Pelvic Adhesions

What are pelvic adhesions?

Pelvic adhesions are bands of scar tissue that occur between organs inside the abdomen and pelvis.

Pelvic adhesions may affect any organs in or near the pelvis, including;

  • Uterus
  • Ovaries
  • Fallopian tubes
  • Bladder
  • Intestines

The problem with adhesions is that they can cause internal organs to become stuck together, possibly affecting their normal movement and causing pelvic pain.

Adhesions can also cause infertility by blocking the fallopian tubes or arising within the uterus (intrauterine adhesions).

What causes pelvic adhesions?

Pelvic adhesions may be caused by a number of factors, but previous pelvic surgery or infection are the most common causes. Pelvic inflammatory disease, which is a complication of certain urogenital infections, often leads to adhesions in the fallopian tubes. Pelvic adhesions may also occur with severe cases of endometriosis.

How can pelvic adhesions cause infertility?

Adhesions can cause infertility if they block the fallopian tubes (the tubes through which eggs pass from the ovaries to the uterus) or if they trap fertilized eggs in the fallopian tubes causing an ectopic pregnancy. If adhesions occur within the uterus they can cause the inside of the uterus to stick together and prevent implantation of a fertilized egg.

How are pelvic adhesions diagnosed?

Diagnosis of pelvic adhesions is often not straightforward or obvious. Non-invasive investigations such as ultrasound, MRI or CT, often do not reveal their presence.

In order to diagnose adhesions, your gynaecologist will first take a full history and perform a pelvic examination. This may be followed by laparoscopy, which is the gold-standard investigation to determine the location and severity of the adhesions.

If the problem is thought to be confined to the uterus (intrauterine adhesions) a hysteroscopy may be sufficient.

What are the treatments for adhesions?

When adhesions cause pain or other health problems that affect a woman’s life, they can be removed through laparoscopic surgery. This approach is far superior to open abdominal surgery as it associated with less adhesion formation, as less tissue is handled directly.

Other benefits of laparoscopic surgery include:

  • Faster recovery
  • Less pain
  • Shorter hospital stay and earlier return to normal activities

Every woman is individual and her situation requires an individual management plan.

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