Adhesions are abnormal bands of scar tissue that join organs or organ parts together even though they aren’t normally meant to be joined. This condition affects many women in Australia and may occur due to an infection, previous surgery, or disease.
Adhesions may lead to infertility by interfering with the ovulation process, preventing the sperm and egg from meeting, and making it difficult for the uterus to accommodate the fertilised embryo. Adhesions are also a possible cause of clogged fallopian tubes. Pelvic inflammatory disease (PID) and endometriosis may cause adhesions that affect one’s ability to conceive.
In other cases, adhesions may cause severe pain, including pain while having sex and menstrual cramps. Some women in Australia also experience abnormal menstrual bleeding, light periods, or lack of menstrual periods due to adhesions. It’s also possible to experience no apparent symptoms, even when you have adhesions.
What causes adhesions?
Adhesions occur whenever the natural healing process of the body goes somewhat awry. Usually, the abdominal cavity, uterus, and fallopian tube surfaces are slippery, which enables the organs to move around quickly.
But the surface may become sticky if there is an injury from previous surgery, an endometrial deposit, or an infection. This will cause the organs to get stuck together. Scar tissue can also form and keep the organs in an abnormal position, creating a web-like attachment between organs. The adhesions can be strong and thick, forcing the organs to pull on each other unnaturally. This causes pain, particularly during menstruation or sexual intercourse.
Regarding Asherman’s syndrome, adhesions will occur within the uterus. While the cases may be rare, the condition causes uterine walls to stick together almost entirely.
Intrauterine adhesions usually prevent healthy endometrium from forming. This can prevent the healthy implantation of the embryo. If the implantation occurs by chance, the risk of getting a miscarriage will be higher.
In the case of pelvic inflammatory disease or other forms of infection that affect the reproductive system, the fallopian tubes may become inflamed. The inflamed surface may even develop adhesions or scar tissue within the tubes.
The adhesions will prevent sperm or egg from coming together. Endometriosis also causes adhesion in the pelvic cavity, especially near the ovaries or fallopian tubes, which leads to ovulation interference.
Endometrial adhesions can also prevent the fallopian tube from moving naturally. Since the ovary isn’t attached to the fallopian tubes, the ovulated egg must find a way to get to the fallopian tube. If adhesions affect the natural movement of the tubes, it will be difficult for the egg to float into the tube, an interference that reduces the chances of conceiving.
Diagnosis of adhesions
Currently, there are three main ways of diagnosing adhesions:
- Hysterosalpingogram (HSG)
A hysterosalpingogram is a form of X-ray used to determine the uterus’s shape and check if the tubes are clear. If the fallopian tubes are blocked, you may be diagnosed with HSG.
A hysteroscopy involves using a clean little tube known as a hysteroscopy that’s inserted into the uterus through the cervix to help the doctor see everything inside the uterine cavity and the openings of the fallopian tubes. You can use this technique to diagnose uterine cavity problems, including Asherman’s syndrome.
A laparoscopy is a process where a tiny incision is made in your abdomen, and a lighted tube with a camera device is inserted along with the instruments. This method is the only way to diagnose endometriosis.
It’s possible to get ordinary results on hysteroscopy and HSG and still have mild or severe endometriosis.
Your healthcare provider may use open or laparoscopic surgery, also called adhesiolysis. In this case, the adhesions will be cut by an electric current or scalpel.
Since adhesions can form after the surgical procedure, open adhesiolysis might not be suitable except when you need to remedy severe problems like bowel obstruction.
In about 70% of the cases, the surgery for removing the initial adhesions may cause the development of more adhesions. Therefore, thoroughly discuss the benefits, risks, and alternatives to surgery with your healthcare provider before making your final decision.
Women who experience adhesion symptoms can consider laparoscopic surgery. One of the primary benefits of this procedure is that it requires a small incision or cut, which is why it is also called keyhole surgery. Laparoscopy is an upstanding method for infertility surgery because it reduces the risks of new adhesion growth.
Laparoscopic adhesiolysis may improve the quality of life among women who have chronic pelvic pain caused by adhesions. The surgery shows similar results to other invasive forms of surgery when dealing with extensive adhesions. But it’s important to note that it can be time-consuming (takes about two to four hours) due to the difficulties involved in the procedure.
Many women who undergo laparoscopic adhesiolysis:
- Experience minimal complications
- Are discharged the same day after the procedure
- Will not need to have major abdominal incisions
- Resume full activity in a week after the surgery
Your healthcare provider may recommend non-surgical treatments if you do not want surgery. This may include:
- Taking medication (this is the first treatment option for acute pain)
- Soft tissue mobilisation
- Physical therapy
- Lifestyle changes
Consult with the healthcare provider to determine if you should choose surgical or non-surgical treatment options depending on your situation.
Remember that the same surgery used to diagnose endometriosis or adhesions is used to treat and eliminate adhesions. This way, you will not have to go through surgery two times.
Fertility treatment for adhesions
In case the scar tissue within your fallopian tubes, it may be possible to have a surgical repair done. But IVF treatment will be more successful and affordable.
If Asherman’s syndrome is the primary cause of your infertility, you may need to remove the adhesions during operative hysteroscopy. The chances of conceiving naturally afterwards will increase, or your provider may recommend fertility treatment after surgery.
In the case of endometriosis or pelvic adhesions, scar tissue removal may minimise pain and improve the odds of conceiving successfully. But depending on your situation, you may need fertility treatment or IVF after surgery. Talk to your doctor about your options and discuss what to expect before and after surgery.
Frequently Asked Questions:
What are the most common causes of adhesions?
Adhesions are primarily caused by previous surgeries, infections, or diseases that lead to inflammation in the body. The healing process after an injury or surgery can sometimes result in the formation of scar tissue, which can bind organs together, leading to adhesions. Conditions like endometriosis and pelvic inflammatory disease can also cause adhesions.
How can adhesions affect fertility?
Adhesions can interfere with the ovulation process, prevent the sperm and egg from meeting, and make it difficult for the uterus to accommodate the fertilised embryo. They can also cause blockage in the fallopian tubes, preventing the egg from reaching the uterus. Conditions like endometriosis and pelvic inflammatory disease can cause adhesions that affect fertility.
What are the symptoms of adhesions?
Adhesions can cause severe pain, including pain during sex and menstrual cramps. Some women may experience abnormal menstrual bleeding, light periods, or lack of menstrual periods. However, it’s also possible to have adhesions without experiencing any apparent symptoms.
What are the treatment options for adhesions?
Treatment options for adhesions include surgical and non-surgical methods. Surgical methods involve cutting the adhesions using an electric current or scalpel through open or laparoscopic surgery. Non-surgical treatments may include medication, exercise, soft tissue mobilisation, physical therapy, and lifestyle changes.
What is the recovery process like after adhesion surgery?
Recovery after adhesion surgery varies depending on the individual and the type of surgery performed. After laparoscopic surgery, many women are discharged the same day and can resume full activity within a week. However, recovery may take longer after open surgery.
Can adhesions return after surgery?
Yes, adhesions can return after surgery. The surgery to remove initial adhesions can cause the development of new adhesions in about 70% of cases. This is why thoroughly discussing the benefits, risks, and alternatives to surgery with your healthcare provider is important.
What are the implications of scar tissue formation in the reproductive system?
Scar tissue formation in the reproductive system can lead to several complications. It can interfere with the ovulation process, prevent the meeting of the sperm and egg, and make it difficult for the uterus to accommodate a fertilised embryo. Scar tissue can also block the fallopian tubes, preventing the egg from reaching the uterus for implantation. This can lead to fertility issues and may require medical intervention for conception.
How can surgical procedures impact fertility?
Surgical procedures, particularly those involving the reproductive organs, can sometimes lead to the formation of scar tissue or bands of tissue that bind organs together. This can interfere with the normal functioning of these organs and potentially lead to fertility issues. For instance, scar tissue can block the fallopian tubes, prevent the egg from reaching the uterus, or interfere with ovulation. Therefore, discussing potential risks and benefits with your healthcare provider before surgery is important.
What are some non-surgical treatment options for fertility issues caused by scar tissue?
Non-surgical treatments for fertility issues caused by scar tissue can include medication, physical therapy, and lifestyle changes. Medication can help manage pain and inflammation, while physical therapy can help improve mobility and reduce discomfort. Lifestyle changes, such as maintaining a healthy weight, regular exercise, and a balanced diet, can also improve overall health and potentially enhance fertility. However, the effectiveness of these treatments can vary depending on the individual and the extent of the scar tissue. Always consult with a healthcare provider for personalised advice.
How can adhesions be prevented?
Preventing adhesions can be challenging as they often form due to the body’s natural healing process after surgery or injury. However, using minimally invasive surgical techniques, applying certain substances that prevent adhesion formation during surgery, and ensuring proper wound care can help reduce the risk.
What is the relationship between adhesions and endometriosis?
Endometriosis can cause adhesions in the pelvic cavity, especially near the ovaries or fallopian tubes, which can interfere with ovulation. The scar tissue from endometriosis can also prevent the fallopian tube from moving naturally, making it difficult for the egg to float into the tube, thereby reducing the chances of conception.
How does endometriosis affect fertility, and what are the treatment options?
Endometriosis is a condition where the tissue that normally lines the inside of the uterus grows outside of it. This can lead to scar tissue or adhesions forming, which can interfere with the normal functioning of the reproductive organs, potentially leading to fertility issues. Treatment options for endometriosis-related fertility issues include hormonal therapy, pain management, and surgical procedures to remove the endometrial tissue. In some cases, assisted reproductive technologies like in vitro fertilisation (IVF) may be recommended. Discussing these options with a healthcare provider to determine the best course of action based on individual circumstances is important.
Evan is the founder of Fertility2Family and is passionate about fertility education & providing affordable products to help people in their fertility journey. Evan is a qualified enrolled nurse and has expertise in guiding & managing patients through their fertility journeys.