The adhesions of endometriosis are thick bands of scar tissue which can connect organs together.
When tissue in the pelvic region undergo damage, adhesions form. We form a part of the normal process of healing.
Adhesions are different from endometriosis implants which develop and bleed in the same way as tissue from the uterine lining in response to hormones.
While endometriosis is a risk factor for adhesions, it is not the only cause, and adhesions do not result automatically from endometriosis.
We look in more detail in this article at endometriosis adhesions including how doctors diagnose and treat them.
What are endometriosis adhesions?
Adhesions on the inside of the body are clumps of thick scar tissue. In response to inflammation and injuries, the body usually forms the scar tissue. Hence, this tissue can develop following surgery.
Advanced endometriosis may cause the formation of adhesions. Endometriosis causes the type of tissue that lines the uterus to grow elsewhere, e.g. on Fallopian tubes, ovaries, or bladder. Such cultivations are called implants.
Endometriosis implants cause inflammation in a person’s menstrual cycle as they develop and bleed. During the healing process the body responds to this inflammation by forming scar tissue.
Large clumps of scar tissue may form in areas affected by endometriosis.
Adhesions can cause severe complications especially if they are very large. The endometrial adhesion will, for example, be applied to the ovaries, cutting off blood supply. It may also collect blood in the ovaries, which can cause ovarian cysts.
Adhesions can also affect fertility, making it harder for an egg to fly to the uterus or implant it in. Research suggests that between 30 percent and 50% of endometriosis patients have fertility problems.
However, endometriosis is not the only condition which causes adhesions. In the pelvic region a individual may develop adhesions because of:
- an inflammatory disorder
- a severe infection
- an injury or trauma to the uterus or surrounding areas
- surgery, including surgery for endometriosis
Having surgery with endometriosis can increase the risk of adhesions. Even operations to remove adhesions can result in new adhesions.
Although many people with endometriosis adhesions report pelvic pain, the relationship between adhesions and pain has only been evaluated in few studies.
Some doctors say that the connection between pain and adhesions isn’t obvious.
There are experts, for example, who believe endometriosis pain is different from adhesion pain. Dr Harry Reich, a specialist in endometriosis, states:
“Endometriosis pain results directly from the inflammatory process going on inside of endometriosis lesions. Adhesions, when they bind the bowels, can cause their own pain, which is separate and different from endometriosis pain.”
A 2009 study examined the role of adhesions in endometriosis pain in a direct way. The researchers identified an correlation between the signs of pain and the location and severity of adhesions.
A smaller but more recent study found, however, that the prevalence of pelvic adhesions did not correlate with the self-reported levels of pain among the participants.
In addition, the highest proportion of people with adhesions were in the category of participants with the lowest recorded pain ratings. Physical, psychological, and emotional testing indicated these individuals were better able to cope with pelvic pain.
Some other symptoms that may affect people with adhesions include:
- vaginal pain
- abdominal pain
- rectal bleeding
- damage to the ovaries, including ovarian torsion, which happens when an ovary twists
- bleeding between periods
- chronic inflammation that causes pain
Many doctors divide endometriosis into stages from 1 to 4 to represent implant amounts and severities. Individuals with stage 3 or 4 endometriosis are more likely to get adhesions.
However, there is no consensus regarding what symptoms endometriosis adhesions cause, and work is ongoing.
Adhesions to endometriosis can form anywhere in the pelvis or abdomen including:
- ovaries and fallopian tubes
- outside of the uterus
Surgery that remove adhesions to endometriosis which can help preserve fertility, reduce bleeding and pain, and prevent ovarian injury.
However, surgery does not treat the underlying cause of the disease, therefore the symptoms may return.
Even after surgery, endometriosis can cause additional adhesions to develop. In addition, the surgery itself represents a risk factor for endometrial adhesions.
This is because the inflammation and scar tissue are normal parts of the healing process. Surgery creates a wound which needs to heal, increasing the risk of forming scar tissue and adhesions.
Dr. Harry Reich recommends that people considering surgery to avoid ablation procedures for either endometriosis or endometriosis adhesions, as these create more dead tissue.
Surgery does not cure endometriosis, but can help with effects reduction. Based on the symptoms and goals of a person’s care, they might need additional treatment to reduce the risk of developing further adhesions.
As surgery itself is a risk factor for adhesions, more adhesions after treatment can also be formed.
Reducing the risk of infection is important in the days following the surgery. A health care professional can prescribe antibiotics. A person should seek immediate medical attention for fever, severe pain, swelling, or any other signs of infection.
Researchers have not yet thoroughly investigated long-term results in people undergoing adhesive surgery.
Questions to ask the doctor
Adhesions can not be self-diagnosed, but a doctor may be able to detect them using medical imaging.
The following questions can help them understand their diagnosis and treatment if a person has adhesions:
- How severe are my endometriosis adhesions?
- Do my adhesions require treatment?
- What are my treatment options?
- What are the risks of surgery?
- Is there anything that I can do to minimize the risks of surgery?
Adhesions of endometriosis can cause pain and other symptoms, depending on where they are. They even can destroy organs in severe cases.
The right treatment will reduce the risk of long-term complications, but with a professional endometriosis specialist, it is necessary to weigh up the benefits and costs.
Surgery to remove implants and adhesions from endometriosis will cause further adhesions to form, so work is underway to find effective therapies.