PELVIC ADHESIONS

Adhesions are a type of scar tissue which forms between internal organs and their surrounding tissues. It has been estimated that 93% of all patients undergoing abdominal surgery develop internal adhesions. Though adhesions are usually referred to as a postoperative complication this is not the only factor. Endometriosis can cause local inflammation, leading to adhesions. Adhesions form as a result of endometrial tissue bleeding into the surrounding area causing inflammation, and as this “heals” scar tissue forms. Adhesions may also form as a result of infection.

In the female pelvis, adhesions may cause a number of problems including infertility, painful intercourse and chronic pelvic pain. Adhesions involving the bowel can cause bowel obstruction or blockage. Once adhesions have formed, medical complications from them may develop at any time. They are the main cause of intestinal obstruction and one of the major female factors in infertility.

Adhesions are believed to cause pelvic pain by tethering organs and tissues, and causing traction on nerves. Internal organs are most sensitive to stretching and distension, causing pain. This is particularly evident in bowel disorders. It is, however, important to understand, that not all adhesions cause pain, they may simply interfere with the normal relationship and function of ovary and tube.

Several studies have shown that surgical cutting of adhesions provides relief from pain. The problem is that to surgically treat them requires another operation and the adhesions almost always recur. Surgeons are therefore reluctant to operate; also the presence of adhesions makes surgery more difficult, with a greater chance of complications.

Non-surgical treatments include trigger point injections, drug treatments, physical therapies, and dietary changes.

Elisabeth Dicke of Germany developed connective tissue manipulation in 1929, since when there has been increasing interest in the use of physical therapy. In the past few years physical therapy has been more frequently utilised for the management of pelvic pain syndromes. The conditions that benefit from this non-surgical approach include vulvodynia, vulvar vestibulitis, dyspareunia (painful intercourse) vaginismus, interstitial cystitis and chronic pelvic pain. A more recent development, the osteopathic technique of visceral manipulation has gained more widespread medical interest.

Over the years, various clinical methods have been tested. The use of vibration, manipulation and low dose laser are well established in the field of physiotherapy. During the 1980s a number of studies in Russia and Bulgaria led to the use of these techniques for Adhesion Related Disorders (ARD).

Our clinic based, non-surgical techniques combine established gynaecological procedures and investigations, with scientifically evaluated physical therapies.