Can Adhesions Contribute to Infertility or Endometriosis?

18940429_sEvery one of us develops adhesions, or internal scars, throughout life. Adhesions can form anywhere in our bodies, as the first step in the healing process after an infection, inflammation, surgery or trauma. An injury to the tissues from any cause may result in the formation of adhesions. Abdominal surgery is the most common cause of iatrogenic abdominal adhesions. Of patients who under go abdominal surgery, ninety-three percent (93%) develop adhesions. Surgery in the lower abdomen and pelvis, including bowel and gynecological operations, carries an even greater chance of abdominal adhesions.

Endometriosis

It is very common for abdominal adhesions to form in women who suffer from endometriosis.  This can happen either when two deposits of endometriosis touch in the abdomen and become fused and cause adhesions. They can also form because of scar tissue following surgery for endometriosis.

Uterine adhesions are a different condition than uterine fibroids or endometrial polyps, and are treated differently. Women with adhesions may not experience any symptoms, and some women may only experience absent, light, or infrequent menstruation cycles. The more significant effects of uterine adhesions can be inability to get pregnant or recurrent miscarriages. In more rare cases, the menstrual flow may be blocked by the adhesions, causing pelvic pain or dysmenorrhea (painful menstrual periods).

Intrauterine adhesions (also referred to as Asherman’s Syndrome) form when scar tissue builds up between the inner walls of the uterus causing the walls to bind together. Intrauterine adhesions often occur after trauma to the uterine cavity, such as dilation and curettage (D&C), which is performed for pregnancy termination or miscarriage, excess uterine bleeding after childbirth, or other gynecological conditions.

Infertility

Adhesions can frequently be the cause of infertility. If the adhesions are near or in the fallopian tubes movement of the egg will be limited and may prevent it from reaching its destination and becoming fertilized. Adhesions may even limit menstruation and the release of eggs. Additionally, they may cause problems with attachment. Once the egg is fertilized, it should attach to the uterus. However, if there are problems with adhesions, this may not occur and a missed miscarriage could actually occur instead.

Doctors associate signs and symptoms of adhesions with the problems an adhesion causes rather than from an adhesion directly. As a result, people experience many complaints based on where an adhesion forms and what it may disrupt. Typically, adhesions show no symptoms and go undiagnosed.

What are the Symptoms of Abdominal Adhesions?

Although most abdominal adhesion goes unnoticed, the most common symptoms are chronic abdominal or pelvic pain. The pain often mimics that of other conditions, including appendicitis, endometriosis or diverticulitis.

Chronic Pain

It has been shown recently that peritoneal adhesions contain nerve fibers. Although the function of this innervation is unknown, it may be speculated that they play some role in the pathogenesis of chronic pain.

Adhesion formation is a complex process that involves multiple factors. The formation of a blood supply appears to play an important role in the development of intraabdominal adhesions. Over time, the adhesion may provide the framework for vascular growth, during the process of forming a blood supply to the adhesion.

Adhesions can have their own nerve and blood supply.

Adhesions can have their own nerve and blood supply. Upper photos show blood vessel supporting adhesion. Lower photos show abdominal wall after surgery to remove adhesion.

Abdominal adhesions can cause intestinal obstruction and female infertility. Abdominal adhesions can lead to female infertility by preventing fertilized eggs from reaching the uterus, where fetal development takes place. Women with abdominal adhesions in or around their fallopian tubes have an increased chance of ectopic pregnancy. Abdominal adhesion inside the uterus may result in repeated miscarriages.

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Adhesions in the belly (abdomen) can cause a kink, twist or pulling may cause a reduction in transit time or blockage of the intestines, causing constipation. Other intestinal problems can accompany the pain. Alternating constipation with diarrhea from partial obstruction can also be seen. Symptoms include:

  • Bloating or swelling of your belly
  • Bad menstrual cramps
  • Painful intercourse
  • Constipation
  • Reduced flexibility and stiffness
  • Pulling sensation
  • Pulling or stabbing pain
  • Nausea and vomiting
  • No longer being able to pass gas
  • Pain in the belly that is severe and crampy
  • Adhesions in the pelvis may cause chronic or long-term pain.

Most commonly, adhesions cause pain by pulling nerves, either within an organ tied down by an adhesion or within the adhesion itself.

  • Adhesions above the liver may cause pain with deep breathing.
  • Intestinal adhesions may cause pain due to obstruction during exercise or when stretching.
  • Adhesions involving the vagina or uterus may cause pain during intercourse.
  • Pericardial adhesions may cause chest pain.
  • It is important to note that not all pain is caused by adhesions and not all adhesions cause pain.
  • Small bowel obstruction (intestinal blockage) due to adhesions is a surgical emergency.

Adhesions form in response to injury, inflammation, surgery, C-sections, repetitive stress, infection, chemotherapy, radiation, cancer, endometriosis, colitis, or poor posture. Once they form, adhesions can become larger or tighter over time. Symptoms and 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.

Adhesions may occur on the surface of our organs and muscles, or deep within them. This may create more irritation and set up a cycle, which increases the formation of adhesions that will persist long after the original trauma has healed. Adhesions often join structures from different bodily systems with strong glue-like bonds that can last a lifetime.

Some adhesions produce dense, three-dimensional matrices. Force alters the biochemistry of the “3D-matrix adhesions.” Adhesions sense and react to physical stress that enhances three-dimensionality and rigidity of the adhesions.

Small Intestine Adhesion

Small Intestine Adhesion

Adhesions may attach to organs, nerves, muscles and other structures, restricting movement and creating blockages and pain. They can join any structure in the body to its neighbor, or to distant structures, causing confusing symptoms of pain or dysfunction. Adhesion can cause a decrease in ranges of movement, as well as affect the speed and quality of those movements.

Externally, they may be seen as a scar on the skin.  Internally, the scar may not be able to be seen, but may be able to be felt by the patient. Some adhesions may be microscopic and invisible to the human eye, creating no discernable problems. Other adhesions may become so large they cause blockages in the fallopian tubes or the bowel.  Adhesions may occur in any area of the body and cause a wide range of discomfort or dysfunction. Adhesions may be filmy or coarse, thick or thin. They may be small enough to join individual muscle cells, deep within a structure. Or they may grow so large that they stretch down the torso from neck to waist, bending a person forward so s/he literally cannot stand erect. Filmy adhesions between movable organs and the peritoneum appear to be worse in terms of generating pain. A Surgical nurse once told me she witnessed an adhesion wrapped around the bowels unravel like a bungee cord when the surgeon cut it.

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As the body’s tissues heal and adhesions are formed, the tissues begin to shrink and pull, which results in restricted movement of the area. This ‘pull’ creates more mechanical irritation, often perpetuating the cycle of adhesion formation. Most people describe pain from adhesions as “pulling” or “stabbing”.

Adhesions may also cause other physical symptoms such as nausea, constipation, infertility, irritable bowel syndrome, headaches, dizziness, and restricted movements, such as the inability to raise an arm, bend a leg, or twist the torso.  Adhesions also restrict blood flow and if they attach to a nerve may cause pain in areas of the body far removed from the original site of the injury.

For example, a fall on the hip or tailbone can cause adhesions to form as the body’s first healing response to that trauma. And while you may only feel the pain at your hip or tailbone after the fall, the adhesions that formed to help you heal from the injury can bind nearby organs such as the bowel, bladder, fallopian tubes or ovaries, prostate or testicles.

What does pain caused by adhesions feel like?

Most will notice the pull of adhesions as tightness, decreased range of motion, or pulls in specific areas of the abdomen. Initially this may be accompanied by a dull pain or ache in these areas that continues or increases over time.

Adhesions create problems in the body when they:

  • Put pressure on pain-sensitive tissues or other structures
  • Pull on nerves causing pain
  • Fasten structures that should be mobile, causing dysfunction such as poor digestion, or even infertility
  • Cause stiffness, reduce flexibility or movements are slower

When nerves or pain-sensitive structures become bound by adhesions, the result is pain. Dysfunction occurs when adhered organs and muscles become inefficient, ineffective, or unable to properly do the job for which they were designed.

What are the Causes of Abdominal Adhesions?

Ischemia (low blood supply and oxygen) has been thought to be the most important insult that leads to adhesion development. Furthermore, a deficient, suppressed, or overwhelmed immune system is an underlying mechanism in adhesion development. Abdominal adhesions can also result from irritations not related to surgery, including:

  • Visceromotor or Surgical Ischemia – Low Blood Supply
  • Hypoxia – Low Oxygen
  • Increased Barrier Variable Permeability – Leaky Gut
  • Imbalanced cytokine, chemokines and Immune Status
  • Exposure to endotoxins, i.e. lipopolysacchride (LPS) produced by bacteria
  • Trauma – physical, surgical
  • Oxidative stress – free radicals
  • Low White Blood Cells
  • Abdominal infections, Appendix rupture
  • Parasitic Infection
  • Gynecological infections
  • Menstrual blood or blood clots
  • Chronic Poor Posture

Support to Reduce Formation of Adhesions

There is no cure for adhesions. However, there are ways to reduce their formation and problems they cause. Several keys issues need to be supported simultaneously – ischemia, hypoxia, and inflammation. These are the main instigators of adhesion formation. Simply doing bodywork to break up the adhesion gives limited short-term symptomatic relief. Support for the reduction and formation of adhesions must include nutritional support to balance neurotransmitters and control the immune response from cytokines in addition to bodywork.

  • Chiropractic

Chiropractic physicians utilizing Sacro Occipital Technique can perform treatments that restore blood supply to the organs. It involves more than just a spinal adjustment. They perform organ reflex procedures to support the blood supply. These procedures support the Autonomic nervous system.

The Autonomic nervous system controls your blood supply. Have you ever heard that you should not go swimming after eating a big meal? It is true. We have enough blood to digest food or support muscles but not at the same time. Blood flows like the ocean tide bringing muscle waste and carbon dioxide into your core for elimination while being replenished with nutrients and oxygen to be sent back out.

Chronic stress puts your system into Sympathetic dominance. This state shunts your blood away from your organs causing them to be ischemic and hypoxic. In simple terms, there is a low blood supply with low oxygen distributed around the organs. Low oxygen increases inflammation setting up a vicious cycle towards adhesion formation.

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  • Yoga,

Apart from the fact that yoga will ask the use of your spine in every possible direction (even if you have restrictions) in addition to strengthening your core muscles – which will very naturally give your internal belly a good workout – there are specific poses which can actively help to break up adhesions.

If you are new to yoga or embarrassed to attend a class with the yoga queens in their pretzel poses. Or maybe you don’t have the time to do an hour-long yoga class. I recommend Rodney Yee’s A.M. Yoga for Your Week with five 20-minute focused morning routines appropriate for all skill levels. There are no weird pretzel poses but the five routines work through the entire body. If I miss a day, I use today’s date to determine which one to do.

  • Rolfing, Deep Tissue Massage

There are many hands-on pain relief methods, such as massage, trigger point therapy, stretching, physical therapy and others. Among these is Rolfing, which specializes in soft tissue release. Basically, by releasing the adhesions and scar tissue holding muscle, fascia and tendon locked into spasm, freer movement can be restored.

The adhesion is both overrated and poorly understood by many healthcare practitioners. There are many techniques that have been developed to suddenly break adhesions from its attachments. Many practitioners seem to think that they can palpate fibrous adhesions. This is a direct mistake. In the first place it is often impossible to examine by touch deeply enough to reach the adhesion and secondly it is impossible to determine its presence by feel alone. It is possible to note lack of movement in adhered tissues by touch, but touch offers no specific clue as to the actual area of attachment.

The fibrous adhesion must depend upon the body for nourishment, therefore, it is more clearly evident that their technique does not instantly detach the adhesion, rather it causes its source of nourishment to become diminished and the adhe­sion is reabsorbed back into the body from which it came.

  • Regulation of Cytokine and your Immune Status

Specific cytokines are responsible for initiating adhesion formation. This recognition leads to the possibility of altering adhesion formation by modifying cytokines and the immune status. This is done supporting the anti-inflammatory cytokines and inhibitory neurotransmitters.

Only lab tests can tell the actual levels of cytokines and neurotransmitters. Questionnaires are helpful but need to be viewed in relation to the lab results. Call 530-615-4083 for more information.

The secret of health lies in maintaining normal flow of all digestive juices, anabolic processes, catabolic process, normal hormones and enzymes, normal secretion, absorption and elimination. When all tissues of the human body that are resilient and remain well within these elastic limits, health abounds. When all movable internal organs remain movable, life abounds to its fullest. When a movable organ becomes impinged upon by an adhesion, you have interference with the normal life forces, which result in disease and diminishing health.

Fill out the Thyroid Assessment Questionnaire

Fill out the Autoimmune Questionnaire

Send in the Thyroid Assessment Questionnaire or Autoimmune Questionnaire to schedule a free 15 minute consultation.

Call today! 530-615-4083

2 thoughts on “Can Adhesions Contribute to Infertility or Endometriosis?

  1. Dr. Dave, again awesome! I didn’t know that chronic inflammation, infection can lead to adhesion. I taught it was only when we had surgery.If seone had many body treatments such as rolfing and sacro cranial treatments before the chronic state of inflammation would that help not forming adhesion?

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