Adhesions / scar tissue (in pelvis or in uterus)

Understanding Pelvic and Uterine Adhesions: Causes, Symptoms, and Treatment Options

Pelvic and uterine adhesions are an often hidden cause of chronic pain, fertility challenges, and menstrual issues. Many women live with symptoms for years without realising that scar tissue could be silently affecting their health.

If you’ve experienced surgery, infection, or endometriosis and now face ongoing pelvic discomfort, it’s worth exploring whether adhesions could be the underlying cause. As a private gynaecologist in London, I regularly see women who find 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. Females 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, potentially affecting fertility. Adhesions can also impact the uterine cavity and vagina, leading to complications in reproductive health.

Adhesions can significantly affect the reproductive health of females and the function of their uteruses.

How Does Scar Tissue Formation Lead to Adhesions?

Pelvic and uterine adhesions often occur in response to:

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

• Endometriosis

• Pelvic infections (such as pelvic inflammatory disease, PID)

• Trauma or severe inflammation

• Past miscarriages or D&C procedures

Scarring caused by these factors can lead to complications if not properly managed.

It’s important to know that 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, such as the pubocervical, cardinal, and uterosacral ligaments, play a crucial role in supporting the uterus within the pelvis and influence its mobility during the healing process.

Causes and Risk Factors

Adhesions can arise from several factors, including surgery, infection, and inflammation in the abdomen. The risk of developing adhesions is particularly high in individuals who have undergone surgical removal of organs or tissues, 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 susceptible to adhesions due to their unique configurations. Additionally, the formation of hypertrophic scars and the use of radiation therapy can further increase the risk of adhesions. Understanding these causes and risk factors is essential for developing effective 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, while others have more serious complications. Additionally, acne can lead to scarring, which may contribute to 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 challenging because they often don’t show up clearly on standard imaging like ultrasound. A high index of suspicion, combined with patient history, is crucial.

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.

The importance of clinical trials in improving diagnostic techniques for adhesions cannot be overstated, as they help validate the effectiveness of new methods and technologies.

How Can Pelvic or Uterine Adhesions Affect Fertility?

Adhesions can significantly impact 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 affecting how the uterus grows during pregnancy, which can impact the development of the fetus

• Creating inflammation that reduces egg quality or uterine receptivity

Women trying to conceive may struggle without understanding that scar tissue is interfering. Prompt diagnosis and treatment can greatly 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 personalised to your specific situation and goals.

Options include:

• Conservative management: This may involve physical therapy, medications, and lifestyle changes. Additionally, onion extract has been noted for its potential 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 effectiveness and lead to better outcomes.

Conservative Management

• For mild adhesions causing 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, providing even greater precision for complex adhesions

• Fertility-preserving techniques wherever possible

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

Post-Surgical Care

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

Complications and Prevention

Adhesions can lead to a range of complications, including intestinal obstruction, bowel ischemia, and infertility. Chronic pain syndrome is another common complication, significantly impacting 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. Maintaining good upright 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 to manage this medical condition.

Living with Adhesions

Chronic pelvic pain, fertility struggles, or the frustration of 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 personalised, empathetic 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.