Adhesions: Causes

Since I have been trying to educate you guys a little more about adhesions and ARD (Adhesion Related Disorder) I decided that today’s post would be in regards to a request that was made by a couple of my readers for more information about the  causes of adhesions. I could just tell you myself, but I thought that it would be better to quote from, and link back to, other websites so that if you want more information, it is right there at your fingertips. The information will be repeated a couple of times, since the topic today is simply causes of adhesions. Again, I decided to do it this way so that you could go to more than one website to look for more information, or you can just pick one, read it, and then if you want more information on something else, you can leave a comment and I can do another post on that topic.

I will start with one of my favorite websites for patient information about adhesions and ARD, www.adhesions.org. This particular article can be found here

“Adhesions occur in response to injury of various kinds. For example, non-surgical insults such as endometriosis, infection, chemotherapy, radiation and cancer may damage tissue and initiate ADHESIONS. By far the most common kind of ADHESION is the one that forms after surgery. ADHESIONS typically occur at the site of a surgical procedure although they may also occur elsewhere.”

This is somewhat off topic, but I wanted to give you these figures as well:

“The rate of adhesion formation after surgery is surprising given the relative lack of knowledge about ADHESIONS among doctors and patients alike. From autopsies on victims of traffic accidents, Weibel and Majno (1973) found that 67% of patients who had undergone surgery had adhesions. This number increased to 81% and 93% for patients with major and multiple procedures respectively. Similarly, Menzies and Ellis (1990) found that 93% of patients who had undergone at least one previous abdominal operation had adhesions, compared with only 10.4% of patients who had never had a previous abdominal operation. Furthermore, 1% of all laparotomies developed obstruction due to adhesions within one year of surgery with 3% leading to obstruction at some time after surgery. Of all cases of small bowel obstruction, 60-70% of cases involve adhesions (Ellis, 1997).

Lastly, following surgical treatment of adhesions causing intestinal obstruction, obstruction due to adhesion reformation occurred in 11 to 21% of cases (Menzies, 1993).”

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This next section came from The New York Times and the article can be found at this address</a</strong.

“Causes

Inflammation (swelling), surgery, or injury can cause adhesions to form almost anywhere in the body, including:
-In joints such as the shoulder
-In the eyes
-Inside the abdomen or pelvis

Once they form, adhesions can become larger or tighter over time. Symptoms or other problems may occur if the adhesions cause an organ or body part to twist, pull out of position, or be unable to move as well.
The risk of forming adhesions is high after bowel or female organ surgeries. Surgery using a laparoscope is less likely than open surgery to cause adhesions.

Other causes of adhesions in the abdomen or pelvis:
-Appendicitis, most often when the appendix breaks open (ruptures)
-Cancer
-Endometriosis
-Infections in the abdomen and pelvis
-Radiation treatment

Adhesions around the joints may happen:
-After surgery or trauma
-With certain types of arthritis
-With overuse of a joint or tendon

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The last source of information on the causes of adhesions is WomensSurgeryGroup.com. I found this site to be the most comprehensive of the three. This page can be found here.

What causes adhesions to form?

The pelvic and abdominal organs, such as the ovaries and uterus, are wrapped in a clear membrane known as the peritoneum (membrane that wraps the pelvic and abdominal organs). Whenever there is any injury, trauma or infection, or when surgery is performed in this area, adhesions can form. Removing these bands of scar tissue aggravates the healing cycle, and can therefore cause the formation of new adhesions.

Adhesions form as the result of the following common gynecologic procedures:

Ovarian Surgery: The ovary is the most common site for adhesions to form, usually resulting from surgery to remove ovarian cysts.

Surgical Treatment of Endometriosis: Endometriosis is a disease in which patches of endometrial tissue – the mucous membrane that lines the inside of the uterus – become implanted outside the uterus. Endometriosis often occurs in the pelvis and abdomen and can be associated with severe inflammation and dense adhesions. The abnormal tissue is removed through surgery.

Myomectomy is the removal of fibroids from the uterus. Adhesion formation at the incision line on the uterus is a common complication of the procedure.

Adhesiolysis is the removal or surgical separation of adhesions. Ironically, the removal of adhesions can aggravate the healing process, thereby leading to the formation of new adhesions.

Reconstructive Tubal Surgery: The repair of blocked fallopian tubes is a delicate procedure that often includes the removal of existing adhesions. Unfortunately, the surgery itself can lead to the formation of new adhesions.”

Adhesions also are a common occurrence in women who suffer from pelvic inflammatory disease (PID) and sexually transmitted diseases.

Factors that contribute to the cause of adhesions include the following:
Trauma: The healing process from surgery is a major contributor to adhesion formation.

Ischemia: During surgery, blood flow is often disrupted as a result of tissue cutting, blood clotting or tying of stitches. This may result in ischemia, or reduction of blood flow to the tissues, therefore contributing to adhesion formation.

Foreign Bodies: Foreign bodies include stitches, lint from sponges or talc from surgical gloves. Foreign bodies can cause an inflammatory reaction in the body and can trigger adhesion formation.

Inflammation: Endometriosis and PID can cause inflammation, which can result in adhesion formation.

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So, as you can see, the causes vary greatly. Most people that have heard about adhesions believe that surgery is the only cause. This is why more public awareness is in order. There could be millions of people with pelvic/abdominal pain who have no idea that they have adhesions. And to be honest, most doctors aren’t jumping the gun to do exploratory surgery to look for them. Some won’t even mention them while others (yes, they do exist) don’t believe that adhesions can cause pain. I often say that adhesions are the medical community’s best kept secret. It’s time to let the secret out of the bag.

These are some more websites about adhesions if you haven’t read enough already 😊:
Medline Plus
Web MD
IFFGD

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