The connection between adhesions and endometriosis: What you need to know about scar tissue.

Adhesions are bands of scar tissue that can form in the pelvis, connecting internal body surfaces that should remain separate, such as attaching the uterus to the bowel. They develop as a result of the body's natural healing process, often triggered by inflammation. This is why adhesions often accompany conditions that are inflammatory in nature like endometriosis, Crohn’s disease, PID, or diverticulitis. Surgery can lead to the formation of adhesions as the body goes through a process of healing itself, although the risk is lower with laparoscopic procedures compared to open surgery. While many individuals don’t know they have adhesions, and go unnoticed, they can cause problems for some, depending on their location and quantity.

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Adhesions can bring about pain, caused by restricted organ motion, nerve involvement, or adhesions themselves generating pain stimuli.(1) This can be quite severe for some people. Adhesions on the bowel can impede normal functioning, causing obstructions that constrain movement and interfere with peristalsis, resulting in various gastrointestinal symptoms. Adhesions affecting the bladder can result in urinary problems whilst adhesions involving the ovaries or blocking the fallopian tubes can contribute to fertility issues in some cases.

If doctors suspect adhesions are causing your symptoms, they may conduct a physical examination or order medical imaging, such as an MRI, to identify any obstructions. However, traditionally the only definitive way to diagnose adhesions is through surgery. Many individuals with endometriosis are unaware of the presence of adhesions, however during surgery, your surgeon will remove any scar tissue found in the pelvis, offering the best chance for a healthy recovery and symptom relief. By removing adhesions, the affected organs can regain their normal functionality, potentially improving overall well-being. 

Adhesions are typically removed through a surgical procedure called adhesiolysis. The success of this operation depends on the location and connections of the scar tissue. Unfortunately, there is a risk of adhesions re-forming after surgery. Hence, your doctor might suggest alternative non-surgical options as a first-line approach if the surgery is just to treat adhesions — considering that every operation carries a risk of new adhesions forming.

1. Sulaiman H, Gabella G, Davis MSc C, et al. Presence and distribution of sensory nerve fibers in human peritoneal adhesions. Ann Surg. 2001;234(2):256-261. doi:10.1097/00000658-200108000-00016