Adhesions

Overview

Adhesions are bands of scar tissue that form between organs and tissues inside your body. They can make organs stick together, which may cause pain or other problems. They most commonly form in the belly (abdomen) after surgery.

Yes, adhesions are very common. Most people who have abdominal surgery develop adhesions, though many don't know it because they don't have symptoms.

Anyone who has had surgery in the belly or pelvic area can get adhesions. They can also happen after infection or inflammation, and sometimes for no known reason. They can affect people of any age, but are more often diagnosed in adults.

Symptoms

Common symptoms

• Dull or sharp belly pain that comes and goes
• Bloating or a feeling of fullness
• Nausea or vomiting
• Changes in bowel habits, such as constipation

Symptoms in children

• Fussiness or crying more than usual
• Poor feeding or lack of appetite
• Vomiting or a swollen belly

Symptoms in older adults

• Confusion or being unusually tired (sometimes the first sign of a problem in older adults)
• Belly pain that may be less obvious than in younger people
• Constipation or difficulty passing gas

Causes

Main causes

• The body's natural healing response after surgery can create scar tissue inside the belly.
• Inflammation or infection in the belly or pelvic area (such as appendicitis or pelvic inflammatory disease)
• Injury to the belly area or prior radiation treatment
• Sometimes, adhesions form for no known reason

Risk factors

• Having had abdominal or pelvic surgery, especially surgery involving the bowel or female organs
• Having had surgery on the same area before
• Conditions that cause inflammation in the belly, such as endometriosis or inflammatory bowel disease
• Peritonitis (infection of the lining of the belly)

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe belly pain, repeated vomiting, or a swollen hard belly, seek urgent care or call your local emergency number.
• If you cannot keep fluids down or have not passed gas or had a bowel movement for more than a day with pain

Book a routine appointment if:

• If you have ongoing belly pain, bloating, or changes in your bowel habits that worry you, make an appointment with your GP.
• If you have had surgery before and are now having new digestive symptoms

Diagnosis

Your doctor will start by asking about your symptoms and medical history, especially any past surgeries. They will examine your belly. Adhesions cannot be seen or felt from outside, so imaging tests may be needed.

Tests that may be done

• Abdominal X-ray
• Ultrasound
• CT scan (computed tomography) – a detailed scan that shows organs and scar tissue
• Barium meal or enema – a special drink or liquid that coats the bowel to show blockages

What to expect at your appointment

You may be referred for scans at a local hospital. These scans are painless. If an adhesion is causing a bowel blockage, the imaging will help the doctor decide whether you need hospital care.

Treatment

Treatment depends on whether the adhesions are causing symptoms and how serious those symptoms are. Many people need no treatment at all. When adhesions cause pain but no blockage, your doctor may suggest ways to manage symptoms at home.

Self-care at home

• Eat small, frequent meals rather than large ones
• Eat slowly and chew well
• Take gentle walks to help keep your bowels moving
• Avoid heavy lifting if it makes your pain worse
• Drink plenty of water, unless your doctor tells you otherwise

Medical treatments

Your doctor may recommend general pain relief available without a prescription, but always ask your pharmacist or doctor which is safe for you. If you have a bowel blockage, hospital care is needed. This may include fluids through a drip and a tube to decompress the stomach, and sometimes medicines to help the bowels work.

When is surgery considered?

Surgery to cut adhesions may be needed if a blockage won't resolve or if pain is severe and other treatments haven't helped. This is usually done with keyhole surgery.

Living with this condition

Most people with adhesions live normal lives. If you have discomfort, learning which foods and activities help can let you manage your symptoms day to day.

Lifestyle tips

• Listen to your body and rest when you need to.
• Stay gently active – walking is often beneficial.
• Manage stress through relaxation or breathing exercises.
• Keep a diary of what makes your symptoms better or worse.

Diet and exercise

Eat a balanced diet with plenty of fibre, fruits, and vegetables to keep stools soft and avoid constipation. Drink enough water. Gentle exercise like walking or swimming can support bowel function and overall wellbeing. If exercise triggers pain, talk to your doctor.

Mental health and emotional wellbeing

Living with chronic belly pain can be frustrating and exhausting. It's normal to feel anxious or down. Talk to your doctor if your mood is affected – support is available.

Prevention

Adhesions cannot always be prevented, especially after surgery. Surgeons use techniques to reduce adhesion formation, such as using special gels or barrier materials during surgery, but these do not always work. Ask your surgeon about what is used in your case.

Vaccines

There is no vaccine for adhesions.

Screening programmes

There is no routine screening test for adhesions. They are found when symptoms occur or during imaging or surgery.

Complications

If left untreated

• Bowel obstruction (a blockage of the intestines) – a medical emergency
• Strangulation – if the blood supply to the bowel is cut off, which can be life-threatening
• Chronic pain or discomfort
• Difficulty getting pregnant in women, if adhesions involve the fallopian tubes or ovaries

Long-term outlook

The outlook is generally very good. Most adhesions cause no harm and many never require treatment. Even when symptoms occur, there are many ways to manage them. If you ever develop signs of a blockage, getting help quickly leads to good outcomes.

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