Complications of Endometriosis

Reviewed by: HU Medical Review Board | Last reviewed: June 2018

Scarring and building scar tissue is part of the body's natural healing process after injury. Most people commonly think of scars and scar tissue in relation to their forming on the surface of the skin after a cut, burn, or other injury. However, scar tissue can also form on the inside of the body as a result of inflammation, trauma, or other damage. Over time, internal scar tissue can build up and form fibrous bands called adhesions. Adhesions can cause severe pain as well as structural damage. As an example, adhesions can form on the surface of an organ and connect it to another structure in the body, such as an ovary being bound to the pelvic wall. Adhesions are most commonly formed after surgery as tissue is healing. Some individuals with adhesions may experience few to no symptoms related to their adhesion, and may never know they have them. Others may experience severe symptoms or potentially life-threatening complications as a result of their adhesions, such as intestinal or bowel blockage.1-4

Scar tissue and adhesions link to endometriosis

Scar tissue often forms in areas that are inflamed. Since endometriosis is a condition that involves constant inflammation, scar tissue is likely to form. Additionally, as endometrial-like tissue is thickening and breaking down regularly in places where blood cannot escape, scar tissue may also be regularly forming as the body attempts to heal from these ever-changing lesions. Endometriosis-related scarring may affect fertility, as it could impact the structure and function of the ovaries, block the fallopian tubes, or affect other female reproductive structures. Additionally, adhesions can form as a result of endometriosis-related surgical procedures, causing further complications.1-4

Possible symptoms of a complication

Not everyone with scar tissue or adhesions will experience symptoms. Additionally, symptoms may vary based on the location and severity of scar tissue or adhesions. Common symptoms of abdominal or pelvic scar tissue or adhesions include:

  • Severe pain or cramping within the abdomen or pelvis
  • A pulling sensation within the abdomen or pelvis
  • Swelling of the abdomen
  • Nausea or vomiting
  • Absent, infrequent, or painful bowel movements
  • Inability to pass gas
  • Inability to become pregnant1,2

Diagnosis and evaluation

Significant scar tissue or adhesions may be suspected during a pelvic or rectal exam, and your doctor may recommend additional imaging tests such as x-rays or CT scans to look for blockages in your abdomen or pelvis that could be the result of adhesions. However, official diagnosis of adhesions is similar to official diagnosis of endometriosis. It can only be confirmed during surgery, often a laparoscopy. A laparoscopy is a minimally invasive surgery in which a tiny incision is made in the abdomen. A small tool with a camera on the end and a light is inserted into the abdomen or pelvis. During this procedure, scar tissue, adhesions, and endometriosis lesions can be clearly viewed and diagnosed.1,2


Not everyone with adhesions will require treatment. Individuals with no symptoms or with few, mild symptoms may never need treatment. Conversely, if an adhesion, or multiple adhesions, are causing severe pain, fertility complications, or an intestinal or bowel blockage, treatment may be necessary. The conundrum with treatment of scar tissue and adhesions is that the only true treatment option is surgery, which can, in turn, can cause more scar tissue or adhesions. This is why it's important that you and your healthcare team weigh the benefits of removing scar tissue or adhesions against the potential risks.

There is no way to prevent scar tissue or adhesions, as the underlying process is a natural mechanism in the body. However, choosing to have minimally invasive procedures when possible, and opting for surgical procedures that are shorter in duration may help reduce your risk of developing adhesions that form as a result of surgery.1

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