How adhesions form
The peritoneum covering the pelvic organs is normally smooth and moist, allowing the organs to slide freely relative to each other. When it is damaged - by surgery, inflammation, blood - fibrin, a kind of “glue”, falls on the surface.
Normally, fibrin is absorbed within a few days. But if the healing process is disrupted, if there is inflammation, blood or tissue ischemia, fibrin adhesions grow with blood vessels and connective tissue - this is how strong adhesions are formed.
- Surgeries on the abdominal and pelvic organs are the main reason; the greater the volume and trauma, the higher the risk
- Inflammatory diseases of the pelvic organs
- Endometriosis - chronic inflammation around lesions
- Blood in the abdominal cavity: ovarian apoplexy, ectopic pregnancy
- Appendicitis, especially with peritonitis
- Caesarean section
- Intrauterine interventions with complications
- Tuberculosis of the genital organs
- Individual tendency to excessive formation of connective tissue
Symptoms
- Chronic nagging pain in the lower abdomen, often on one side
- Increased pain with physical activity, sudden movements, or heavy lifting
- Pain during intercourse, especially with deep penetration
- Increased pain before and during menstruation
- Bloating, bowel movements, tendency to constipation
- Infertility with tubal and ovarian involvement
- Discomfort when filling the bladder and bowels
- Sometimes there is a complete absence of symptoms; adhesions are discovered accidentally during surgery
Why are they dangerous?
- Tubal infertility - adhesions impair the mobility of the tubes and the capture of the egg
- Increased risk of ectopic pregnancy
- Chronic pelvic pain that reduces quality of life
- Intestinal obstruction is a rare but dangerous complication that requires emergency care.
- Difficulty in subsequent operations and increased risk of organ damage
- Bowel and bladder dysfunction
Diagnostics
- History: previous surgeries, inflammation, endometriosis; often it is he who prompts the diagnosis
- Examination by a gynecologist - limited uterine mobility, pain
- Ultrasound of the pelvic organs - the adhesions themselves are not visible, but indirect signs can be seen: limited mobility of organs, fluid accumulation
- Hysterosalpingography - assessment of tubal patency
- MRI of the pelvis - sometimes allows you to suspect an adhesive process
- Diagnostic laparoscopy is the only reliable method that simultaneously allows treatment
- Exclusion of other causes of pelvic pain: endometriosis, inflammation, intestinal and urinary tract pathologies
It is worth emphasizing: the conclusion “adhesion process” based on ultrasound data alone is not a reliable diagnosis. Adhesions are thin adhesions that ultrasound does not directly visualize.
Treatment
- Laparoscopic adhesiolysis - separation of adhesions under optical control; main method
- Salpingo-ovariolysis - release of the tubes and ovaries
- The most gentle technique: minimal trauma, careful hemostasis, avoidance of unnecessary coagulation
- Introducing anti-adhesion barriers and gels at the end of surgery to prevent re-formation
- Simultaneous removal of endometriosis foci if present
- Early activation after surgery
- Physiotherapy and exercise therapy during the recovery period
- Pain therapy and chronic pain management
- IVF for infertility, when restoration of anatomy is impossible
Prevention
- Refusal of operations without clear indications
- Prefer laparoscopic over open approach where possible
- Gentle surgical technique and minimal tissue trauma
- Use of Adhesion Barriers in High Risk Surgeries
- Early activation after surgery - movement reduces the likelihood of adhesions forming
- Complete treatment of inflammatory diseases of the pelvic organs
- Timely treatment of endometriosis
- Prevention of infections and abortions
Where is treatment in Tashkent
Laparoscopic surgery with gentle technique and the possibility of using anti-adhesion barriers is required.
In Tashkent, laparoscopic separation of adhesions, salpingo-ovariolysis and the introduction of anti-adhesion gels are performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have been diagnosed with “adhesions” only by ultrasound and are offered surgery, clarify the rationale: adhesions are not visualized by ultrasound, and the indication for intervention is specific problems - pain or infertility, and not the find itself. Clinic contacts are below.
