Abdominal adhesions: causes, symptoms and when they need urgent care

Normally the organs in the abdomen have slippery surfaces that let them slide over each other as you move. Guts UK explains that sometimes bands of tissue form that cause these surfaces to stick together, and that these bands are called adhesions. They are areas of scar tissue and usually affect the small intestine around the site of previous operations or inflammation. Great Ormond Street Hospital adds that adhesions on their own may not cause symptoms but can lead to obstruction when they make the intestines twist, kink or pull out of alignment.

Adhesions are a normal part of healing rather than a sign that something went wrong. Great Ormond Street says they do not form because something went wrong during the operation: they are the body's natural response to the abdomen being opened to the air and handled during surgery. Guts UK says no matter how skilful or careful the surgeon is, adhesions can form.

Guts UK lists surgery to the abdomen or pelvis as the most common cause. Other causes include radiotherapy, conditions such as endometriosis and pelvic inflammatory disease (the commonest cause of non-surgical adhesions in females), inflammatory bowel disease such as Crohn's disease and ulcerative colitis, infections inside the abdomen such as tuberculosis, and an episode of appendicitis, especially if the appendix bursts. Great Ormond Street also lists peritonitis and appendicitis as inflammation that can lead to adhesions.

Research is under way. Guts UK says adhesions affect more than half of patients after abdominal surgery, that there are still no medical treatments to stop them forming, and that it funds work on medicines that might stop the scarring process.

Guts UK lists bloating, cramping, discomfort or pain in the abdomen, a change in bowel habit from constipation to loose poo, and feeling sick or being sick, and says that in females adhesions may cause infertility and pain during sex. Symptoms may grumble on for years or come on quickly and become severe. It notes that sub-acute obstruction, a partial or intermittent blockage, can become an urgent problem and says you should get same-day medical advice from your GP or NHS 111.

A complete blockage is an emergency. Guts UK says to call 999 or get someone to take you to A&E if you have severe belly pain that is always there and makes it hard to do usual activities, pain when you touch your belly, vomiting blood or what looks like ground coffee, bloody or black sticky foul-smelling poo, an inability to poo or pass wind, chest pains or difficulty breathing, or if you are being sick and have diabetes. It describes complete obstruction as causing severe pain, vomiting and complete obstipation, and rarely the bowel losing its blood supply with sudden severe pain.

• Severe, constant belly pain: call 999 or go to A&E.

• Repeated vomiting, particularly if blood-stained or dark: call 999 or go to A&E.

• Unable to pass wind or poo with a swollen tummy: treat as an emergency.

• Comes-and-goes cramping, bloating or sickness: same-day advice from your GP or NHS 111.

Guts UK says diagnosis depends on how long symptoms have been present and their pattern. The doctor takes a history and examines the abdomen, and sometimes does an internal examination. Blood tests help to assess your general health, inflammation and kidney function, but there is no simple blood test that can diagnose adhesions. A CT scan of the abdomen can show the cause and location of a blockage and check on the blood supply of the bowel.

Great Ormond Street adds that adhesions do not usually show up well on X-rays unless there is an acute blockage, that contrast scans may be used to show where the intestine is obstructed and that occasionally an exploratory keyhole operation (laparoscopy) is needed, sometimes combined with treatment.

Adhesions that cause no problems do not need treatment, according to Great Ormond Street. For a blockage, Guts UK says care should be delivered in hospital with fluids given into a vein, sometimes a nasogastric tube to drain the stomach and a scan to find the blockage. A gastrografin challenge can relieve a blockage without removing adhesions, so symptoms could come back. If the blockage is not relieved by around day 3 of admission, or if surgeons are worried about the bowel, an emergency operation is likely, either keyhole or through a larger cut, to free up scar tissue and assess the bowel.

For sub-acute and chronic problems, Guts UK says a low-fibre soft diet may be recommended for some people but should not be followed without a dietitian's referral, mild pain can be treated with paracetamol, and opioids should be avoided where possible because they may slow the gut. It notes that a surgeon helps decide whether surgery is needed and that new adhesions can form after surgery, so some people need repeated operations. Ask about risks and benefits, and about referral to a pain specialist if pain is not controlled.

Guts UK points out that long-term pain and bloating can affect mood and wellbeing, and may lead to anxiety and depression, and encourages people to talk to their doctor. It also warns that social media can spread wrong advice about adhesions and recommends relying on NHS and professionally approved sources. Adhesions in the pelvis can affect female fertility, and a doctor can advise and refer for specialist help if you are trying to conceive.

Tell any clinician who treats you about past abdominal surgery, particularly if you present with abdominal pain, because it changes how symptoms are interpreted.

Acute blockages are treated as emergencies on the NHS through emergency departments and surgical teams. Longer-term symptoms are managed by a GP with referral to a gastroenterologist or surgeon, a dietitian and sometimes a pain clinic. Private surgical and gastroenterology review is available in the UK; the investigations and the cautious approach to repeat surgery are the same.