Where do the adhesions after a cesarean come from?
Caesarean section, like other surgical procedures, is associated with tissue disruption. The consequence of healing these damages is development of local inflammation, and thus the possibility of adhesions (in and around the healing lesions). Adhesions can be described as abnormal, non-naturally occurring connective tissue connections between organ walls and tissues. Their examples can be adhesions forming between or between intestinal loops
organs located within the smaller pelvis - fallopian tubes, ovaries, bladder, or uterus.
Caesarean adhesions - effects
Adhesions that appear after a cesarean section can limit mobility, and distort and narrow the lumen of organs covered by them.
This results, among other things:
- Pelvic pain syndromes - they are characterized by the presence of pelvic pain (usually in the lower abdomen or sacral region) for a minimum period of 6 months. They are often accompanied by painful sexual intercourse (so-called dyspareunia).
- Spinal pain syndromes - abdominal adhesions, by changing the anatomical interrelationships between organs and pulling muscle and nerve structures, can cause chronic back pain.
- Bowel obstruction or obstruction - abdominal adhesions are an important risk factor for intestinal obstruction or ileus. Both of these conditions are most often manifested by flatulence, abdominal pain and gas and stool retention. In most cases, their treatment requires urgent surgical intervention.
- Increased risk of subsequent operations and cesarean section - it is believed that 4 cesarean sections constitute the upper limit above which the risk of making a cesarean increases dramatically.
- Secondary infertility - adhesions that distort the uterus or fallopian tubes may be the reason why you cannot become pregnant or continue to have a pregnancy until it is terminated.
Adhesions after cesarean section and infertility
It is assumed that 7% and 6%, respectively, of infertility are conditioned by fallopian and uterine factors. In the first case, it is most often associated with adhesions that model or completely close the fallopian tube. This results in the inability of the egg to get from the ovary to the oviduct bubble, where fertilization is most common. In some cases of fallopian tube obstruction, sperm comes into contact with the egg, but the embryo cannot get into the uterus - this is called ectopic pregnancy.
When it comes to infertility associated with the uterine factor, it is also often conditioned by adhesions (congenital defects of the uterus may also be responsible for this type of infertility - for example, two-legged uterus). Additional connective tissue bands can model the uterus from the outside and fill its light.
It is worth noting that the adhesions and defects of the uterus can also result in the inability to report pregnancy, which will manifest in habitual miscarriages.
Treatment of infertility associated with adhesions after cesarean section
Treatment of infertility associated with adhesions varies depending on their location. So, ovarian-conditioned infertility cases are first attempted to be surgically treated - by laparoscopic surgery (efficiency around 15%). In case of its ineffectiveness, in vitro fertilization is recommended.
In the case of infertility associated with the uterine factor, the first line of treatment is also surgery - the so-called interventional hysteroscopy. The effectiveness of this form of treatment is higher than in the case of tubal infertility.
In conclusion, the cesarean section is fraught with numerous complications. One of them is adhesions, which may manifest as pain and, in some cases, infertility. Therefore, Caesarean section should be performed only in selected cases when specific medical indications exist.