Pelvic adhesions are bands of scar tissue that develop between two parts of pelvic tissue or organs that are not normally supposed to join together. Pelvic adhesions appear as thin sheets of tissue but may grow into thick, fibrous bands over time. It can form anywhere in the pelvis and abdomen between tissues or organs, including:
- Ovaries and fallopian tubes
- Outside the uterus
The location of pain entirely depends upon the location of adhesion. Mostly the pain is limited to the lower abdomen and pelvis. It is tugging and stabbing in character and is aggravated with movement and exertion.
Symptoms of pelvic adhesions
- Pain in pelvis
- Pain during sexual intercourse
- Obstruction of bowel and constipation
- Urinary bladder dysfunction
- Pain on stretching and exertion
- Mood and emotional disorders
- Intermenstrual bleeding
Causes of pelvic adhesions
Pelvic adhesions form when the scar due to any sort of inflammation starts to heal. Deposition of fibrous tissue takes place to complete the healing process of the scar. This fibrous tissue can sometimes form between adjacent structures, binding them together via bands of these fibrous tissues. The adhesions mostly develop after a surgical process that involved scar or any inflammatory cause, such as given:
- C-section scar
- Dilatation and curettage after miscarriage
- Inflammatory disease of the pelvis
- After endometriosis
- After radiation exposure as it may lead to inflammation.
Following women are at risk of developing pelvic adhesions:
- Women who undergo any pelvic surgery
- Who have endometriosis
- Pelvic inflammatory disease
- Healed ovarian cyst
- Undergo radiation procedure
- Who had dilatation and curettage
Complications of pelvic adhesions
Pelvic adhesions may give rise to a lot of complications that are:
- Chronic pain syndrome
- Ovarian torsion
- Chronic inflammation
- Hemorrhage due to tugging
- Diagnosis is made based on the history of the patient’s symptoms and a detailed Pelvic examination by an experienced doctor.
- Several imaging facilities like MRI and CT scans are of no use in the diagnosis of pelvic adhesions.
- Laparoscopy is a definite but invasive procedure that can diagnose adhesions properly.
- Hysteroscopy is used to find out any sort of blockage in fallopian tubes due to the formation of adhesions.
Management of pelvic adhesions
Management depends upon the location, extent of adhesions, and complications caused by these:
- Over-the-counter pain killers like ibuprofen and acetaminophen decrease the pain.
- Iron supplements if there is anemia.
- Adhesiolysis is the technique that includes cutting and releasing the adhesions. It is done by two methods; laparoscopic and open adhesiolysis.
- Laparoscopy is done to visualize and confirm the existence of adhesions and treat them using a scope.
- Open adhesiolysis involves the same procedure but a larger incision is made and the surgeon directly sees the adhesions and treats them.
- Adjuvant treatments like intercoat can be used to prevent the formation of adhesions after adhesiolysis.
- For the pain, a hot water bottle on the abdomen can help.
- Inflammation can be relieved by sitting in a warm bath.
- Massage techniques and physical therapy can break up the scar tissue and decrease the pain.
- Myofascial release is a technique employed for soft tissue mobilization that breaks up the scar tissue that is present just under your skin.
- Stay stress-free.
- Aromatherapy is also a very good option for relaxation.
When to consult a doctor?
If the pain has aggravated lately and you have excessive dyspareunia or an increase in severity of other symptoms you should consult your doctor immediately.
Can I get pregnant with pelvic adhesions?
Yes, but it entirely depends upon the placement of adhesions. If you are fallopian tubes are blocked it will become difficult for you to conceive naturally and will require assistance from a fertility specialist.
Do pelvic adhesions go away?
No, pelvic adhesions do not go away with time and require a surgical process for their removal.
Is physiotherapy helpful for pelvic adhesion?
Yes, physical therapy can be employed to break up the scar tissues that are present just under your skin.