Pelvic Adhesive Disease—NYCEndometriosis and Dr. Bozdogan
Fertility specialist Dr. Ulas Bozdogan of NYCEndometriosis centers his professional practice on problems that can affect your fertility and the general health of all women. He uses his expertise in the office identification and surgical approach to diagnosing and treatment of these problems. One of these question is what is pelvic adhesive disease.
What is pelvic adhesive disease?
Our bodies are constructed in a way that works well for us. All of our organs are designed to fit together and also occupy space together without hampering the other organs and tissues. Nowhere is this more true than in your pelvis, which must accommodate your intestinal tract, reproductive organs, and urinary tissues. Adhesions are either abnormal connections between organs or abnormal tissue within them.
Adhesions between or among organs:
Pelvic adhesions are when these tissues get stuck together as a result of inflammation (due to endometriosis, infection, or internal bleeding) or scarring from surgery (in which tissues heal, stuck together). The simple—yet tragic—result of adhesions is that they distort the normal anatomy. Our bodies are no longer constructed in a way that works well!
Organs that are meant to be free-floating within your pelvis, when stuck together by adhesions, can cause them to be jostled unnaturally by simple and normal mechanical actions, such as sex, exercise and even walking, or the actions occurring with bowel movements or in the act of urination.
Adhesions can be caused by
- Endometriosis: a specialist in endometriosis, like Dr. Bozdogan, will always be—additionally—a specialist in pelvic adhesions and how to surgically remove them, because endometriosis is one of the most common causes of adhesions. Endometriosis causes severe inflammation (see next) and can kink your fallopian tubes that block their function. Adhesions between your uterus/tubes and rectum can cause what is called a “frozen pelvis,” interfering with the function of all the tissues involved. This can result in severe pain from bowel movements or sexual intercourse.
- Inflammation: your body has a protective tendency to wall bad things off from the rest of the body. Think of an abscess (boil) which has a wall to separate a bad infection (collection of pus) from the healthy tissue around it. An infection, just as in an abscess on the skin, can form a walled-off structure in the pelvis that sits on top of your uterus, tubes, ovary, bowel or rectum, and bladder; or bridges an area between any of these. A long-cured infection, such as a sexually transmitted infection (gonorrhea, chlamydia, even tuberculosis), can leave a permanently “adhesed” architecture which interferes with normal structure. Also, inflammation hurts: inflammation prone to making adhesions can cause painful intercourse, painful urination, or painful moving of your bowels. It is most often the pain that will drive a patient to seek help.
- Bleeding: blood anywhere but inside blood vessels is very irritating to tissue. If there is internal pelvic bleeding, such as with a rupture cyst or ectopic pregnancy, the blood will cause the adjacent organs to adhere to the site of the bleeding, leaving adhesions there long after the blood has been reabsorbed.
- Surgery: surgery, although necessary at times, is an invasion into the normal organ architecture. Mere handling of the tissue can cause areas of poor blood supply for oxygenation, causing tissue to break down, become inflamed, and attract other tissues to stick to it. This is why the minimally invasive surgical approaches like those Dr. Bozdogan uses (i.e., the exact, meticulous, and gentle techniques inherent in robotic surgery) are favored above all other methods in removing adhesions.
Adhesions within organs:
Besides adhesions being outside the organs and causing them to stick together (see above), they can also be present within the organs, which alters or prevents their very function. An example of this is the problem of adhesions in the fallopian tube(s), caused by a sexually transmitted disease, endometriosis, or scarring from the blood of a previous ectopic (tubal) pregnancy or the rupture of the tubal wall associated with it.
Blockage within the tube not only can block sperm from swimming upward to fertilize an egg (which takes place inside the tube) and blocking an egg from migrating down a tube for fertilization, but also can cause an egg that is successfully fertilized from migrating down toward your uterus for implantation (and a successful pregnancy). The first example results in infertility; the second in an ectopic pregnancy.
How are adhesions diagnosed?
Organs that are stuck together often look normal on the usual imaging techniques, such as ultrasound (most common method), X-ray, CT scan, or MRI. Since adhesions cause a problem in function (the process of fertilization or the mechanical actions of sex, urination, or bowel movements), diagnosis is made based on
- History: a history indicative of infection—having been treated for a sexually transmitted infection, having had appendicitis or diverticulitis, or having had pelvic surgery in the past. Painful bowel movements or urination are also a tip-off that all is not well. Alternatively, the history can be completely unsuspicious except for the painful periods or painful sex seen in endometriosis, which is not caused by infection or surgery.
- Physical exam: an exam that uses a gloved hand of the examiner to determine whether such an exploration is painful indicates that other mechanical actions (sex, exercise) are also painful when they shouldn’t be.
Because there are not blood tests for adhesions and because the usual imaging technology cannot show it well, diagnosis relies on the expertise and experience of the examiner. A patient with suspected pelvic adhesive disease is best served seeing a specialist like Dr. Bozdogan who not only is specifically skilled to make the diagnosis, but has the robotic and microsurgical expertise to treat adhesive disease so as to restore fertility and a woman’s quality of life (i.e., reduce suffering and restore a normal sex life).
How are adhesions treated? It’s a good news/bad news story.
The bad news: adhesions, since they are physical structures, can only be separated or removed physically, and that means surgery; worse, surgery can cure adhesions but set you up for making more.
The good news: a specialist in minimally invasive gynecologic surgery and robotic surgery uses techniques that not only reduce the tendency to make more adhesions, but shorten recovery time and significantly reduce or eliminate pain, which is important for things like employment or attempting pregnancy. Such surgery, in the hands of such as specialist, can be same-day surgery with minimal scarring, which is a cosmetic concern that also should be respected.
How do you get on the road to recovery from the ravages of pelvic adhesive disease?
It begins with an appointment, but it relies on an appointment with the right specialist—one like Dr. Ulas Bozdogan of NYCEndometriosis—who can assure you accuracy in identifying adhesions, but also success in eliminating them and getting you back on the right track for the rest of your life.