Adhesions are scar tissues that develop within the body in response to any chronic irritation. The source of this irritation can include many varied events, including infection, trauma, surgery, the presence of a foreign body or object, exposure to irritating chemicals, bleeding into the abdomen, rupture of a nonfunctional ovarian cyst, twisting of tissues resulting in a compromised blood supply or tissue damage, endometriosis, or an ectopic pregnancy. Adhesions may be thin and filmy or thick fibrous bands. Most often, these adhesions tend to connect or bind tissues that normally are separate and this displacement of tissue and restriction in their range of mobility may cause pain.
Abdominal adhesions are reported in up to 10% of women with no prior history of surgery and up to 90% of women with a prior history of surgery. Adhesions are reportedly found in up to 60% of women with chronic or persistent pelvic pain. As with endometriosis, the location of the adhesions is highly correlated to the location of the pain, but the intensity of the pain is poorly predicted by the extent of visible findings. This may suggest that some women have far more pain sensing nerves to the affected tissues (to produce more pain sensation) or that the "gate" that modifies the pain signal may allow a greater ultimate signal in some women.
Scar tissues or adhesions themselves are generally not painful but they can pull other tissue out of place, restrict the motion of the adherent tissues, incarcerate or strangulate tissues if they are caught within bands of adhesions, and attach to and irritate some highly sensitive tissues.
The most common symptoms of adhesions include increased abdominal or pelvic pain with stretching or motion (especially running), pain with intercourse, pain around the time of ovulation when the ovary has a large ovarian cyst (follicle) containing the mature egg, abdominal pain or bloating after eating, and pain consistently in a particular location that is increased when resting in certain positions.
Radiological tests can suggest the probability of adhesions when tissues that are normally separated from one another appear to be bound together, but a definitive diagnosis requires visualization. Laparoscopy is a minimally invasive same day surgical procedure that has become the gold standard for the diagnosis of adhesions since it can visualize and treat most pelvic adhesions.
Whenever a surgeon enters the abdominal or pelvic cavities, (s)he should exercise great care to minimize postoperative adhesion formation. Postoperative adhesions can be extensive, cause considerable pain, reduce future fertility and in some uncommon cases require additional emergency surgery for bowel obstruction. In one study assessing the cost of care in the USA for the treatment of postoperative adhesions during the year 1994, it was reported that approximately 1.3 billion dollars was spent just to care for these problems. With the recognition of the need for, and the implementation of, surgical techniques to reduce postoperative adhesion formation this problem has been reduced. Microsurgical techniques intended to reduce postoperative adhesion formation involve extremely gentle tissue handling, meticulous control of bleeding, limitation in the use of foreign bodies like suture material, minimizing char formation or devascularization of tissue with cautery devices, and a laparoscopic approach rather than laparotomy when feasible.