Surgical Adhesions from Gynecologic Surgery

• Pelvic pain: One study found that 82 percent of 224 patients suffering from chronic abdominal pain had adhesions and no other disease. Other studies find that adhesions are the most common reason for chronic pelvic pain in women. This pain occurs because adhesions bind together normally separate organs and tissues. As you move throughout the day, these tissues stretch, affecting nearby nerves and causing pain.
• Pain during intercourse: Adhesions can also cause pain during intercourse (a condition called dyspareunia).
• 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 prevent an egg from the ovaries from getting into and through the fallopian tubes. Adhesions around the fallopian tubes may make it difficult or impossible for sperm to reach the egg. One study found adhesions in 37 percent of 733 infertile women; in 41 of these women, adhesions were the only reason for their infertility. Overall, some experts suspect that pelvic adhesions may be responsible for up to 40 percent of infertility.
• Bowel obstruction: Adhesions are one of the leading causes of intestinal blockages, responsible for 30 to 60 percent of all cases. Such obstruction limits or stops passage of feces through the intestines, leading to pain, nausea and vomiting, possibly resulting in infection and additional surgery.

Adhesions can also make other abdominal surgeries longer and more challenging. For instance, they may make it impossible to perform a laparoscopic procedure, meaning you must undergo an open abdominal incision, which typically has a greater risk of complications and pain and requires a longer recovery time.

All surgeons know about the risks of adhesions, so they try their best to reduce this risk. The most important thing they can do is limit any injury of the peritoneum, the membrane that covers the inside of the abdomen. Surgeons can also reduce the risk of adhesions by: