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C-section & Pelvic Surgery Risks

There are steps you can take now to help protect your health post surgery and speed your recovery.

Some of the most common problems after a C-section include:

  • Pelvic adhesions

  • Bacterial infections at the surgical site

  • Scarring

Many of these risks can be addressed with proper planning and by talking with your doctor about prevention techniques he or she can use during surgery.

What are pelvic adhesions?

Pelvic adhesions are abnormal bands of scar tissue that may form after surgery, including C-sections, and bind tissues or organs that are usually not connected.

Most patients develop adhesions after pelvic surgery, although in some cases these adhesions do not cause symptoms or problems.

What causes pelvic adhesions?

All of the abdominal and pelvic organs, except the ovaries, are at least partially wrapped in a clear membrane called the peritoneum (per-i-toe-nee-um). When the peritoneum is damaged during surgery, it becomes inflamed. Inflammation is normal and part of the healing process, but inflammation also encourages fibrous bands of scar tissue to develop.

Usually, this scar tissue dissolves, and the area continues to heal. In some cases, however, the scar tissue may develop into adhesions that grow and connect pelvic organs or tissues that normally are separate.

How common are pelvic adhesions?

Adhesions are very common after pelvic or abdominal surgery. The chances that adhesions will form after surgery and what problems may result depend on many things: the type of surgery you’re having, the number of previous surgeries you've had, and the surgical technique used.

Most patients develop adhesions after pelvic surgery. In fact, studies have shown that 55-100% of patients who have had reproductive pelvic surgery will form adhesions.1

What problems are caused by pelvic adhesions?

Pelvic adhesions may result in the following symptoms or complications:

  • Chronic pelvic pain – adhesions are found in about 25% of women with chronic pelvic pain2

  • Increased potential for bladder injury during subsequent surgery3

  • Infertility – up to 20% of infertility in women may be caused by adhesions4

  • Bowel obstruction – postoperative adhesions are the most common cause of small bowel obstruction5

An ounce of prevention…

46% of women develop adhesions after their first C-section; that figure rises to 75% by their third C-section6.

Susan Jones,* a working mother of three, describes the impact adhesions had on her life and the importance of reducing the risk of pelvic adhesions:

"My first C-section took about 10 minutes […but] my second C-section took nearly 45 minutes and the my final C-section took nearly an hour and a half. My doctor had such a hard time maneuvering around the scar tissue to get to my baby."

“If I had known about adhesions, I would have talked to my doctor about what can be done to reduce my risk for getting them.”+

*Patient name has been changed for confidentiality purposes.
+Patient testimonial has been provided by National Women’s Health Resource Center.

Reducing your risks during C-sections and pelvic surgeries

Reducing the risk of adhesions
Reducing the risk of adhesions should be a key topic to discuss with your doctor before surgery.

Your doctor can help you to reduce the risk of adhesions by using careful surgical technique.

In addition, adhesion barriers are effective at reducing adhesion formation after surgery. An adhesion barrier is a physical barrier that is used to separate injured tissues from other tissues and organs during the healing process. Different types of adhesion barrier materials are available to your doctor.  

Learn more about reducing the risk of pelvic adhesions using a barrier method

If pelvic adhesions form, the only way to treat them is to cut them in a surgical procedure called adhesiolysis (ad-he-ze-o-li-sis). That's why it is important to try to minimize adhesions with good surgical technique and use of an adhesion barrier.

Addressing the risk of bacterial infections
As many as 1 in 10 women develop infections at the surgical site after C-section.7 By using antibacterial sutures, surgeons can address one of the risk factors associated with surgical site infection by inhibiting colonization of the suture.

Remember to talk to your doctor about reducing risks before your surgery.

References:
1. diZerega GS. Peritoneum, peritoneal healing, and adhesion formation. In: diZereg GS ed. Peritoneal Surgery. New York, NY: Springer; 2000; 16.
2. Howard FM, Chronic pelvic pain. Obstet Gynecol. 2003;101:606.
3. Van Goor H, Consequences and complications of peritoneal adhesions. The Association of Coloproctology of Great Britain and Ireland, 2007;9(2):25-34.
4. Hershlag A, Diamond MP, DeCherney AH. Adhesiolysis. Clin Obstet Gynecol. 1991; 34:395.
5. Al-Took S, Platt R, Tulandi T. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol. 1999;180(2):313-315.
6. Morales KJ, Gordon MC, Bates Jr GW. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol. 2007;196(5):461.e1-461.e6.
7. Couto RC, Pedrosa TMG, Nogueira JM, et al. Post-discharge surveillance and infection rates in obstetric patients. Int J Gynaecol Obstet. 1998;61:227-31.

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