C-Sections and Adhesions
If you have had a cesarean section before, then you may be wondering if it will impact upon your next pregnancy. Cesarean sections are becoming more and more popular, with many women electing to have c-sections instead of vaginal births. Typically, c-sections are a safe and viable birthing option. However, c-sections are not without their drawbacks. One primary drawback to the c-section is that is can cause surgical adhesions. These may result in pain, discomfort, and can sometimes interfere with subsequent births.
What are Adhesions?
Adhesions are actually bands of scar tissue that form inside your abdomen or pelvis after surgery. As your body heals from surgery, this scar tissue connects organs together, causing them to stick to one another. Abdominal adhesions are a common outcome of any pelvic or abdominal surgery. In fact, they develop in 93% of people who have undergone pelvic surgery. They are especially common after cesarean sections.
What Surgeries cause Adhesions?
Any surgery can cause adhesions to form. Adhesions are your body’s natural way of healing itself. However, certain operations are more likely to trigger the formation of pelvic adhesions. In addition to cesarean section, these procedures include:
- dilatation and curettage
- fibroid removal
- ovarian surgery
How do Adhesions Form?
Adhesions form as a natural response to trauma that your body has undergone. All of your abdominal organs are wrapped in a clear membrane, called the peritoneum. During cesarean section, the peritoneum is cut in order to expose the uterus. As a result, the peritoneum becomes inflamed. After surgery, this inflammation triggers the formation of scar tissue.
Typically, this scar tissue disappears after a little while, in a process called fibrinolysis. However, cesarean section surgery sometimes decreases the blood flow to the peritoneum, preventing the fibrinolysis process from taking place. As a result, the scar tissue forms into adhesions.
Complications of Adhesions
Unfortunately, adhesions can cause a number of different side effects and complications. If you are undergoing cesarean section, it is important to be aware of these complications. Report any side effects of surgery to your health care provider.
Pelvic or Abdominal Pain:
Pelvic or abdominal pain is a common result of surgical adhesions. About 38% of women who experience pelvic pain are actually suffering from adhesions. Adhesions cause pain because they limit the movement of internal organs. Since adhesions "tie down" organs, as you move or become active you may experience quite severe pain.
Bowel obstruction is also a fairly common result of surgical adhesions. Sometimes scar tissue forms over the small intestine, causing a blockage in your bowel. As a result, your bowel cannot excrete any waste, causing side effects like nausea, vomiting, and pain. Bowel obstruction can occur immediately after surgery or it can develop years later.
Very rarely, surgical adhesions can impair a woman’s fertility. If adhesions form between the ovaries or fallopian tubes, it may be impossible for sperm to enter to fertilize an egg. These adhesions may also make it difficult for an egg to travel through your fallopian tubes.
Birth After Cesarean Section
If you have had a cesarean section and are pregnant or planning to have another child, these adhesions could complicate matters. If you are having another c-section, your health care provider will have to separate and cut through all of your adhesions before she can begin the c-section. For women who have had more than three cesareans, this could take ten minutes to an hour or more. In an emergency, this could place your baby at risk.
If you elect to have a vaginal birth after a cesarean , or VBAC, adhesions shouldn’t pose much of a problem, unless you have had multiple cesarean sections. Typically, women who have only had one cesarean section can deliver vaginally without any difficulties. There is a chance that the scar tissue covering the incision in your uterus could rupture. This can be very dangerous, as it can cause massive bleeding or cut off your baby’s oxygen supply. However, the risk of uterine rupture during a VBAC is very low, typically occurring in less than 1 out of every 1,000 births.
Treating Cesarean Section Adhesions
Cesarean section adhesions can be treated in order to reduce pain or restore fertility. Adhesions are separated and removed through a surgical procedure. These procedures are highly successful, and generally help 60% of all patients. However, surgical adhesions can form again, and do so in about 70% of cases.
Preventing Cesarean Section Adhesions
Recent studies have shown that the adhesions caused by cesarean section can be prevented, or at least reduced. Typically, the peritoneum is not repaired after cesarean section. This was originally thought to help reduce the formation of scar tissue. However, studies illustrate that by surgically repairing the peritoneum after a c-section, you actually decrease your likelihood of developing adhesions by seven fold.
In a study conducted at Stanford University, women who had undergone cesarean sections were analyzed for scar tissue and adhesions. 73% of women who had not had their peritoneum repaired had developed adhesions. However, only 52% of women who had their peritoneum repaired showed evidence of these adhesions.
If you have had a c-section and are considering having another for a subsequent pregnancy, speak with your health care provider about whether a VBAC or another cesarean section would be the best option for you.