What are C-Section Adhesions?
C-section adhesions form from bands of internal scar tissue that are created after a Caesarian section surgery. The scar tissue itself is not a problem, but the adhesion occurs when it sticks to other internal organs and creates complications, such as bowel blockages. Some adhesions cause pain and discomfort, while others may have no symptoms at all.
Adhesions are common in any type of abdominal surgery but tend to happen fairly regularly with C-sections because of the location of the incision site. In ideal cases, scar tissue disappears over a period of time. Since C-sections can decrease blood flow to certain tissues, the process that makes the scar tissue heal and disappear is sometimes interrupted, making the scarring permanent.
The more C-section surgeries a woman has, the more likely she is to develop adhesions, which can cause problems in future pregnancies where the baby is also delivered in this way. Since the delivery doctor has to cut through adhesions in addition to the rest of the skin, tissue, and fat layers, it can take more than five minutes longer to get through to the baby than it took with the first birth. This can be problematic if the baby is in distress and needs to be removed immediately. Third and fourth C-section deliveries can take more than eight and 18 minutes longer, respectively. Nearly half of women who had a second C-section experienced adhesions afterward and 83% of women with four or five C-sections had them.
C-section adhesions can cause chronic pelvic pain in women. This may be notably worse during physical activity or movement because the organs have less ability to flex with body movement, since they are tied down by the scar tissue. These can also form over parts of the small intestine, causing bowel obstruction even years after the original C-section surgery. Symptoms of this condition include vomiting and severe abdominal pain, and this problem is sometimes confused with irritable bowel syndrome or endometriosis.
Symptoms can include feelings of cramping, vomiting, a tender and bloated stomach, and abdominal pain that worsens upon eating. When adhesions are causing pain and interfering with everyday movement, a second surgery can be scheduled to remove the scar tissue. This does have the further complication of possibly producing more scar tissue as a result of that surgery. If C-section adhesions are not causing pain, it is likely that no action will be taken.
I developed adhesions from my first c-section. It made being pregnant a second time around painful because as the baby grew, that scar tissue was being broken up. Now that I have had another c-section, I have a lot of problems with bowel movements. It is always very large, painful and hard to pass out of the body.
My hospital refused to do a vaginal birth. I would have had to convince my insurance company to cover for me to have my second baby at a larger more expensive hospital in order to have done a VBAC. I'm a bit worried now about how much scar tissue I will develop this time and the complications that will come with it.
A VBAC (vaginal birth after cesarean) is statistically safer than a repeat c-section. The chances of a rupture that her OB described is extremely low. You are more likely to die or your baby to die, or have very serious complications during a second c-section. Not only that, but abnormal placentas and adhesions could put future pregnancies at risk. Each surgery increases your risk. What her doctor told her is wrong and against ACOG guidelines for VBACs. A c-section should only be done in a dire emergency.
I have a very big adhesion that, four years after a C-section, I am afraid has affected my bowel movements. I am constipated and gassy. How do I go about treating it? Is this the reason why am not conceiving again? --Irene
I've had four C-sections with a surprise number 5 on the way, so that will be five C-sections for me all within 14 months and 26 months respectively. When I was in surgery with number four, I had the specialist check and confirm whether we could have another as we weren't sure if we could or not. He said all was good for another.
In my own experience, each C-section recovery has been better. My last three, I was out within a couple of days. With number four, I was out two days only because I was feeling so great!
Do the research, speak with specialists and especially others who have had numerous C-sections. Everyone will tell you their own opinion and experiences as I have shared mine above.
Personally, I wouldn't risk a VBAC after a C only because the birth of our children have been so close together. Good luck.
@Kat919 - Doctors do tend to emphasize the risks of vaginal birth after cesarean (VBAC) while minimizing the risks of repeat cesarean. I think there are a couple of reasons for that; one is that doctors know they are much more likely to be sued for problems with a vaginal birth than for problems with a c-section. The other is that when something goes wrong with VBAC, it goes so spectacularly wrong, whereas some of the consequences of repeat cesarean take years to develop.
No one choice is right for everyone. I personally chose VBAC because it is usually safer for the mother and because I knew I wanted to have a large family (each VBAC is safer than the one before, while each C section is more dangerous). Anyone experiencing pregnancy after cesarean should do their own research on the risks and benefits of each option. NIH did a big statement on this a few years ago; people should also research ACOG's recommendations. ICAN is a good source for pro-vaginal birth information and statistics. Good luck!
My sister had her first baby by cesarean section and is now pregnant again. While healing after her first c section went well, she is concerned that with another section, she might not do as well.
But her doctor seems to think that having a second c-section is the safest option for her baby. He has told her that there is a risk of uterine rupture - that if she goes into labor, her previous incision could come apart internally, allowing her baby to move into the abdominal cavity. The baby could die and she could lose her uterus or even die herself.
He hasn't mentioned anything about adhesions. How can she weigh the risks if she doesn't even know them?
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