FAQs

An adhesion is an internal scar. Adhesions tend to form in all people at the site of tissue damage whenever and wherever the body heals. Adhesions consist largely of tiny but powerful strands of collagen that bind to each other and to underlying surfaces, isolating injured areas to set up the process of healing. These collagen fibers can form in random patterns to form a patch or in parallel patternslike the strands of a nylon rope.  Adhesions occur on the surface of our bodily structures or deep within them.

Adhesions can be formidable, with a strength estimated at over 2,000 pounds per square inch (140K/cm2). Responding to inflammation, they can squeeze muscles, organs, and nerves like a straitjacket, or spread to join any bodily structure to nearby, or even distant structures. When this occurs, the internal squeeze or pull can cause confusing symptoms of pain or dysfunction.

Because adhesions are virtually invisible to diagnostic tests, doctors sometimes fail to consider the profound effect these internal scars can cause. Physicians may truthfully say, “I don’t see anything” or “all tests are coming back as normal.” The mistake comes if they say “there’s nothing there” when powerful bonds are squeezing or joining areas that are designed to be free and mobile. Thus, the patient is confused by the diagnosis of “unexplained pain or dysfunction.”

Many women are not receiving the education needed from their doctors about adhesions. Very few women even know they have adhesions. Most commonly known as “scar tissue,” adhesions are simply scar tissue that forms inside the body. Once formed, the body has no way to deal with the scar tissue, so it will remain in place and sometimes spread to neighboring structures.

Adhesions consist of tiny strands of collagen that form around injured tissue as the body’s first step in the process of healing. Common areas of adhesion formation are areas affected by a prior infection, inflammation, or endometriosis. Pelvic adhesions can lead to a host of female health problems, ranging from infertility to chronic pain, including pain with intercourse. If you’ve had any kind of surgery, infection, injury, or endometriosis, there’s a good chance you have adhesions. We made a short guide that can help you figure out if you have adhesions after surgery.

Adhesions may be filmy or coarse, thick or thin. They may be small enough to join individual muscle cells deep within a structure, or large enough to stretch down the front of the torso from neck to waist, bending a person forward so that s/he literally cannot stand erect. (We frequently see this in people as they age.)

To us, adhesions appear to take four forms.

Microscopic bonds: Tiny adhesions can form as individual bonds within the structure of a muscle, organ, or joint as a response to infection, injury, or damage. When this occurs, they tend to decrease the natural mobility and function of that structure.

Curtains: Collagen fibers can join to form curtains or sheets that can cover a bodily structure or join it to another, like a sheet of stretched glue. We feel these are fairly easy for us to decrease, as we shred the curtain-like adhesion apart, like pulling out the run in a sweater.

Rope-like strands: Collagen fibers can join together like the strands of a nylon rope, creating bonds powerful enough to pull the body forward, drawing the shoulders and neck down toward the pelvis. These are among the most challenging of the adhesions we treat as we focus on detaching the fibers of the rope from one another, shredding the rope-like formation back to individual strands, then detaching the strands from the internal structures to which they are bound.

Clumps or balls: In some areas, collagen fibers join together in masses or clumps, similar to a ball of rubber bands one might see on someone’s desk. To us, these can feel like an oddly shaped ball beneath the surface. We address these similarly to the way we address the ropes, slowly detaching the balls from structures to which they are attached, then working to detach the individual strands that comprise the ball from each other.

Adhesions form as part of the body’s natural healing process after tissue damage due to an infection, inflammation, surgery, trauma, or radiation therapy. Once formed, adhesions can remain in the body for a lifetime. Due to their pull on internal structures, adhesions can cause ongoing inflammation, causing more adhesions to form. Surgery is a primary cause of adhesion formation.

Surgery – Studies show that 55% to 100% of people who undergo pelvic surgery will develop pelvic adhesions. Cutting into the delicate tissues near your reproductive structures can result in a large amount of scar tissue growing around the healing site. Many of the women we treat for secondary infertility or chronic pelvic pain have undergone a prior C-section, hysterectomy, or appendectomy  (appendix removal)

Inflammation – Recurring inflammation is a very common cause of adhesions. Pelvic inflammatory disease (PID) is a major contributor to many of the infertility and pain cases we have treated. The constant inflammation causes scar tissue to grow in the pelvic area, often around the fallopian tubes or ovaries.

Infection/STIs – Sexually Transmitted Diseases (STDs) can lead to chronic infection and inflammation, which cause scar tissue to grow within the pelvis. The longer an infection or STD remains untreated, the more adhesions will form as the body attempts to surround and contain the infection. A major cause of blocked fallopian tubes is an untreated infection as a result of chlamydia or gonorrhea.

Trauma – Contact sports, car accidents, falls, or work-related injuries are common traumas that can cause the formation of pelvic adhesions. Since the body’s first step in healing is to create adhesions to contain and isolate the injury, almost everyone has adhesions somewhere in their body.

Chronic conditions – Conditions that don’t have a definitive cure and recur periodically are considered chronic conditions. Two conditions responsible for a large portion of pelvic adhesions are polycystic ovarian syndrome (PCOS) and endometriosis. Both conditions share characteristics that result in adhesion formation. Chronic inflammation is explained in detail above, and abnormal growths within a woman’s reproductive tract. PCOS gets its name from the cysts that form on a woman’s ovary. Both the cysts and the surgeries needed to remove the cysts will cause adhesions. Endometriosis is when endometrial tissue forms outside of the uterus. Endometriomas and endometrial implants can become inflamed and cause scar tissue to form around the site, causing endometriosis infertility, period, or intercourse pain.

Radiation Therapy – We have treated many previous cancer patients for chronic pelvic pain because of radiation therapy. Radiation therapy is a treatment that can cause significant scarring and mechanical dysfunction inside a woman’s abdomen and pelvis. We often hear these patients describe their pain as a “stuck” or “tight” feeling that won’t go away.

Blocked fallopian tubes – One of the most common forms of infertility caused by adhesions is blocked fallopian tubes. Adhesions wrap around delicate structures inside the reproductive tract, preventing the reproductive system from working normally. Adhesions can restrict the flow of sperm through the fallopian tubes, preventing the fertilization of an egg. Most physicians no longer perform surgery on these delicate structures because post-surgical adhesions tend to block the tubes once again when the body heals from the surgery.

Hydrosalpinx – Another common tubal blockage is a hydrosalpinx. This occurs when fluid collects in the fallopian tube – generally as the result of an infection. As adhesions form at the end of the tube closest to the ovary, the tube swells, much as your knee might swell after a knee injury. Hydrosalpinx usually indicates a totally blocked tube; in the rare case that the end is open, the sperm still tend to get lost in a large amount of fluid in the tube, greatly decreasing the chance for conception and increasing the chance for an ectopic pregnancy, in which the fertilized egg becomes stuck in the tube.

Unexplained infertility – Adhesions don’t show up on most diagnostic tests. In order to verify that a patient has adhesions, an exploratory surgery is required to directly visualize the adhesions. Unfortunately, since most patients are unaware of adhesions, the question is never asked: “Maybe my infertility is caused by adhesions?” This can lead to many women suffering from unexplained infertility.

Prior surgery – Surgeries are sometimes necessary to save a woman’s life, as in the case of an appendectomy. There may be less urgency to perform surgery in the case of undiagnosed pain. In these cases, a doctor may suggest doing an exploratory surgery to directly visualize the pelvic contents. Because adhesions form after most pelvic surgeries, the very surgery to correct a problem can be the cause of adhesion formation as the body heals.

Chronic pain – Stuck, tight, immobile, constantly uncomfortable. These are all common descriptions we hear from patients suffering from adhesions. Because adhesions bind to structures and create constant tension, it is no wonder that so many patients with adhesions also suffer from chronic pain.

Sexual dysfunction – Some non-surgical treatments are available for women with intercourse pain (dyspareunia) or other sexual dysfunction. Studies on our work in this area have shown that women have an increase in every measurable criterion of their sexual health (desire, orgasm, lubrication, pain, and arousal) after being treated for adhesions.

Experience relief from debilitating pelvic adhesions with Clear Passage® Physical Therapy’s Free Consult and Request Info – discover how their unique, non-surgical Clear Passage® Approach has helped countless women overcome infertility, chronic pain, and sexual dysfunction caused by internal scarring, without the risks of additional surgery or medication. To learn more, visit our Apply to Therapy page.

Few options exist for treating pelvic adhesions. Many treatments are aimed at treating the symptoms of adhesions, rather than the adhesions themselves. Following the Hippocratic Oath that all physicians should adhere to, we have always believed a natural, non-surgical, and drug-free approach should be the first step in the treatment of adhesions. Below are the options we see that have passed scientific scrutiny and been found to be effective, listed from safest to most invasive:

Manual Physical Therapy – A non-surgical, all-natural treatment plan is what we consider the best treatment for adhesions. Clear Passage® has been researching and treating patients with adhesions for over 25 years. The Clear Passage® Approach (CPA) is a hands-on therapy that focuses on detaching and weakening adhesions inside the body. Helping patients have natural pregnancies, live a pain-free life, and avoid future surgeries is our number one goal.

If you or a woman you know is suffering from the symptoms above, we encourage you to complete a contact form or call us at 1-352-336-1433. You will be able to schedule a phone consultation with a member of our patient support team, at no cost, and learn whether our non-surgical and drug-free treatment is right for you.

Surgery – Lysis (destruction) of adhesions by cutting or burning them during surgery is one of the most common ways to combat adhesion growth. Many surgeons note that this isn’t a permanent solution and often leads to more surgeries, because surgery is the number one cause of adhesions. Surgery also has risks, such as the risk of anesthesia, complications or infection, and “inadvertent enterotomy” in which a surgeon mistakenly cuts into or through an organ s/he had not intended to, in the crowded and adhered structures of the pelvis.

Pain Medications – The rise in chronic pain conditions has been met with a rise in pain medication prescriptions. The opioid epidemic is a well-known phenomenon in America. Pain medication simply masks pain; they do nothing to address the cause of the pain. They do not provide permanent solutions; further, they can lead to severe digestive issues along with addiction and dependency. Pain medications should be considered a temporary palliative measure while the patient searches for an actual treatment.

According to the American Academy of Family Physicians, pain is categorized into two types: acute and chronic. Acute pain tells you that your body is injured and typically does not last long. It tends to resolve as your body heals from injury. Chronic pain can last for months or even years, interfere with your daily activities, and significantly impact your quality of life. It can lead to low self-esteem, depression, and anger. Because adhesions are a common natural occurrence in the body and are undetectable by most diagnostic tests, they are a common cause or contributor to chronic pain. We find that unexplained chronic pain is often caused by adhesions that form after a surgery, injury, or infection. Our clinic started as a place to relieve chronic pain, and that remains a central focus of our work. Studies and patient testimonials address this throughout this website.