A common cause of pelvic pain, pelvic adhesions are bands of scar tissue formed inside your body that can make tissues and organs in your peritoneal cavity (pelvic/abdominal space) stick together. Some of the tissues and organs that can be affected include your uterus, ovaries, fallopian tubes and bladder.
Pelvic adhesions are made of the scar tissue your body produces naturally as part of the healing process and can appear as sheets of thin tissue or thick fibrous bands. Most don’t cause any symptoms or just very mild symptoms, which means you may have some adhesions without realising it. But when they make your organs or tissues stick together – which doctors often call pelvic adhesive disease – they can sometimes cause problems, some of which can be severe and even life threatening. These problems happen because your pelvic and abdominal organs and tissues normally move freely against each other, but when you have adhesions, it can make this movement difficult or even impossible.
What are the symptoms of pelvic adhesions?
Ongoing abdominal and pelvic pain is a common symptom of pelvic adhesions; however, you may also experience one or more of the following:
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Pain while exercising or stretching, or while walking, sitting or lying in certain positions
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Pain during sex
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Frequent urination
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Frequent urinary tract infections
Some of these symptoms can indicate a possible complication of pelvic adhesions, such as:
Blocked bowel (partial or complete) This can happen if different parts of your bowel stick together, causing a narrowing of the bowel or a total blockage. Symptoms include cramping pains, bloating, nausea, vomiting, difficulties having a bowel movement, being unable to pass wind and constipation (or sometimes constipation alternating with diarrhoea).
According to experts at the Department of Health in Victoria, Australia, 60 - 70 per cent of small bowel constructions in adults are caused by pelvic adhesions (i). Meanwhile, a bowel obstruction can also cause a condition called peritonitis, which is an infection of the lining of the abdominal cavity.
It’s essential to get medical advice immediately if you’re experiencing the symptoms of a bowel obstruction since a complete bowel obstruction is a medical emergency and can be potentially fatal if it isn’t treated quickly.
Strangulated bowel This isn’t quite the same as a bowel obstruction, but it too can be life threatening if you don’t get treatment right away. Bowel strangulation happens when part of your bowel becomes twisted around a band of adhesions, which can cut off the blood supply to part of the bowel (this can cause tissue death). Symptoms include severe and persistent pelvic/abdominal pain, bleeding from the anus and a high temperature. Seek immediate medical help if you experience these symptoms.
Fertility problems You may find it difficult to get pregnant if you have adhesions that are affecting your ovaries or fallopian tubes (for instance, adhesions can block your fallopian tubes). If adhesions trap a fertilised egg in a fallopian tube, they can also cause an ectopic pregnancy. This means the egg won’t develop into a foetus plus it can put a woman’s life at risk if the pregnancy continues (according to the NHS, around one in 90 pregnancies is ectopic (ii)).
You can read more about fertility problems in our guide to infertility.
However, many of the symptoms of pelvic adhesions can also be caused by a range of other health issues. This can make diagnosing adhesions difficult. But if you have symptoms – pelvic or abdominal pain, for instance – and they aren’t getting any better, see your GP (if you have symptoms of a blocked or strangulated bowel, call 999 for an ambulance or go to your nearest hospital A&E department).
What causes pelvic adhesions?
Pelvic adhesions most often form after you have pelvic or abdominal surgery, including operations that involve the ovaries, fallopian tubes, fibroids, the digestive tract and even surgery for adhesions themselves. According to the National Institute of Diabetes and Digestive and Kidney Diseases in the US, adhesions are more common in people who’ve had emergency abdominal surgery, or surgery that involved the lower digestive tract (including the colon and rectum) (iii). It also suggests nine out of 10 people who have open abdominal surgery develop adhesions, though most don’t develop symptoms or complications (iii).
If you have keyhole (laparoscopic) surgery, you’re less likely to develop adhesions than someone who has open surgery (read on for more information about surgical treatments for adhesions). Experts from the Pelvic Pain Support Network, meanwhile, suggest that adhesions can begin to form immediately after surgery, and certainly within the first five days after surgery (iv) – though symptoms and complications can develop any time from straight away to many years later.
Surgery, however, isn’t the only cause of adhesions – they can also develop if you’re affected by inflammatory conditions such as:
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Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
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Appendicitis (especially when the appendix ruptures)
Infections such as gastroenteritis can also cause pelvic adhesions, as can injury/trauma, long-term dialysis to treat kidney failure and radiation therapy to treat cancer.
How are pelvic adhesions treated?
If your doctor suspects you have pelvic adhesions they can refer you for tests, though there isn’t a single specific test that will confirm it. These include blood and urine tests, as well as imaging tests including CT and MRI scans, ultrasound and X-rays.
But even if you’re diagnosed with pelvic adhesions, you may not need any treatment because there’s a good chance you won’t develop anything more than mild symptoms or any complications. Those who do have severe pelvic or abdominal pain, however, may need treatment at a hospital. You’ll also need emergency hospital treatment if you have a suspected blocked or strangulated bowel.
If your bowel blockage is a partial one, you may need to stay in hospital for a few days until the blockage is cleared. This usually involves not eating or drinking anything for a day or two to give your bowel a rest, while receiving fluids through a drip. You’ll usually be given strong painkilling medicine to relieve your pain. Then once the blockage starts to clear you’ll be able to begin having small amounts of food and drink again.
If these measures aren’t effective – or if you have severe pelvic pain or the signs of a complete bowel obstruction – you’ll usually need surgery. The surgery for cutting through and separating adhesions is called adhesiolysis. This is usually carried out using keyhole surgery, where surgical instruments are inserted into your abdomen through small incisions.
On rare occasions, open surgery – which involves a much bigger incision in the abdomen than keyhole surgery – is used for pelvic adhesions, though this is usually only performed in emergencies (in the case of a complete bowel obstruction, for instance). However, having any type of surgery, including adhesiolysis, can mean you could develop new adhesions afterwards – though your risk with keyhole surgery is lower than that of having open surgery. Besides this, the benefits of keyhole surgery over open surgery include faster recovery, less pain and shorter stays in hospital.
Unfortunately, having surgery for pelvic adhesions comes with no guarantee that your symptoms will improve in the long term. Some people do get better after surgery, but symptoms in others can stay the same or even get worse. Your doctor or specialist can advise you whether the benefits of having surgery will outweigh the risks.
Meanwhile, if your adhesions are causing problems with fertility, you may be referred to a gynaecologist.
How can you help yourself?
If your pelvic adhesion symptoms are mild, there are a few things you can do yourself at home to feel better. Taking an over-the-counter painkiller such as paracetamol or ibuprofen can be helpful if your adhesions are causing pain. If these don’t bring you sufficient relief, speak to your GP about stronger medicines that may be more effective.
If you have pelvic adhesions that are affecting your digestive tract and causing complications such as constipation, your doctor may recommend a dietary change or two to help food pass through your gut more easily.
You may, for instance, be advised to eat only soft foods or foods that are low in fibre for a while – for instance, creamed or strained soup, white bread instead of wholemeal or granary, and well-cooked mashed vegetables without skin, pips or seeds – plus you may want to make sure you’re drinking plenty of fluids. Eating smaller, more frequent meals may also be helpful. But if these measures don’t solve the problem, your doctor may recommend laxative medicines in the short term.
Natural support
There are also a couple of nutritional supplements you could try that may offer some support if you’ve developed pelvic adhesions as a result of having an inflammatory condition.
Turmeric, for instance, is a spice that may help, as its active ingredient curcumin is thought to help reduce the concentration of pro-inflammatory proteins called cytokines in the blood (v). Indeed, widely thought to have an anti-inflammatory effect, curcumin may help with some of the conditions linked to the development of pelvic adhesions, including preventing flare-ups in people with ulcerative colitis (vi).
PEA – which is short for palmitoylethanolamide – may also help with pain (vii) and inflammation. A fatty acid produced naturally in the body, it’s found in all of your cells, tissues and fluids, as well as in foods such as soya beans, peanuts, flaxseed, eggs and milk. Scientists call PEA an endocannabinoid-like chemical – indeed, it is often described as an alternative to cannabidiol (CBD), with both substances having similar properties. However, research suggests PEA is safer than CBD as it’s been studied more extensively and has a more robust safety profile (viii) with no known side effects (ix).
Can exercise help too?
Staying active and taking regular gentle exercise can also be beneficial for people with pelvic adhesions, since exercise increases the body’s production of natural pain-killing chemicals called endorphins. Some, however, may find that certain exercises increase their pain – if this happens, speak to your doctor, who may be able to recommend alternative activities that may not aggravate your adhesions (they may also refer you to a physiotherapist who can advise you about suitable types of exercise).
Need more information?
For lots more information about conditions that can cause pain, take a look at the pain section of our pharmacy health library. You may also find a visit to our women’s health pages helpful.
References
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Available online: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/adhesions#bhc-content.
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Available online: https://www.nhs.uk/conditions/ectopic-pregnancy/.
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Available online: https://www.niddk.nih.gov/health-information/digestive-diseases/abdominal-adhesions.
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Available online: https://www.pelvicpain.org.uk/conditions/adhesions/.
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Panahi Y et al. (2016) "Effects of curcumin on serum cytokine concentrations in subjects with metabolic syndrome: A post-hoc analysis of a randomized controlled trial." Biomed Pharmacother. 82:578-582. Available online: https://www.sciencedirect.com/science/article/abs/pii/S0753332216303997?via=ihub.
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Hanai H et al. (2006) "Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial." Clin Gastroenterol Hepatol. [Epub ahead of print] Available online: https://www.cghjournal.org/article/S1542-3565(06)00800-7/fulltext.
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Gabrielsson L, Mattsson S, Fowler CJ. (2016) "Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy." Br J Clin Pharmacol. 82(4):932–942. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094513/.
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Clayton P et al. (2021) "Palmitoylethanolamide: A Potential Alternative to Cannabidiol." J Diet Suppl. 28:1-26. Available online: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733.
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Clayton P et al. (2021) "Palmitoylethanolamide: A Natural Compound for Health Management." Int J Mol Sci. 22(10):5305. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/.
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.
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