Adhesions Following Cesarean delivery

Adhesions following a cesarean delivery are a common condition affecting 24-73% of women. They are bands of scar tissue that form anywhere in the abdomen after surgery, including between the surgical incision and internal organs such as the uterus, intestines, and bladder. (1)


In most cases, adhesions do not cause any problems. However, sometimes it can narrow, twist, or trap the intestines, leading to various complications. (1)

Symptoms of Adhesions Following Cesarean delivery

Early diagnosis and treatment of adhesions are essential. Pay attention to these possible signs: (3)

  • Chronic pelvic pain, especially that gets worse during ovulation, menstruation, or sexual intercourse.
  • Abdominal pain, cramping, or bloating.
  • Changes in bowel habits, such as constipation or difficulty passing gas.
  • Nausea and vomiting.


If you experience any of these symptoms after a cesarean section, consult your doctor to discuss the possibility of adhesions and appropriate treatment.


Causes of Adhesions Following Cesarean delivery

After a cesarean section, the body may begin to form scar tissue between the surgical wound and the internal organs. This formation leads to these organs connecting to each other, causing adhesions. (2)


There are a number of factors that increase the chance of adhesions occurring, including: (1) (4)

  • Number of cesarean deliveries: The more C-sections you have, the more likely you are to develop adhesions.
  • Previous abdominal surgeries: Any previous abdominal surgeries increase the risk of adhesions.
  • Infection: Postoperative infections can increase inflammation and adhesions formation.
  • Other factors: Such as ischemia at the site of the operation, a quantity of blood remains at the site of the wound or bleeding occurs during the operation, and the type of stitching of the wound.


Diagnosis of Adhesions Following Cesarean

Unfortunately, there is no definitive way to diagnose adhesions without endoscopic surgery. Doctors often rely on your symptoms, medical history, and clinical examination to make a diagnosis. In some cases, imaging tests may be used, but they are not always accurate. (5)


Treatment of Adhesions Following Cesarean

There are three main methods for treating adhesions after cesarean section:


Massage therapy

The doctor massages the abdominal area to break up the formed scar tissue and relieve the discomfort that the patient is experiencing. (6)


Advantages:

  • A non-surgical solution that does not cause any harm.
  • Inexpensive.
  • Relieves pain and discomfort associated with adhesions.
  • Increases abdominal flexibility and movement.

      


Disadvantages:

  • It is not a suitable and effective option for everyone.
  • Not all adhesions may respond well to it; its effectiveness depends on the severity of the adhesions and their location.
  • It provides temporary relief, and adhesions often return over time.


Laparoscopy

This procedure involves making small incisions in the abdomen and inserting a laparoscope, a thin tube with a camera and specialized tools at its end, to visualize, locate, and remove adhesions. (7)


Advantages:

  • A safe and simple procedure performed through small incisions in the abdomen, which reduces the risk of complications and new scarring.
  • It requires a shorter recovery time compared to other surgeries.
  • High accuracy; the surgeon often targets and removes the adhesions without causing damage to healthy tissue.
  • It does not cause much pain compared to open surgery.


Disadvantages:

  • It may not be an appropriate choice for large or complex adhesions.
  • It causes discomfort due to the gas used during endoscopy to increase the size of the abdomen.
  • It may increase the chance of new adhesions forming over time.



Open surgery

This procedure involves reopening the abdomen to remove adhesions. (3)


Advantages:

  • The doctor can see the adhesions accurately and remove them completely, thus reducing the chance of the adhesions returning over time.
  • Symptoms of adhesions disappear immediately after the procedure.


Disadvantages:

  • Because the procedure involves opening the abdomen completely, this causes many complications and risks.
  • The patient needs longer time to recover compared to previous treatments.
  • This procedure leaves a large scar in the abdomen, which may be annoying for some women.
  • The surgery itself can cause adhesions to return.




Comprehensive Care After Cesarean Delivery! At Al-Ahli Hospital’s Obstetrics and Gynecology Department, our expert medical team specializes in diagnosing and treating post-cesarean adhesions using the latest technologies and advanced medical standards—ensuring a safe, comfortable, and effective recovery. Book your appointment today for personalized care.




Frequently Asked Questions

When do adhesions occur after cesarean section?

There is no specific time for uterine adhesions to occur after a cesarean section. They can occur a few weeks, a few months, or even years after undergoing a cesarean section. (1)


What are the possible complications of postpartum adhesions?

It often does not cause problems, but it may sometimes cause: (3)

  • Chronic pelvic pain: It is the most common complication, and causes persistent pain in the lower abdomen or pelvis.
  • Bowel obstruction: Adhesions can obstruct the intestines, leading to colic, bloating, constipation, and vomiting. In severe cases, it may require surgery.
  • Intestinal perforation: Rarely, adhesions can cause a rupture or opening in the intestine, requiring emergency surgery.
  • Infertility: For some women.


Do adhesions after cesarean section prevent pregnancy?

Yes, adhesions after cesarean section can prevent pregnancy in some cases, such as: (5)

  • If it affects the uterine lining such that it becomes unsuitable for the implantation of a fertilized egg.
  • If it affects the ovulation process.
  • If it affects the fallopian tube and prevents the sperm from reaching the egg to fertilize it.
  • If it causes pelvic inflammatory disease.


However, this does not necessarily mean that all women with uterine adhesions will experience fertility issues. Many women discover their adhesions during a second cesarean section. If the adhesions affect fertility, surgical intervention may improve the chances of conception. If the surgeon cannot remove them completely, in vitro fertilization (IVF) may be suggested. (7)

                                              

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