Ask Dr. Cook Archives
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What Causes Adhesions? Question: Why do I have adhesions? And what are my treatment options? Answer: Scar tissue usually results from previous trauma to the tissue. The most common causes of scar tissue formation are endometriosis, past infection, and previous surgery. Endometriosis is traumatic to the surrounding tissue. Every month the endometrial implants are stimulated hormonally and bleed internally when a woman has her period. The endometrial implant itself and the recurrent bleeding are very irritating to the inside lining of the body (peritoneum). In response, the body forms scar tissue; this is the body's effort to 1. heal the damaged tissue, and 2. wall off the disease and try to protect the rest of the body. As scar tissue matures, it shortens. Over time this cycle of irritation and scar tissue formation results in more and more normal tissue getting pulled into this adhesive mass (consider how material gets pulled into a curtain pleat; your body acts in much the same way). Scar tissue is commonly located in the posterior cul-de-sac on the utero-sacral ligaments, and can involve the uterus, bowel, and vagina. Clinically, a patient with endometriosis may notice pain with periods, lower back pain, pain with intercourse (deep penetration) and pain with bowel movements. She may even notice pain radiating down her leg(s). Patients who have an endometrioma are especially at risk for having extensive adhesion formation. An endometrioma is a collection of endometriosis in the ovary. If an endometrioma becomes large enough it can leak or rupture, spilling its contents into the pelvic cavity. This substance is very irritating to the body, and is a setup for the extensive formation of adhesions. The most common pelvic or abdominal infectious causes of adhesion formation are pelvic inflammatory disease (PID) and appendicitis. PID is an infection of the fallopian tubes; this is different from a routine vaginal infection. A patient with PID (usually, but not always) has severe pelvic pain, and is often hospitalized so she can receive I.V. antibiotics. In my experience PID is an overused diagnosis with patients experiencing pelvic pain, especially with an emergency room visit. Appendicitis does not usually cause pelvic infections. The creation of an unrecognized hole in the bowel during surgery also can result in a post-operative infection and adhesions (this is an uncommon situation, but severe nevertheless). If a hole is recognized and repaired during surgery it rarely causes an infection or adhesions. By definition, surgery is traumatic to tissue; thus, scar tissue formation can result. The most critical factor in preventing post-operative scar tissue formation is good surgical technique. How the surgeon handles the tissue is crucial: If the tissue is handled roughly, squeezed tightly with instruments, rubbed with dry cloths, or coagulated (burned) with electrosurgery, scar tissue formation is more likely to form. I will never forget my first experience in the animal microsurgery laboratory: I was shocked to watch a piece of tissue that I had picked up with a set of surgical tweezers die off; one of the first steps in scar tissue formation. All I had done was pick up the tissue! I learned then that even what seemed to be a normal action could have a devastating surgical outcome. |
