Adhesions are believed to cause pelvic pain by tethering down organs and tissues, causing traction (pulling) of nerves. Nerve endings may also become entrapped within a developing adhesion causing severe pain. Also if the bowel becomes obstructed, distensions will cause pain.

Some patients in whom chronic pelvic pain has lasted more than six months may develop "Chronic Pelvic Pain Syndrome.” In addition to the chronic pain, emotional and behavioural changes appear due to the duration of the pain and its associated stress.

Despite doubts as to the relationship between Adhesion and pain, several studies show that lyses (cutting) adhesiolysis of Adhesions can provide some relief. Although this is not always guaranteed.

Treatment of Chronic Pain

A full discussion of this subject is outside the scope of this article and I would recommend visiting The World Congress on Pain, The International Pelvic Pain Society and The Endometriosis Society for more information. The first step towards treatment is of course diagnosis, and your doctor will take a history, examine you and possibly conduct some tests, in an attempt to determine the cause of pain. These tests may include a laparoscopy.

In limiting my remarks to patients in whom Adhesions are believed to be the cause of pain, I will start out by saying that there are no easy answers. There may not be a cure for the pain, but it may be controlled to a more acceptable level.

For reasons stated above, adhesiolysis may not be the answer and may not even be the first choice. I would certainly ask your doctor if s/he might consider an adhesiolysis. If s/he was able to use an Adhesion barrier, s/he needs to read the product label to determine whether it is appropriate.

If extensive adhesiolysis surgery is required, often a general surgeon will be (and should be) asked to collaborate with the gynaecological surgeon. Pain mapping is an emerging technique where, under local anaesthetic, the surgeon attempts to locate the focus of pain by prodding different areas within the pelvis. Sometimes pain is associated with Adhesions, and sometimes Adhesions (or even loci of endometriosis) do not appear responsible for the pain.

If an endometriosis site is discovered and removed, this should be covered with an adhesion barrier.

I would also seek the counsel of a pelvic pain specialist who may suggest other treatments including trigger point injections, neuroablative procedures (where certain nerves from the 'source' of the pain are cut) as well as drug treatments, physical therapy, exercise and dietary changes. In extreme cases where bowel function is disturbed, comprehensive nutritional support is a necessity.