Adhesions in endometriosis

by Lone Hummelshoj
Women with endometriosis describe the pain associated with adhesions as "stabbing, sharp, pulling, sickening, intense and nauseating" whereas adjectives most commonly used to describe active endometriosis pain itself are "burning, pinching, dull, heavy, and miserable" [1].
Adhesions are bands of fibrous scar tissue, which forms inside the body. They can be found anywhere in the body between almost all organs and tissue. For women with endometriosis, they may bind an ovary to the side of the pelvic wall, or they may extend between the bladder and the uterus, etc.
Whilst adhesions are more often than not spoken of as a postoperative complication then this does not necessarily hold entirely true for women with endometriosis, eventhough they, of course, are a group of people who often have had numerous surgeries and thereby, by that factor alone, increase their risk of developing further adhesions [2].
Endometriosis, however, can cause local inflammation, which is a key factor in adhesion formation. Adhesions may therefore form as a result of endometrial implants bleeding onto the area around them, causing inflammation, which again leads to the formation of scar tissue as - ironically - part of the healing process. Unfortunately, sometimes this injured tissue does not just form a scar it comes into contact with another inflamed area nearby and forms a band of scar tissue - an adhesion - between these two areas. Adhesions vary in appearances from thin, flimy and transparent to thick, dense, and opaque. In some cases, adhesions have been found to such a extent throughout the pelvis to create what is known as a "frozen" or "fixed" pelvis.
Just like endometriosis itself, adhesions can cause pain and subsequently affect a woman's quality of life to the extent that her day-to-day activities are impaired [3,4].
Yet, whilst the problem of adhesions in endometrisis is widely recognised, there is at the moment no way of preventing them, when caused by the disease alone, nor a fool proof profylactic which can be applied during surgery, though many companies are at present working on finding a product which prevents adhesions.
The field of adhesions, and their prevention, remains controversial, as these discussions prove:
Adhesions: an updateDr Ken Sinervo, USA
The impact of adhesions on endometriosisDr Robert Franklin, USA, and Professor Hugo Verhoeven, Germany

REFERENCES1. Zimlicki P, Ballweg ML. Adhesions and endometriosis: the puzzle continues. In: Ballweg ML, ed. The Endometriosis Sourcebook. Chicago: Contemporary Books Inc, 1995:146.2. Hummelshoj L. Endometriosis: a special problem with adhesions. Adhesions News and Views 2002;1:25-26.3. Duffy DM, diZerega GS. Adhesion controversies: pelvic pain as a cause of adhesions, crystalloids in preventing them. J Reprod Med 1996;41(1):19-264. Steege JF. Clinical significance of adhesions in patients with chronic pelvic pain. In: diZerega GS, ed. Peritoneal Surgery. New York: Springer Verlag, 2000:343-348.

Source: Endometriosis.org