What Women Should Know About Prevention and Treatment
Pelvic pain that is chronic and debilitating, and affects your emotional and sexual health...
Infertility that interrupts your plans for a family, your hopes and dreams for the future...
These are two of the major problems that post-surgical pelvic adhesions can cause. Pelvic adhesions are abnormal bands of scar tissue that form in the pelvis and cause organs to stick or bind to one another. Adhesions occur in the majority of women who have pelvic surgery. And yet, many women don't know about adhesions and don't discuss the subject with their doctors before having gynecologic surgery - or afterwards when these problems develop. But you should.
Adhesions are a common and occasionally serious outcome of surgery of all kinds, including common gynecologic procedures such as dilation and curettage, cesarean section, hysterectomy, surgical treatment of endometriosis (a condition in which the uterine lining becomes implanted outside of the uterus), myomectomy (fibroid removal), ovarian surgery and reconstructive tubal surgery. Adhesions that form after surgery in the pelvic area are among the leading causes of post-operative pelvic pain, infertility, and small bowel obstruction.
The incidence of post-operative adhesions can often be reduced and sometimes even prevented. And it is very important to try to prevent adhesions since once they form they tend to recur, even after they are surgically removed. The use of a barrier during surgery such as GYNECARE INTERCEED* to protect raw tissue surfaces as they heal has been shown to be one of the most effective methods of reducing adhesions. Studies demonstrate that GYNECARE INTERCEED barrier significantly enhances good surgical technique and its use reduces adhesion formation by 50% compared to the use of good technique alone.
How do adhesions form?
All of the abdominal and pelvic organs, except the ovaries, are at least partially wrapped in a clear membrane called the peritoneum (per-i-toe-ne-um). When the peritoneum is traumatized during surgery or in some other way, the site of the trauma becomes inflamed. Inflammation is normal and in fact is part of the healing process. But inflammation also contributes to adhesion formation by encouraging the development of fibrous bands of scar tissue (called a fibrin matrix).
Normally, these fibrin bands eventually dissolve through a biochemical process called fibrinolysis (fi-bri-no-li-sis), and the traumatized site continues to heal. But sometimes the nature of the surgery results in decreased blood flow to these areas (a problem called ischemia/is-kee-me-ah), which can suppress fibrinolysis. If the fibrin bands do not dissolve, they may develop into adhesions that grow to connect or bind together pelvic organs or tissues that normally are separate.
How common are adhesions?
Adhesions are a common occurrence after pelvic or abdominal surgery. Adhesions are also common in women who suffer from pelvic inflammatory disease (PID), endometriosis (en-do-me-tree-o-sis), or sexually transmitted diseases. The likelihood that adhesions will form after surgery and what problems may result will vary based on many things - for instance, the type of surgery you are having, the number of previous surgeries you've had, the surgical technique used during the procedure, and your own individual predisposition to adhesion formation.
However, studies have consistently shown that a majority of women who have gynecologic surgery will experience some degree of adhesion formation. For example, in one review of six studies involving patients who had pelvic reconstructive surgery, between 55% and 100% of these patients developed adhesions within six months of surgery - and often adhesions were evident within just a few weeks.
What problems can adhesions cause?
While most adhesions do not cause trouble, adhesions can lead to a variety of potentially serious complications including:
Pelvic pain: Adhesions are a common cause of pelvic pain - an estimated 38 percent of women suffering from pelvic pain have adhesions. Adhesions cause pelvic pain because they bind normally separate organs and tissues together, essentially "tying them down" so that the stretching and pulling of everyday movements can irritate nearby nerves.
Pain during intercourse: Adhesions can also cause pain during intercourse (a condition called dyspareunia/dis-pah-roo-ne-ah).
Infertility: Adhesions that form as a result of certain types of gynecologic surgery, especially tubal surgeries and surgeries to remove fibroids (myomectomies), are a common cause of infertility. Adhesions between the ovaries, fallopian tubes or pelvic walls can block the passage of the ovum (egg) from the ovaries into and through the fallopian tubes. Adhesions around the fallopian tubes can also make it difficult or impossible for sperm to reach the ovum.
Pelvic organ adhesions
Source: Minkin, M.J., MD and Wright, C.V., Ph.D. The Yale Women's Guide to Women's Reproductive Health. Yale University Press. 2003, page 156. ISBN: 0-300-09820-0.
Bowel obstruction: Adhesion formation involving the bowel is particularly common following a hysterectomy. While these adhesions don't normally result in any problems, there is one serious problem that can develop. This problem is called intestinal or bowel obstruction (blockage of the intestine that limits or stops passage of its contents) and it can occur a few days or many years after surgery. Symptoms of bowel obstruction may include pain, nausea, and vomiting.
Adhesions are also a costly medical problem. A recent study found that surgery to remove adhesions (a procedure called adhesiolysis/ad-he-ze-o-li-sis) was responsible for more that 300,000 hospitalizations during one year, primarily for procedures involving the female reproductive system and digestive tract, and accounted for $1.3 billion in hospitalization and surgeon expenditures (Source: Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998; 186:1-9).
Adhesion prevention should be one of the things you discuss with your doctor when preparing for gynecologic surgery. The occurrence of post-operative adhesions can often be reduced and sometimes even prevented. And, it is very important to try to prevent adhesions since, once they form, they tend to recur. Even after adhesions have been removed, they form again about 80 percent of the time. The information in this section will provide you with basic facts and tools to help you understand adhesions and what can be done about them, and will help you talk with your doctor about adhesion prevention and treatment.
