Adhesions / scar tissue (in pelvis or in uterus)

Pelvic and Uterine Adhesions: Causes, Symptoms, Treatment Options

Pelvic and uterine adhesions are a hidden cause of chronic pain, fertility issues and menstrual problems. Many women live with symptoms for years without realising scar tissue is silently affecting their health.

If you’ve had surgery, infection or endometriosis and now have ongoing pelvic discomfort it’s worth exploring whether adhesions could be the underlying cause. As a private gynaecologist in London I see many women who get real relief once these hidden problems are identified and treated properly.

What are Adhesions?

Adhesions are bands of scar tissue that form inside the body. Instead of normal healing after an injury, surgery or infection the tissues stick together abnormally — creating connections where none should exist. Women can be particularly affected by adhesions due to the complexity of their reproductive organs.

In the pelvis or uterus adhesions can involve:

• The uterus

• Fallopian tubes

• Ovaries

• Bladder

• Bowel

• Pelvic walls

• Vagina

• Uterine cavity

These bands of scar tissue can restrict normal movement of organs, cause pain, block the fallopian tubes or distort the shape of the uterus and affect fertility. Adhesions can also affect the uterine cavity and vagina and cause reproductive health problems.

Adhesions can significantly affect a woman’s reproductive health and her uterus.

How does Scar Tissue Formation lead to Adhesions?

Pelvic and uterine adhesions often occur in response to:

• Previous surgeries (C-sections, fibroid removal, laparoscopic procedures)

• Endometriosis

• Pelvic infections (PID)

• Trauma or severe inflammation

• Past miscarriages or D&C procedures

Scarring from these can cause complications if not managed properly.

It’s important to know adhesions are the body’s natural response to healing — but in sensitive areas like the pelvis they can cause more harm than good over time. Ligaments like the pubocervical, cardinal and uterosacral ligaments support the uterus in the pelvis and influence its movement during the healing process.

Causes and Risk FactorsAdhesions can occur from several factors including surgery, infection and inflammation in the abdomen. The risk of adhesions is higher in individuals who have had organs or tissues removed such as the uterus or fallopian tubes. Other significant risk factors include endometriosis, pelvic inflammatory disease and previous abdominal surgeries. Anatomical structures like the anterior superior iliac spine and the male pelvis are also more prone to adhesions due to their unique shape. Hypertrophic scarring and radiation therapy can also increase the risk of adhesions. Understanding these causes and risk factors is key to developing prevention and treatment strategies.

Symptoms of Pelvic or Uterine Adhesions

Symptoms vary depending on the location and extent of the scar tissue. Some women experience mild discomfort others have more serious complications. Acne can lead to scarring which can cause adhesions.

Common symptoms include:

• Chronic pelvic pain

• Pain during intercourse (dyspareunia)

• Pain during bowel movements or urination

• Infertility or difficulty conceiving

• Menstrual irregularities (lighter periods if the uterus is scarred)

• Skin issues related to adhesions

In some cases adhesions can cause no symptoms at all and are only discovered during investigations for infertility or pain.

Adhesions can also affect the menstrual cycle by causing irregularities due to the scarring of the uterus.

How are Adhesions Diagnosed?

Diagnosing adhesions can be tricky as they don’t show up clearly on standard imaging like ultrasound. A high index of suspicion combined with patient history is key.

At Happiher, diagnosis may involve:

• Detailed consultation to understand symptoms and past surgical/infection history

• Pelvic ultrasound, sometimes with saline infusion (sonohysterography) to assess the uterus

• MRI scans in complex cases

• Diagnostic laparoscopy — a minimally invasive surgery that allows direct visualisation of adhesions including those involving the rectum

Laparoscopy is considered the gold standard for detecting pelvic adhesions especially when pain or infertility is unexplained by other tests.

Clinical trials are important in improving diagnostic techniques for adhesions as they help validate new methods and technologies.### How do Pelvic or Uterine Adhesions Affect Fertility?

Adhesions can affect fertility by:

• Blocking or narrowing the fallopian tubes which can prevent the fertilized egg from reaching the uterus and thus affect pregnancy

• Distorting the uterus making it harder for an embryo to implant and how the uterus grows during pregnancy which can impact the development of the fetus

• Causing inflammation that reduces egg quality or uterine receptivity

Women trying to conceive may not know that scar tissue is the issue. Early diagnosis and treatment can improve fertility outcomes.

Treatment Options for Adhesions

Treatment depends on the severity of the adhesions and the symptoms they are causing. At Happiher every treatment plan is tailored to you and your goals.

Options include:

• Conservative management: This may involve physical therapy, medications and lifestyle changes. Onions have been noted to have benefits in scar management particularly in preventing scar formation and reducing inflammation.

• Surgical treatment: In some cases surgery may be necessary to remove adhesions. Combining surgery with other treatments such as mitomycin C or cryotherapy can enhance the outcome and lead to better results.

Conservative Management

• For mild adhesions with no symptoms, monitoring may be all that’s needed.

Surgical Treatment

For more severe adhesions surgery can offer significant relief. Dr Kaur specialises in:

• Laparoscopic (keyhole) adhesiolysis — carefully cutting and freeing the scar tissue to restore normal organ movement

• Robotic-assisted surgery, for complex adhesions

• Fertility-preserving techniques wherever possible

Minimally invasive surgery results in less trauma, quicker recovery and reduced risk of new adhesions forming.

Post-Surgical Care

In some cases special gels or barriers can be placed during surgery to prevent adhesions from returning. Physiotherapy and pelvic floor rehabilitation may also be part of the recovery plan.

Complications and PreventionAdhesions can cause a range of complications including intestinal obstruction, bowel ischemia and infertility. Chronic pain syndrome is another common complication that can significantly impact a person’s quality of life. Preventing adhesions involves managing symptoms and preventing further scar tissue formation. This can be achieved through various treatments including scar massage, pressure therapy and laser therapy. Good posture and avoiding heavy lifting can also help prevent adhesions. In some cases surgical removal of adhesions may be necessary to alleviate symptoms and prevent further complications.

The pelvis which consists of the hip bones, pubic bones and sacrum plays a vital role in supporting the abdominal organs and preventing adhesions. The pelvic girdle including the hip joint and pubic symphysis helps maintain the position of the uterus and other reproductive organs reducing the risk of adhesions. By understanding the anatomy of the pelvis and its role in preventing adhesions healthcare professionals can develop effective treatment strategies for this condition.

Living with Adhesions

Chronic pelvic pain, fertility struggles or being told “everything looks normal” can be incredibly isolating. But adhesions are real — and so is the relief that comes from proper diagnosis and expert treatment. The healing process can significantly impact scar height especially when adhesions become fibrotic and affect organ function.

At Happiher we believe you deserve answers and a clear path forward. Every woman’s story is different and your care should reflect that.

Why Choose Happiher for Adhesion Management?

If you’re looking for expert care for pelvic or uterine adhesions Happiher offers:

• Fast access to private consultations

• Specialist imaging and diagnosis

• Minimally invasive and robotic surgical options

• Compassionate, tailored treatment planning

• Clinics located at Chelsea & Westminster, The Lister and The Wellington Hospital

Dr Kaur combines surgical expertise with a personal approach to help women reclaim their health and confidence.

Final Thoughts

If you suspect adhesions may be behind your pain, fertility issues or other symptoms don’t settle for uncertainty. You deserve a clear diagnosis and a team that listens.

At Happiher we’re here to support you every step of the way — from diagnosis to treatment to long term wellbeing.