Intestinal Adhesions

An adhesion is a band of scar tissue which usually forms after surgery. In some cases, adhesions can cause pain in the abdomen, and in severe cases, the scar tissue can to stick to organs and potentially become very serious. Adhesions are usually formed after surgery as a result of the body’s immune system responding to the procedure. The immune system launches a response whenever tissues are damaged, disturbed or the body is under threat. The immune system response causes inflammation, which prompts the body to start making scar tissue, a band of which is called an adhesion. Scarring is a natural part of the healing process and scar tissue will be produced after any surgical procedure, including key-hole surgery, although this produces much less scarring.

In the majority of cases, scar tissue does not cause any problems, but in others it can contribute to abdominal pain. If it sticks to the bowel or the fallopian tubes in women, it can be very serious and should be treated as a medical emergency.

What causes adhesions?

Adhesions are usually caused by surgery, as scar tissue is produced as a part of the natural healing process. However, there are other possible causes, which include:

• Appendicitis (adhesions are more common if the appendix has ruptured).
• Endometriosis (a gynaecological condition that causes tiny pieces of the womb lining to appear outside of the womb).
• Radiotherapy treatment for cancer.
• Infection, such as gastroenteritis, can cause adhesions.
• Conditions that cause the bowel to become inflamed, such as Crohn’s disease.

Symptoms of adhesions

In some cases, adhesions do not cause any problems but they can contribute to symptoms, including abdominal pain. Abdominal pain can be caused by many different health conditions and may be nothing to worry about, but it is always worth getting checked out, especially if you experience pain or bloating for a prolonged period of time.

How are adhesions diagnosed?

If you experience symptoms of an adhesion or you feel unwell, you should see your GP for a thorough examination. They will also ask you questions about relevant symptoms and your medical history. If your symptoms suggest an adhesion, your doctor will refer you to a specialist (either a colorectal surgeon or a gynaecologist, depending on your symptoms) for further tests. Keyhole surgery may then be carried out to determine whether you have adhesions. Your doctor may also carry out the following tests to see if you have bowel obstruction:

• Physical examination, which will include feeling your abdomen to check for inflammation and tenderness.
• X-ray.
• Checking your heart rate.
• Blood tests (this is to check your white blood cells).
• Taking your temperature.

Complications of adhesions

Adhesions is a condition that can lead to other complications, including bowel obstruction and issues related to fertility, both of which are explored below:

Bowel obstruction

For most people, adhesions are not a problem and they do not cause any symptoms. However, there is a risk of complication and adhesions can be fatal in extreme cases. Bowel obstruction is a complication of adhesions, which occurs when the scar tissue sticks to the bowel. Symptoms of bowel obstruction include:

• Bloating.
• Severe pain, which usually feels like cramp and tends to come and go.
• Inability to pass wind, which causes further discomfort.
• Nausea.
• Constipation.

If you experience these symptoms, you must seek emergency medical treatment. In rare cases, part of the bowel can become twisted around the scar tissue (this is sometimes referred to as strangulation of the bowel), which prevents blood from flowing freely to the bowel. This can be life-threatening and you should call 999 if you experience symptoms such as a high temperature, racing heart rate and a dull ache in the abdomen.

Fertility issues

Adhesions in the fallopian tubes can make it difficult to conceive, so if you have been trying to conceive for at least a year without success, you should consider seeing your GP. However, it is worth taking into account that it can take a while to get pregnant even if you are healthy and having regular intercourse.

Treatment for adhesions

In most cases, adhesions do not cause any problems and no treatment is required. However, treatment will be required if the adhesions starts to cause pain and other symptoms. In most cases, bowel obstructions clear on their own without treatment, but you may be advised to go into hospital for a couple of days so that doctors can monitor your condition. During this time you will be put on a drip and a thin tube may be placed into your nose to release gas and liquid from the bowel. Doctors may advise you to follow a liquid diet or a low fibre diet. If the obstruction does not clear by itself after a few days you may need to have surgery. The only way of treating adhesions is a surgical procedure known as adhesiolysis. However, doctors will only use this procedure if they think the benefits outweigh the risks, seen as it can contribute to further scarring. Adhesiolysis is usually only carried out in an emergency when a patient has bowel strangulation, complete bowel obstruction or when a woman is experiencing fertility problems as a result of scar tissue in the fallopian tubes. Your doctor will discuss all the risks, disadvantages and advantages of surgery, before you have to make a decision on whether or not to go ahead with the procedure. Adhesiolysis is carried out via keyhole surgery now and involves cutting through the scar tissue using very small instruments. Keyhole surgery tends to produce less scarring and the risk of adhesions is lower than traditional open surgery.