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One of the many complications that can arise from endometriosis is the formation of adhesions. These bands of scar tissue can bind organs to other structures, block the tubes causing infertility, and cause immense pain even after the endo itself has been removed surgically. Adhesions present a special problem concerning treatment as well. The hormonal methods of treating endo have no effect on the adhesions, so the only method of treating them is with surgery. Often, a woman will have to have additional surgeries to remove adhesions formed from her previous surgeries to remove endo. This can start a sort of viscious circle, with adhesions forming during surgery and then needing subsequent surgery, which in turn can cause more adhesions, to remove them.

The most common sites for adhesions are the pelvic organs. Often the ovaries and tubes are involved. Additionally, the adhesions can form over top of an endo lesion. This can increase pressure and pain as well as make the lesion difficult to visualize during surgery. Pelvic adhesions are more frequently found with moderate to severe endo, but can also occur with milder endo. Since adhesions are probably formed due to irritation from the endo lesions bleeding or rubbing against the surfaces of organs, it makes sense that there are usually more severe adhesions when the endo is denser and more proliferative. The number and density of the adhesions are frequently factors considered in the assignment of a stage number to endo.

Of the other sites adhesions are found, the bowels are by far the most frequent. Adhesions on the bowel can cause a set of symptoms all their own. These may include pain, nausea, irritable bowel syndrome, and occasionally intestinal blockage. The pain may mainfest itself after exercise, during pelvic exams, or completely unsolicited. Most people describe the pain caused by adhesions as "pulling" or "stabbing" whereas they describe endo pains as "burning" or "pinching". Adhesions can, however, be found wherever there is endo. This can lead to adhesions forming on or near the diaphragm or the organs in the abdomen. Occasionally adhesions are even found on the lungs, but this is rare.

There are now several treatments that can be used during surgery to prevent the formation of adhesions. These have included the infusion of certain solutions into the pelvic cavity through the laparoscope, insertion of pieces of material such as Gore-Tex into the area, or the application of a methylcellulse barrier during surgery. These barriers are degradable and are absorbed by the body a couple of weeks after surgery. Most of the adhesions formed as a result of surgical irritation will form within this time period. The methylcellulose barrier acts to keep the surfaces from rubbing together post-surgically, and then it dissolves and is absorbed when it is no longer needed. These are marketed under the names Interceed and Surgicel, and they have proven to be very effective in reducing post-surgical adhesion formation. However, once adhesions have formed, the only method for treating them is more surgery. Fortunately, the development of surgery through the laparoscope and new adhesion barriers can reduce the chances of adhesions forming in the first place.

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International Adhesions Society
David Wiseman Ph.D., M.R.Pharm.S.
Founder, International Adhesions Society (IAS)
http://www.adhesions.org
email: david.wiseman@adhesions.org

Support for the IAS is provided free of charge by Dr. David Wiseman and
Synechion, Inc.

Adhesion Related Disease

Adhesions are internal scars that occur after surgery. They connect internal organs and tissues that are not normally attached, causing disturbance in function, chronic pelvic or abdominal pain, infertility, bowel obstruction and other problems. Even if adhesions are cut, they will inevitably reform. Patients face a life of pain and suffering punctuated by temporary periods of respite that lysis (cutting) of adhesions sometimes allows. Adhesion-related disease (ARD) is both underestimated and underappreciated. ARD is one of the most common complications of surgery. Hospital admissions for ARD rival those for heart bypass, appendix and other routine operations. In many cases, ARD is a debilitating condition, causing disruption to family life and day-to-day living. Because of the lack of knowledge of this significant condition, its treatment and prevention, patients are often sent on frustrating quests for sympathetic, knowledgeable and funded medical help. We have established the International Adhesions Society (IAS) with a mission is to: 1) provide information on ARD, its treatment and prevention, to patients, doctors, and other professionals. 2) provide support to patients suffering from ARD. 3). promote research in the prevention and treatment of ARD.

Neither the IAS, Synechion, Dr. Wiseman or any other representative offers medical advice. Always consult a qualified medical professional.