Ask Dr. Cook Archives
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What Are Adhesions? Question: My doctor tells me I have extensive adhesions of my pelvic organs and my intestine. I'm in a lot of pain. I've gone through a couple of surgeries to get rid of my adhesion, but it seems to keep coming back (and if anything, the pain is getting worse). Can you tell me more about where adhesions come from, and if there's anything that can be done to help me out? Answer: Yes, fortunately your situation can be helped. There are recent medical advances that make it more likely that you can permanently get rid of your adhesions and pain. To answer your question adequately we need to address several issues. First, what are adhesions? An adhesion is the medical term for scar tissue, which is abnormal tissue that can form during the healing process. Scar tissue inside the body often connects two parts of the body that are not supposed to be connected, resulting in pain. There are three basic types of scar tissue or adhesions that connect two normal body parts: filmy adhesions, thick vascular adhesions, and dense cohesive adhesions. Filmy adhesions are similar to spider webs. Since there are few blood vessels running through this type of adhesion, if the surgeon sweeps an instrument through filmy adhesions, they easily give way (just like running your fingers through a spider web). This type of adhesion usually does not cause pain. Vascular adhesions are thick. They're more like string or ropes connecting two organs, which are not supposed to be connected (e.g., the ovary to the bowel). This type of adhesion can also cause pain. Scar tissue that forms after surgery usually does so in the first couple of days or weeks. Adhesions rarely form months or years after surgery. However, this type of adhesion can become progressively shorter over time as it matures, shrinking and leading to a "pulling" sensation. For this reason, the pain can become progressively worse months following the surgery. Dense cohesive adhesions connect two pieces of tissue together tightly (think about gluing two pieces of wood together). In this case, there is no space in between the two pieces of tissue. Dense cohesive adhesions can be the worst type to have. Technically they are the most difficult to remove, and the most likely to recur after removal. Among gynecologists, the most common location in which we see this type of adhesion is between the ovary and the pelvic sidewall. The patient may experience pain just prior to ovulation when the follicular cyst forms, tugging on the adhesion. Finally, scar tissue can be present without connecting two body parts together. This is a tough, leathery type of tissue. An example is the thick tissue that can be left after a severe burn. Inside the body this tissue can cause pain when growing on the bowel, ureter (the tube from the kidney to the bladder), or the nerves. Remember, scar tissue tends to shorten over time. When it is growing on tissue, it will tend to restrict the normal tissue's movement or constrict the tissue, ever tightening its grip. This can result in abnormal bowel motility, or the narrowing of the ureter (causing dilation upstream and pain, usually mid back), or pressure on a nerve, resulting in pain. This pain can be local, at the site of the adhesions or remote, such as pain radiating down the leg as a result of pelvic adhesions. |
