Endo: What are Adhesions?

Many women with endometriosis also have adhesions. You may have heard the term "adhesions," but you might not know exactly what they are or what they do. Well, we're here to help!

WHAT ARE ADHESIONS?

Adhesions are the body's "repair cells" that try to fix internal damage but end up creating more confusion. These "repair cells" can form on the surface of one organ but come into contact with another, creating a band or bands of scar tissue that grow inside the body, sticking two or more organs together. Think of spider webs; they vary in appearance, resembling thin bands of plastic or even thick fibrous bands of tissue. They can also obstruct organs, such as the intestines, ovaries, or fallopian tubes, preventing them from functioning properly. Adhesions can occur anywhere in the body. They have been known to form in joints and eyes and can continue to tighten or grow over time, causing further obstructions, restrictions, and pain (by pulling organs where they shouldn't be or even tugging on nerve endings). Adhesions over the liver can even cause pain during deep breathing.

WHAT CAUSES ADHESIONS?

Adhesions form due to inflammation (such as endometriosis!) or after the body experiences trauma (such as damage caused by chemotherapy, radiation, cancer, infections, surgeries, or other bodily harm). A 2017 study stated that endometriosis and pelvic inflammatory disease are the most common causes of non-surgical adhesions in women. Other causes, in both men and women, can include Crohn's disease, diverticular disease, and abdominal tuberculosis. The same 2017 study also states that 90% of adhesions develop after abdominal surgery. Adhesions commonly form after surgeries near the incision site, but laparoscopic and/or robotic laparoscopic surgeries have been shown to be less prone to adhesion growth due to the surgical interventions. Any internal trauma or damage to the body can start an adhesion growing.

HOW ARE ADHESIONS DIAGNOSED?

Common symptoms of adhesions can be constant bloating, abdominal cramps, constipation or diarrhea, bowel obstruction, nausea, infertility, painful intercourse, or painful defecation. Unfortunately, there are no tests or X-rays that diagnose adhesions. However, ultrasound, CT, or contrast imaging studies can show obstructions or displacements caused by adhesions. It seems that surgery is the only true way to diagnose the presence of adhesions.

HOW CAN WE REMOVE ADHESIONS?

So far, it seems that surgery to remove or detach adhesions is the only "removal" option. Your surgeon might also choose to cover the adhesion site with a barrier medication, hoping to discourage the growth of new adhesions in that particular location. Unfortunately, adhesions almost always reform. Since many do not cause pain or risky obstructions, most adhesions are left alone and not operated on. The risk of regrowth might influence the decision to surgically destroy adhesions.

ARE THERE NON-SURGICAL INTERVENTIONS FOR ADHESIONS?

It seems that surgery is the only option if adhesions cause pain or obstructions/restrictions. But that doesn't mean we can't care for our adhesions. Many women with endometriosis regularly practice stretching and yoga to keep their adhesions "flexible," so to speak. There's the Wurn Technique, which has provided relief to many people from the pain caused by adhesions. Maintaining adequate fiber intake can help with constipation. Muscle relaxants can be helpful if you suffer from abdominal cramps related to adhesions. Every person is different, as are their adhesions. Only you know your body, and only you know how or if you can stretch.

HOW CAN WE PREVENT ADHESIONS?

There isn't a definitive way. Adhesions can form because of our disease, arthritis, surgeries, or a multitude of other reasons. Many women rely on serrapeptase or wobenzym (a supplement) to prevent and/or keep adhesion growth under control. If you decide to try these supplements, please do your research and have an in-depth conversation with your doctor.

1. Abdominal Adhesions: Current and Novel Therapies
   Ward, B. C., & Panitch, A. (2011). ScienceDirect. This article discusses the development of adhesions after abdominal surgery and their implications, including chronic pelvic pain and infertility.
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2. Post-Operative Adhesions: A Comprehensive Review of Mechanisms and Prevention
   Hwang, A. F., Zhang, A. N., & DeWitt, J. F. (2021). MDPI. This comprehensive review summarizes the mechanisms of post-surgical adhesion formation and discusses potential prevention strategies.
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3. Adhesion: MedlinePlus Medical Encyclopedia
   This entry provides an overview of adhesions, including causes, symptoms, and treatment options, as well as references to further reading in medical literature.
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4. Bowel Adhesions
   This book chapter discusses the pathophysiology, evaluation, and management strategies for bowel adhesions, highlighting their clinical significance and complications.
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5. Abdominal Adhesions: Current and Novel Therapies
   This article from PubMed reviews the clinical burden posed by abdominal adhesions and discusses various therapeutic approaches to manage them.
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6. Adhesions Overview
   WebMD provides a general overview of adhesions, including their causes, symptoms, and implications following surgery.
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7. Adhesions - Guts UK
   This factsheet offers insights into the nature of adhesions, their causes, symptoms, and treatment options related to gastrointestinal health.
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8. Abdominal Adhesions - Great Ormond Street Hospital
   This resource explains what abdominal adhesions are, their causes, symptoms, diagnosis methods, and treatment options for affected patients.
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