Definition: In the process of repair of injured tissue, a series of normal healing events may cause some structures in the pelvis to become unintentionally ‘stuck’ to another tissue or structure. Pelvic adhesions cause many problems for millions of women, ranging from obstructed tubes associated with infertility, pelvic tenderness and painful intercourse, to chronic pelvic pain. Curiously, adhesions can be very extensive, yet relatively silent. They may remain silent indefinitely, or long after the causative event, become symptomatic.
The causes of adhesions are multiple but basically the tissue irritation that produces the adhesive process arises from an inflammatory event, or from trauma (e.g. post-surgical). Examples of an inflammatory event would be a tubal infection from a sexually transmitted disease (e.g. Gonorrhea), a post-surgery infection, or appendicitis. Chronic ‘irritation’ of the pelvic tissues from a common disease process such as endometriosis, may also incite adhesions. A very significant proportion of symptomatic pelvic adhesive disease arises from previous pelvic surgery.
Does everybody develop adhesions? No they do not, but it is not understood why one person develops very extensive adhesions, and the next individual none at all. The nature of the traumatic tissue event, the duration of the inflammatory insult, the nature of the preceding surgery, the operative technique of the surgeon, and the unknown healing characteristics of a given individual all interplay in the final outcome.
Prevention: What can be done to minimize pelvic adhesions from forming? Early treatment of an infectious process if identified, utilization of safe sexual practices to minimize the transmission of sexually transmitted disease, meticulous surgical technique to minimize unnecessary tissue trauma, and perhaps using barrier products where appropriate. The latter may be helpful in reducing the extent or severity of the post-operative adhesion development.
Pain is the main symptom which may vary from a dull, low intensity ache to severe
Diagnosis: Done with proper history and physical examination of the patient. Ultrasonography may help visualise and diagnose pelvic adhesions. Laparoscopy may be used to visualize the intra-abdominal organs and adhesions and correct them in the same sitting.
If pelvic adhesions are mild i.e. only symptom is mild pain then they can be treated with pain killers. In an infertile patient or in a patient with other symptoms laparoscopic removal of adhesions (adhesiolysis) is the most reliable procedure rather than major surgery (laparotomy) which should be avoided as it may again lead to adhesions with laparotomy scar.