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Ask Harry: Don't Blame Your Endometriosis Pain on Adhesions

Ask Harry: Don't Blame Your Endometriosis Pain on Adhesions

Do you have a burning question for EndoFound’s Honorary Medical Director Emeritus and Senior Medical Advisor, Dr. Harry Reich? E-mail him at harry@endofound.org or visit EndoFound’s official Instagram, Facebook or Twitter, tag us and ask a question with the hashtag #askharry, and you could see your answer featured here!

I would like to unravel the confusion between adhesions versus endometriosis.

Adhesions are bands of scar tissue that often bind two organs together.

Many women with endometriosis blame adhesions for their endometriosis pain. But they shouldn't! If you remove the endometriosis, you remove the pain, if you remove the adhesions, you'll still have endometriosis pain.

Here's why: Endometriosis pain results directly from the inflammatory process going on inside of endometriosis lesions. Adhesions, when they bind the bowels, can cause their own pain, which is separate and different from endometriosis pain.

Another common misconception? Many believe that adhesions are a by-product of endometriosis or the endometriosis process. They are not! Adhesions, however, are a by-product of previous surgery, especially if you have had multiple surgeries. To put it plainly: the more surgeries you've had, the more adhesions you're likely to have. Although not as common, there are some instances where adhesions can result from Pelvic Inflammatory Disease caused by bacteria, viruses or foreign bodies.

RELATED: Ask Harry: Endometriosis Is Present at Birth

No matter your gender, adhesions are part of our body's normal healing process. Whenever cells are not getting enough oxygen, they become damaged and start forming adhesions. Any surgical injury to surrounding tissue results in a healing process with the formation of scar tissue. The body has another system that attempts to get rid of the scar tissue. If the scar tissue reaction wins, the result is—you guessed it—adhesions. And adhesions are on the rise, because of the widespread use of thermal energy sources during surgery, which destroys tissue.

Endo women, if you want to avoid having a ton of adhesions, stay away from ablation. Ablation equals dead tissue. Excision with cold scissors has the potential for the least post-operative adhesions.

@aschima1 asks: I'm 40, no children, one miscarriage. I had one excision surgery where I lost half an ovary. My periods are cripplingly painful for about three days; otherwise I am fine. Would a hysterectomy be recommended in my case?

A hysterectomy should be the patient's choice. Beware of doctors who are pushing you to have a hysterectomy. Should you not want one, there are always options. With endometriosis, there is always a choice. You don't ever have to have a hysterectomy because of endometriosis. The only exception to that rule, is if you have cancer inside of the uterus.

@jojohitch asks: How common is it to wind up with a hernia after laparoscopic surgery, and when should you be concerned about one?

Hernias should be quite rare after laparoscopic surgery. Hernias are dependent on incision size and fascial defects. (Fascia is the solid structure you can feel below your skin if you move your skin back-and-forth.) The smaller the skin and fascial incision are, the lesser the chance of hernias. A belly button fascia is easy to identify and suture repair. Incisions larger than half an inch should be suture-repaired.

@_lamiavitabella_asks: Can endometriosis affect your heart? I have read that it increases a woman's chance of heart disease.

Harry: I am not aware of endometriosis increasing heart disease, or its risks.


Editor’s note: The opinions, beliefs, and viewpoints expressed by Dr. Harry Reich in this column are solely his own and based on his experience.