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Adhesion

Adhesions are bands of scar-like tissue that form between two surfaces inside the body and cause them to stick together.

Alternative Names

Pelvic adhesion; Intraperitoneal adhesion; Intrauterine adhesion

Causes

As the body moves, tissues or organs inside are normally able to shift around each other. This is because these tissues have slippery surfaces. Inflammation (swelling), surgery, or injury can cause adhesions to form and prevent this movement. Adhesions can occur almost anywhere in the body, including:

  • Joints, such as the shoulder
  • Eyes
  • Inside the abdomen or pelvis

Adhesions can become larger or tighter over time. Problems may occur if the adhesions cause an organ or body part to:

  • Twist
  • Pull out of position
  • Be unable to move normally

The risk of forming adhesions is high after bowel or female organ surgeries. Surgery using a laparoscope is less likely to cause adhesions than open surgery.

Other causes of adhesions in the abdomen or pelvis include:

  • Appendicitis , most often when the appendix breaks open (ruptures)
  • Cancer
  • Endometriosis
  • Infections in the abdomen and pelvis
  • Radiation treatment

Adhesions around the joints may occur:

  • After surgery or trauma
  • With certain types of arthritis
  • With overuse of a joint or tendon

Symptoms

Adhesions in joints, tendons, or ligaments make it harder to move the joint. They may also cause pain.

Adhesions in the belly (abdomen) may cause a blockage of the intestines . Symptoms include:

  • Bloating or swelling of your belly
  • Constipation
  • Nausea and vomiting
  • No longer being able to pass gas
  • Pain in the belly that is severe and crampy

Adhesions in the pelvis may cause chronic or long-term pelvic pain.

Exams and Tests

Most of the time, the adhesions cannot be seen using x-rays or imaging tests.

  • Hysterosalpingography may help diagnose adhesions inside the uterus or Fallopian tubes.
  • X-rays of the abdomen, barium contrast studies, and CT scans may help diagnose a blockage of the intestines caused by adhesions.
Endoscopy (a way of looking inside the body using a flexible tube that has a small camera on the end) may help diagnose adhesions:
  • Hysteroscopy looks inside the uterus
  • Laparoscopy looks inside the abdomen and pelvis

Treatment

Surgery may be done to separate the adhesions. This can let the organ regain normal movement and reduce symptoms. However, the risk for more adhesions goes up with more surgeries.

Depending on the location of the adhesions, a barrier may be placed at the time of surgery to help reduce the chance of the adhesions returning.

Outlook (Prognosis)

The outcome is good in most cases.

Possible Complications

Adhesions can cause various disorders, depending on the tissues affected.

  • In the eye, adhesion of the iris to the lens can lead to glaucoma .
  • In the intestines, adhesions can cause partial or complete bowel obstruction .
  • Adhesions inside the uterine cavity, called Asherman syndrome , can cause a woman to have irregular menstrual cycles and be unable to get pregnant.
  • Pelvic adhesions that involve scarring of the fallopian tubes can lead to infertility and reproductive problems.
  • Abdominal and pelvic adhesions can cause chronic pain.

When to Contact a Medical Professional

Call your health care provider if you have:

  • Abdominal pain
  • An inability to pass gas
  • Nausea and vomiting that do not go away
  • Pain in the belly that is severe and crampy

References

Munireddy S, Kavalukas SL, Barbul A. Intra-abdominal healing: gastrointestinal tract and adhesions. Surg Clin N Am. 2010;90:1227-1236.

Kulaylat MN, Dayton, MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 13.

Paine R. Rehabilitation and therapeutic modalities: a language of exercise and rehabilitation. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 5 section A.

Updated: 2/24/2014

Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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