A Case of Disabling Urinary Frequency and Pelvic Pain Due to Postoperative Uterine Adhesions

Dense lower abdominal adhesions are known to cause urinary frequency by restricting expansion of the bladder. However, since preoperative diagnosis of adhesions has been difficult and there are multiple other causes of urinary frequency, such patients may go undiagnosed. With the improving resolution of ultrasound, ever smaller pathologic structures may be visualized, particularly if they are considered in the differential diagnosis.

To confirm the possibility that clinically significant lower abdominal adhesions may be visualized by ultrasound, we report on a patient who had developed disabling urinary frequency and pelvic pain after a cesarean section. Over a 5-year period, the patient underwent multiple diagnostic and therapeutic interventions at 2 large medical centers in multiple departments without success. Following this, a pelvic sonogram revealed a band of adhesions between the uterus and abdominal wall. Laparoscopic lysis of extensive pelvic adhesions was undertaken. Postoperatively, the patient was able to resume an active lifestyle, with good improvement in urinary frequency and pelvic pain.

Ultrasound diagnosis of uterine adhesions to the abdominal wall led to successful laparoscopiclysis of adhesions with significant improvement in a patient's urinary tract symptoms and pelvic pain.