time the mother and baby are under anesthesia. Adhesions also increase the risk of damaging surrounding organs such as the bladder.

Ovarian Surgery: Adhesions commonly form on and around the ovaries. Adhesion formation after ovarian surgery can lead to pelvic pain and infertility.

Surgical Treatment of Endometriosis: Endometriosis is a condition in which patches of cells similar to the ones in the uterine lining become implanted outside the uterus, usually on the ovaries, bladder or fallopian tubes. Both endometriosis and the surgical treatment thereof can lead to adhesions, and when those adhesions are surgically removed, new ones can form.

Myomectomy: Myomectomy is surgery to remove fibroid tumours from the uterus. Adhesions may form at the incision line, and can involve the ovaries and fallopian tubes, potentially causing infertility and pelvic pain.

Reconstructive Tubal Surgery: The repair of blocked fallopian tubes is a delicate procedure that often includes the removal of existing adhesions. Unfortunately, the surgery itself can lead to the formation of new adhesions and associate complication such as pelvic floor pain and infertility.

Hysterectomy: Hysterectomy is a procedure in which the uterus is removed. Removal of one or both ovaries (oophorectomy) is sometimes performed simultaneously. After surgical removal of the uterus, adhesions may form involving the small intestine, causing pelvic pain, constipation, and sometimes the more serious complication of bowel obstruction (blockage of the intestine). Bowel obstruction may occur shortly after surgery, or sometimes only years later.

Removing adhesions: Adhesiolysis is the surgical procedure to remove adhesions resulting from prior pelvic procedures. This surgery removes the scar tissue binding the organs together so that they are separate once again. Unfortunately, adhesion formation can be a vicious cycle, and this procedure usually results in further adhesion development. Studies show that adhesions reoccur as a result of adhesiolysis in 76%of cases.

How Are Adhesions Diagnosed?

To determine whether adhesions are the cause of pelvic pain or fertility problems, your doctor may perform a laparoscopy. This is an exploratory procedure using a narrow lighted telescope, or laparoscope, which is inserted through a small incision in the belly button.

How Are Adhesions Treated?

The only way to treat adhesions is to remove or separate them surgically. Studies have shown that patients with pelvic pain and sever adhesions can experience marked reduction in symptoms after adhesiolysis. Unfortunately, this very surgery to treat existing adhesions often results in their reoccurance, with 3 out of 4 women experiencing a resurgence after adhesiolysis surgery. Talk to your doctor about what can be done to prevent adhesions, regardless of the type of surgery you are anticipating.

What Can Be Done to Prevent Adhesions?

Meticulous surgical technique can help minimize trauma, bleeding and the interference with the blood supply, as well as prevent the introduction of foreign bodies, lessen the incidence of raw surfaces and decrease the incidence of infection, all of which help reduce adhesion development.

Lactated Ringer’s Solution is sometimes used to keep tissues and organs separate, however, clinical studies have shown that the solution is ineffective in reducing pelvic adhesions.

Barriers applied during surgery physically separate raw tissue surfaces so they don’t bind while healing. Thin tissue-like fabric barriers may be used to reduce adhesion formation at specific sites.

More and more surgeons are using adhesion prevention products to help make sure their patients receive the best possible care. Your surgeon has choices in adhesion prevention products that can be applied during your surgery. Your type of surgery will help determine which adhesion prevention product is best for you.

Solid information is your strongest ally in the fight against adhesions. Your doctor or surgeon will be glad to answer any questions you may have about adhesions and their prevention. Knowing the basics about adhesions can help you do everything you can to reduce the risk of this common and sometimes serious problem. Your doctor will be able to go into more detail about any aspect of adhesions that concerns you.

If you have any questions about adhesions and what you can do to prevent them, contact us by emailing and we will gladly provide you with further information.

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