Endometriosis is a painful and chronic condition that affects more than 11 percent of women of child-bearing age in the U.S. It is caused by the growth of endometrial-like tissue outside the uterus, in the pelvis or abdomen. Endometrial growths, or lesions, cause inflammation. In some cases, that inflammation can occur on the ovaries, fallopian tubes, bladder, intensitines, the outside of the uterus, the lining of the pelvis, and other organs.

What Are Adhesions?

Adhesions are fibrous bands of scar tissue. When they form inside the pelvic cavity, they are called pelvic adhesions. When they form in the abdominal cavity, they are called abdominal adhesions. These bands of scar tissue cause organs to stick to each other and to the peritoneum — the lining of the pelvis and abdomen.

Endometrial adhesions can cause chronic pelvic pain. However, they can also distort the normal anatomy of the pelvis and abdomen and impair organ function. When endometrial adhesions occur on the ovaries, fallopian tubes, or uterus, infertility can result. Another severe condition can be bowel obstruction.

What Causes Endometrial Adhesions?

Adhesions may be caused by inflammation or surgery. In particular, adhesions that form due to endometriosis may occur as a result of localized inflammation where endometrial lesions occur. Other chronic conditions related to endometriosis that produce inflammation, such as Crohn’s disease and pelvic inflammatory disease, can also cause adhesions.

Adhesions can also form after surgery to diagnose and treat endometriosis. Excision of lesions, as well as hysterectomy and oophorectomy, can all lead to pelvic adhesions.

There are two general types of pelvic and abdominal surgeries: open surgery (laparotomy) and laparoscopy. Open surgery involves making a large incision (cut) to expose the contents of the abdomen or pelvis. Laparoscopy involves making very small incisions into the belly so that a small camera and long surgical instruments can be used to perform minimally invasive surgery.

Studies have shown adhesions occur in as many as 95 percent of open surgeries and as few as 5 percent of laparoscopic surgeries.

Signs and Symptoms of Adhesions

Most people with adhesions never experience any symptoms at all. When people do experience symptoms, the most common is chronic pelvic pain. Many symptoms of adhesions are the same as those of endometriosis. Like other endometrial symptoms, they can be either mild or severe.

Symptoms include:

• Chronic pelvic or abdominal pain
• Difficulty getting pregnant (infertility)
• Pain during sexual intercourse (dyspareunia)
• Bloating
• Nausea
• Abdominal cramps
• Changes in bowel habits (constipation, diarrhea, or pain)

Adhesions can cause partial or complete blockages of the small and large intestines. Symptoms of bowel obstruction include:

• Cramping and severe abdominal pain
• Nausea and vomiting, sometimes with green or yellow bile
• Constipation and diarrhea
• Blood in the stool
• Inability to pass gas
• Bloating
• Abdominal distention (firm swelling of the belly)
• Fever
• Lethargy

Symptoms of bowel obstruction require immediate medical evaluation and may require emergency treatment, including surgery.

Treating Adhesions

Many people with adhesions do not experience symptoms that affect their quality of life, so no treatment is required. Some nonsurgical interventions can help treat milder symptoms, and surgery may be recommended for adhesions which cause pain or interfere with organ function. Adhesions which block the intestines will require immediate medical attention If you are experiencing symptoms from endometrial adhesions, talk to your doctor about the best treatment option for you.

Nonsurgical Treatments

Several treatments can improve symptoms of adhesions. Managing pain is the primary goal of most nonsurgical interventions. Chronic pain due to adhesions is typically treated the same way as other types of chronic pain related to endometriosis. Here are some nonsurgical treatments that can help.

Medication

Both over-the-counter and prescription pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) — including ibuprofen, acetaminophen, and opioids (for severe pain) — can be effective to control pain. Antidepressants can also help treat chronic pain.

Acupuncture

Acupuncture is the traditional Chinese medicine method of placing small needles in precise locations in the skin. It may also be an effective way to find pain relief.

Physical Therapy

Physical therapy and exercise are also recommended to help relieve pain due to adhesions. Soft tissue mobilization is a physical therapy technique that uses manual manipulation of the abdomen, somewhat similar to massage, to increase the mobility of scar tissue. Soft tissue mobilization may improve symptoms of adhesions, and some studies suggest it may treat partial bowel obstruction due to adhesions.

Diet

For some people, constipation due to partial bowel obstruction can be relieved by eating a liquid diet or low-residue diet that is low in soluble and insoluble fiber. Always talk to your doctor before making any changes to your diet.

Surgery

Adhesiolysis (adhesion removal surgery) is the primary treatment for adhesions that cause symptoms. Your doctor may prefer to use laparoscopic surgery instead of open surgery to reduce the risk of new adhesions developing from the surgery itself.

A recent development in surgical technique is the use of thin sheets of absorbable barrier material between damaged surfaces in the abdominal or pelvic cavity. These sheets may help prevent new adhesions from forming. Despite careful surgical technique, however, surgery to treat adhesions can still sometimes cause more adhesions to develop.

Stay Persistent

You don’t need to resign yourself to a life of pain. Seek out health care providers who have experience treating endometriosis, and don’t stop advocating for your health until you find the quality of life you need and the pain relief you deserve. Know that there is no single treatment that works for everyone — you may need to try a variety of methods to find out what works for you and your symptoms.

Talk With Others Who Understand

Dealing with endometriosis is challenging, and adding the complication of adhesions can make it even more difficult. Hope is out there, but sometimes it can be hard to find. Tap into that hope on MyEndometriosisTeam, the social network for people with endometriosis and their loved ones.

Alongside more than 122,000 other members asking questions, giving advice, and sharing their stories, you will find a supportive community with others who understand life with endometriosis.

How about you? Have you been treated for adhesions? Have you found a successful — or unsuccessful — approach to dealing with them? Share your experience in the comments below, or start a conversation by posting on MyEndometriosisTeam.