Why Are Uterine Balloon Stents Used After Asherman Surgery?

Surgery to remove scar tissue (adhesiolysis) is the main treatment for Asherman syndrome, but the surgery itself creates new healing areas inside the uterus. As these treated surfaces heal, they can stick back together and form new bands of scar tissue. To help prevent this, doctors often use anti-adhesion barriers—such as temporary uterine balloon stents or special gels—to physically hold the uterine walls apart while they heal ^[1].

Understanding how these barriers work can help reduce the anxiety of waking up with a balloon catheter in your uterus. The device is not treating the scar tissue itself; instead, it acts as a temporary spacer to help reduce contact between the walls during the early healing phase ^[1].

The Challenge of Healing After Surgery

The inside of the uterus is normally a potential space, meaning the front and back walls touch each other. When a surgeon cuts away scar tissue, they leave behind freshly treated surfaces on opposing walls. If these surfaces rest directly against each other during the early stages of healing, the body may bridge the gap with new scar tissue.

By placing a physical barrier inside the uterus immediately after surgery, the doctor helps keep the healing surfaces apart so they can recover independently ^[1].

Commonly Used Physical Barriers

Doctors rely on two main approaches to separate the uterine walls: mechanical spacers (like balloons) and coating gels. Not every patient receives a balloon or gel; the choice depends on the severity of your adhesions, your surgeon’s experience, and their specific postoperative protocol ^[2][3].

Uterine Balloon Stents

A uterine balloon stent is a soft, flexible catheter inserted into the uterine cavity and inflated with sterile fluid. It acts as an internal spacer, occupying the cavity to keep the newly treated surfaces from touching ^[1].

Commonly used balloons include:

• Foley catheter balloons: Originally designed for the bladder, these have a round balloon at the tip and are widely used as temporary uterine spacers ^[1].
• Cook intrauterine balloons: These are purpose-designed balloons shaped more like the natural triangular cavity of the uterus ^[1].

Both devices are intended to provide a physical blockade against scar bridging.

Hyaluronic Acid Gels

Instead of, or in addition to, a solid spacer, some surgeons use hyaluronic acid (HA) gel. Hyaluronic acid is a natural substance that helps retain moisture in tissues.

When applied after surgery, HA gel forms a thick, viscous coating over the treated surfaces ^[4]. It acts as a temporary hydrogel barrier, reducing direct contact between the uterine walls ^[4]. Research across various intrauterine surgeries suggests HA gels can reduce the formation of postoperative adhesions ^[5]. However, in trials looking specifically at Asherman syndrome surgery, the benefits are less consistent, and it is not proven to guarantee better pregnancy or live-birth rates ^[6].

Some surgeons use a balloon and a gel together, though research does not point to a single method that is clearly superior for every patient ^[2][3].

What to Expect: Care and Recovery

If a balloon stent is placed, it is a temporary measure. A tube will extend through your cervix and out of your vagina, which can cause cramping or discomfort.

Duration of Placement

The length of time the balloon stays in place varies widely based on the specific device and the severity of the adhesions. Seven days is a conventional and common duration ^[7]. However, some studies evaluate leaving balloons in place for 4 to 8 weeks for severe adhesions, particularly depending on whether a Foley or Cook balloon is used ^[7][8]. Prolonged placement is not always better, as longer durations with some purpose-designed balloons might adversely affect later pregnancy outcomes ^[9]. Your surgeon will determine the safest duration for your specific situation.

Medications and Restrictions

While the balloon is in place:

• Medications: Your doctor will likely recommend pain relief. Depending on their clinical assessment and protocol, they may also prescribe antibiotics to reduce the risk of infection, as bacteria can colonize the balloon ^[10]. Estrogen or other hormones are also frequently prescribed as part of a broader plan to encourage the uterine lining to heal ^[2].
• Activity: You must use strict contraception to avoid pregnancy while the device is in place ^[11]. You should also ask your surgeon for specific restrictions regarding sexual intercourse, tampons, douching, swimming, and heavy lifting, as protocols vary.

Warning Signs

If you go home with a balloon stent, contact your surgical team promptly if you experience:

• Fever or chills
• Worsening or severe pelvic pain
• Foul-smelling vaginal discharge
• Unexpectedly heavy bleeding
• The balloon or tube falling out or moving significantly

Do not attempt to push the balloon back in or remove it yourself. Only a healthcare professional should adjust or remove the device.

Follow-Up Care

A balloon or gel is not a guarantee that adhesions will not return ^[12]. Because recurrence is possible, your balloon placement is typically just one part of a comprehensive recovery plan. Many surgeons recommend a follow-up assessment—such as a second-look hysteroscopy (a camera examination of the uterine cavity)—to check how the walls are healing and to treat any mild new adhesions before they become severe ^[12].