Endometriosis adhesions are thick bands of scar tissue that can bind organs together.
Adhesions form when tissue in the pelvic region sustains an injury. They form as part of the natural healing process.
Adhesions are different than endometriosis implants, which grow and bleed in response to hormones in the same way as tissue from the uterine lining.
Although endometriosis is a risk factor for adhesions, it is not the only cause, and adhesions are not an inevitable result of endometriosis.
In this article, we look at endometriosis adhesions in more detail, including how doctors diagnose and treat them.
Adhesions are clumps of thick scar tissue on the inside of the body. The body usually forms scar tissue in response to inflammation and injuries. This tissue may, therefore, form after surgery.
Advanced endometriosis can cause adhesions to form. Endometriosis causes the type of tissue that lines the uterus to grow in other places, such as on the fallopian tubes, ovaries, or bladder. These growths are called implants.
Endometriosis implants cause inflammation when they grow and bleed during a person’s menstrual cycle. The body responds to this inflammation by forming scar tissue during the healing process.
Large clumps of scar tissue may develop in the areas that endometriosis affects.
Adhesions can cause serious complications, particularly when they are very large. For example, an endometrial adhesion can attach to the ovaries, cutting off the blood supply. It may also trap blood in the ovaries, causing ovarian cysts.
Adhesions can also affect fertility, making it more difficult for an egg to travel to or implant in the uterus. Research suggests that between 30% and 50% of people with endometriosis have fertility issues.
Endometriosis is not the only condition that causes adhesions, however. A person may develop adhesions in the pelvic region due to:
- an inflammatory disorder
- a severe infection
- an injury or trauma to the uterus or surrounding areas
- surgery, including surgery for endometriosis
Having endometriosis surgery can increase the risk of adhesions. Even surgery to remove adhesions can cause new adhesions.
Although many people with endometriosis adhesions report having pelvic pain, few studies have assessed the relationship between adhesions and pain.
Some doctors argue that the correlation between adhesions and pain is not a clear one.
For example, there are experts who believe that the pain from endometriosis is different than the pain from adhesions. Dr. Harry Reich, an endometriosis specialist, states:
“Endometriosis pain results directly from the inflammatory process going on inside of endometriosis lesions. Adhesions, when they bind the bowels, can cause their own pain, which is separate and different from endometriosis pain.”
A 2009 study looked directly at the role of adhesions in endometriosis pain. The researchers identified an association between pain symptoms and the location and extent of the adhesions.
However, a smaller but more recent study found that the presence of pelvic adhesions did not correlate with the participants’ self-reported pain levels.
In fact, the group of participants with the lowest reported pain scores included the highest proportion of people with adhesions. Physical, social, and emotional scoring showed that these individuals were best able to cope with their pelvic pain.
Some other symptoms that people with adhesions may experience include:
- vaginal pain
- abdominal pain
- rectal bleeding
- damage to the ovaries, including ovarian torsion, which happens when an ovary twists
- bleeding between periods
- chronic inflammation that causes pain
Some doctors classify endometriosis into stages from 1 to 4 to reflect the amount and severity of the implants. People with stage 3 or 4 endometriosis are more likely to have adhesions.
There is no consensus on what symptoms endometriosis adhesions cause, however, and research is ongoing.
Endometriosis adhesions can form anywhere in the pelvis or abdomen, including the:
- ovaries and fallopian tubes
- outside of the uterus
Surgery can remove endometriosis adhesions, which may help preserve fertility, reduce bleeding and pain, and prevent injuries to the ovaries.
However, surgery does not treat the underlying disease process, so the symptoms can return.
Endometriosis can cause additional adhesions to form even after surgery. Moreover, the surgery itself is a risk factor for endometrial adhesions.
The reason for this is that inflammation and scar tissue are normal parts of the healing process. Surgery creates a wound that must heal, increasing the risk of scar tissue and adhesions forming.
Dr. Harry Reich recommends that people considering surgery for either endometriosis or endometriosis adhesions avoid ablation procedures, as these create more dead tissue.
Surgery does not cure endometriosis, but it can help reduce symptoms. Depending on a person’s symptoms and treatment goals, they may need additional treatment to reduce the risk of more adhesions forming.
As surgery itself is a risk factor for adhesions, it is also possible to develop more adhesions following treatment.
In the days following surgery, it is vital to reduce the risk of infection. A doctor may prescribe antibiotics. A person should seek prompt medical care for a fever, intense pain, swelling, or any other signs of infection.
Researchers have not yet thoroughly investigated long-term outcomes in people who have surgery for adhesions.
It is impossible to self-diagnose adhesions, but a doctor can use medical imaging to detect them.
If a person has adhesions, the following questions can help them understand their diagnosis and treatment:
- How severe are my endometriosis adhesions?
- Do my adhesions require treatment?
- What are my treatment options?
- What are the risks of surgery?
- Is there anything that I can do to minimize the risks of surgery?
Endometriosis adhesions may cause pain and other symptoms, depending on their location. In severe cases, they may even damage organs.
The right treatment can reduce the risk of long-term complications, but it is important to weigh up the benefits and risks with a knowledgeable endometriosis specialist.
Surgery to remove endometriosis implants and adhesions can lead to more adhesions forming, so research is ongoing to find effective treatments.