Pelvic Adhesions (scar tissue)
Adhesions are bands of scar tissue that can cause internal organs to be stuck together when they are not supposed to be. Most often, adhesions are the result of previous surgery, but some can occur following pelvic infection, and many times they accompany more severe stages of endometriosis. When adhesions are dense, or restrict the normal movements of internal organs like the bowels, pain can result. Uncommonly, adhesions can cause blockage of the bowels (intestinal obstruction).
Adhesions, when they are involved in causing pain, are usually present along with some other disease process that can cause pain, such as irritable bowel syndrome (IBS) or endometriosis. They may signal their presence by aggravating the symptoms of IBS or by causing pain during sexual intercourse. Unfortunately, diagnosing the presence of pelvic adhesions is difficult. Except in extreme cases, an examining physician cannot feel them during a pelvic examination, and tests like ultrasound, MRI scans, and CT scans do not detect them very often. This means that a thorough history and a pelvic examination by a physician experienced in evaluating pain problems are the best tools for detecting their presence.
When it seems likely that adhesions may be important, then a laparoscopy can be done to see them, and the adhesions can often be removed during the same laparoscopic procedure. There are several cautions here.
First, laparoscopic treatment of adhesions is most safely and effectively done by laparoscopic surgeons specially trained and experienced in performing this type of surgery. Except in rare cases, it is not thought to be useful to perform a laparotomy (large open incision) in order to treat adhesions, because they much more often re-grow after open surgery.
Second, just because adhesions are present doesn’t mean they are the cause of pain! It often takes the clinical experience of physicians trained in the evaluation of pain to know when surgical treatment of adhesions is likely to be helpful, and when it is not. When surgery for adhesions is done, it works best when combined with an overall approach to all the components of an individual pain.
In the Pelvic Pain Clinic at UNC, the staff have over 20 years of experience as a referral center in evaluating chronic pelvic pain, and in performing high level laparoscopic surgery for adhesive disease. Our safety record in these cases is unmatched in the state. We combine surgical treatment with multiple other avenues of pain management and treatment, such as physical therapy, diet and exercise, stress reduction techniques, counseling, and medication management.