"Ask Dr. Cook" is a series of questions and answers regarding endometriosis. The current subject and answer can be found on Current Ask Dr. Cook web page. The questions may represent a summary of questions I have been asked by several different patients. I hope you find this information helpful. If you have a question you would like answered, please Submit A Question.

What Are Adhesions?

Question:
My doctor tells me I have extensive adhesions of my pelvic organs and my intestine. I am in a lot of pain. I have gone through a couple of surgeries to get rid of the adhesion, but it seems to keep coming back and if anything the pain is getting worse. Is there 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? This is part one of a three part series. Also see part 2"What Causes Adhesions?" and part 3 "How Are Adhesions Treated?".

Adhesion is the medical term for scar tissue. Scar tissue 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 suppose to be connected, which can result 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. There are few blood vessels running through this type of adhesion. If the surgeon sweeps an instrument through filmy adhesions, they easily give way. This type of adhesion usually does not cause pain. Vascular adhesions are thick, more like string or ropes connecting two organs which are not suppose to be connected (e.g. the ovary to the bowel). This type of adhesion can cause pain. Scar tissue that forms after surgery, usually does so in the first couple of weeks. Adhesions rarely form months or years after surgery. However, this type of adhesion can become progressively shorter over time as it matures. This is the reason that the pain associated with this type of adhesion can become progressively worse months following the surgery. Dense cohesive adhesions connect two pieces of tissue together tightly, similar to gluing two pieces of wood together. There is no space in-between the two pieces of tissue. This can be the worst type of adhesions to have. This is technically the most difficult to remove and the most likely to recur after it is removed. The most common location we see this type of adhesion in gynecology 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 but not 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) and 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, narrowing of the ureter (causing dilation upstream and pain, usually mid back), or pressure on a nerve resulting in pain.

Updatede October 29, 2005