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Abdominal adhesions refer to scarring or tissue repair that occurs anywhere in the abdomen.
They form as the first step in the healing process after any surgery, trauma, infection, or
inflammation. Wherever they form, adhesions join structures with strong glue-like bonds that
can last a lifetime (see our general adhesions page for more detail.)
The abdomen contains several major organs, including those which digest food, create or filter
blood, or assist elimination. Abdominal adhesions frequently occur within the 7½ to 12 feet
length (Abdominal Imaging, 1984)1 of the small intestines. To maintain its length in this small
area, the small bowel has dozens of loops and folds. These help absorb nutrients en route from
the stomach to the large intestines. However, the close sinews of these folds are perfect places
for abdominal adhesions to form.
When adhesions form around the abdomen, intestines, or digestive tract,
dysfunction such as constipation or abdominal pain may result. Abdominal
adhesions can contribute to irritable bowel syndrome, or cause total blockage of the
intestines. Since the patient cannot eat or eliminate food, this blockage is
considered a life-threatening condition and must be treated by a physician
Treating Abdominal Adhesions with Surgery
Until recently, lysis of adhesions was the only choice medical science offered to treat abdominal
adhesions. This involves cutting or burning the abdominal adhesions under general anesthesia,
via laparoscopy or laparotomy (open surgery).
While lysis of abdominal adhesions can be effective, surgery has two major drawbacks:
A study in Digestive Surgery showed that more than 90% of patients develop adhesions
following open abdominal surgery and 55% to 100% of women develop adhesions following
pelvic surgery.2 Another study reported that 35% of all open abdominal or pelvic surgery
patients were readmitted to the hospital more than twice to treat post-surgical adhesions during
the 10 years after their original surgery.3 Thus, abdominal surgery itself has been implicated as
a major cause of adhesion formation and many patients become trapped in a cycle of surgery-
adhesions-surgery – with no end in sight.
Causes of adhesions: Surgery
Surgery is a primary cause of adhesions. A study in Digestive Surgery showed that more than
90% of patients develop adhesions following open abdominal surgery and 55% to 100% of
women develop adhesions following pelvic surgery.2 As noted above, surgery to remove
adhesions has itself been implicated as a major cause of adhesion formation. Other surgeries
that may cause adhesions or scars to form in and around organs include:
Adhesions can form wherever we heal from injury, surgery, or inflammation. Abdominal adhesions join structures
with strong glue-like bonds that can last a lifetime.
A study in Digestive Surgery showed that more than 90% of patients develop adhesions
following open abdominal surgery and 55% to 100% of women develop adhesions following
pelvic surgery.2 Another study reported that 35% of all open abdominal or pelvic surgery
patients were readmitted to the hospital more than twice to treat post-surgical adhesions during
the 10 years after their original surgery.3 Thus, abdominal surgery itself has been implicated as
a major cause of adhesion formation and many patients become trapped in a cycle of surgery-
adhesions-surgery – with no end in sight.
Treating Abdominal Adhesions with the Wurn
Technique
Belinda Wurn, PT treats a patient with her manual
physical therapy which has been shown to reduce
adhesions, decrease pain, and improve function, in
peer-reviewed medical journals.
Because of its unique location, complexity, and vulnerability, the pelvis is a frequent site of
recurring pain. Pelvic pain is often caused by adhesions – tiny glue-like bonds that form to help
the body heal from lifetime events (e.g. surgery, trauma, accident, infection). Pelvic pain and
dysfunction can cause great frustration, in part, because most adhesions do not appear on
diagnostic tests. Laparoscopic surgery may help a physician view or remove some adhesions,
but adhesions that form due to the diagnostic or “clean up” surgery can cause the pain to
return – sometimes worse than before. Clear Passage Physical Therapy has over two decades
®
of experience and has seen excellent results (some published in major medical journals)
evaluating and treating chronic pelvic pain. All treatment is without surgery or drugs.
Adhesions can form
wherever healing takes
place from injury, surgery,
or inflammation. Pelvic
adhesions join structures
with strong glue-like bonds
that can last a lifetime and
cause chronic pelvic pain.
Adhesions
and Chronic
Pelvic Pain
Chronic pelvic pain can
refer to any number of
acute or chronic
conditions, and may
stem from various
causes. The pain can
originate from
gynecologic organs
(cervix, uterus, or
ovaries) or other areas
of the pelvis.
The causes of acute
pain are generally
easier to diagnose than
chronic pelvic pain, and
may include infection,
a cyst, or even an ectopic pregnancy – one which occurs outside the uterus. Women with acute
pelvic pain should consult a doctor, especially if the pain disrupts daily life or gets worse over
time.
Chronic pelvic pain is defined as pelvic pain which lasts longer than six months. We often find it
is associated with the adhesive process that occurs after an infection or inflammation (such as
endometriosis), or from a surgery or trauma.
Trauma
According to the American College of Gynecology, 40% to 50% of women with chronic pelvic
pain have experienced the trauma of physical or sexual abuse.1 Many people have had bad falls
onto their tailbone, back, or hips, especially during sports activities. Any of these events can
cause adhesions to form, which may later cause chronic pelvic pain.
Medical causes
Bladder, vaginal, and yeast infections, and inflammations such as chlamydia, pelvic
inflammatory disease (PID) or endometriosis may cause chronic pelvic pain. The body’s healing
response to all of these conditions is to create adhesions. Once any area has become adhered,
the adhesions often remain in the body as a permanent scar, binding nearby structures
together. We find that adhesions within and between the structures of the pelvis are a frequent
cause of chronic pelvic pain. See our adhesions page for a full explanation of adhesions.
Treating Chronic Pelvic Pain
Most physicians will attempt to treat chronic pelvic pain non-surgically, with medication or
conventional physical therapy. If the patient does not fully respond to these methods, a
physician may suggest surgery to view the interior environment and clean out any adhesions or
endometriosis.
Therapy at Clear Passage, the Wurn Technique®, can feel like a deep stretch; other times, the
work can be very light, as it follows the subtle rhythm within the sheath that surrounds the
spinal cord. Depending on the diagnosis and treatment area, the therapist may work to improve
motility – subtle organ movements. At other times, therapists may ask the patient to flex large
muscles, or move in certain ways, to improve the body’s symmetry and function. We keep good
communication with patients at all times, to maintain their comfort level, and to make sure they
understand our intent, and our findings. We educate most patients in techniques to prevent
reinjury, and to maximize results.
Our therapists have unique skills and training, unavailable anywhere else in the world. They are
screened for experience and excellent manual skills before being accepted for training. In fact,
we typically accept and train less than one percent of therapists who apply. Every therapist
undergoes required pre-training coursework, which can take a year or more to complete. They
study a 600 page Therapist Training Manual we wrote; then, they must attend extensive on-site
training at our home-office. Only therapists who pass our certification test at the end of the
training period become certified Clear Passage® therapists.
We have helped many women overcome infertility, and adults of both sexes to relieve their
pain, obstruction, or dysfunction - often without surgery or drugs. Our directors and instructors
have spent decades studying advanced manual physical therapy techniques, then developing
and researching new protocols to restore patients’ bodies to a state of increased balance,
mobility, and function. Along with these increases, patients generally note greatly reduced or
totally eliminated pain by the end of five days of treatment.
Your treatment begins with a thorough review of your history and a (roughly one-hour) on-site
physical evaluation by your evaluating therapist. We relate our findings to you, and ask you for
any comments or input you would like to share with us. We invite (but do not require) your
active participation with the team that is creating your results.
In your very first hour, we use our hands to locate adhered tissues in and around the organs,
muscles, connective tissue and support structures of your body. We apply gentle, specific
pressure in affected areas. This pressure is designed to reduce the adhesions that formed in
your body over time, and return your structures to normal mobility, tone, and function.
Treatment sessions are individualized to you – based on your history, goals and physical
evaluation. We explain our ongoing findings and our work on you; we listen deeply to you, and
appreciate your feedback. Your therapy is always one-on-one, performed by a Wurn Technique
certified therapist in a lovely private treatment room.
During your visits, your evaluating therapist will feel and treat deeply in your body, finding
areas that healed and became adhered years, or even decades ago. We find and treat the
compensatory pattern of adhesions which formed in your body due to trauma, surgery,
inflammation, infection or poor posture over the course of your life. We always work within your
tolerance and comfort level. Our intent is to slowly and meticulously break down the tiny,
powerful cross-links that are the building blocks of adhesions.
Patients regularly describe our therapy as a deep or profound relief, or “something my body has
needed for a long time.” We often hear “you have found the area I’ve been telling my doctor(s)
about for years – but they couldn’t find anything.”
Sometimes, you will notice a pattern of pain, such as, “when you push there, I feel it in my low
back, my leg, the base of my skull.” This tells us exactly where the “run” exists in your fascial
sweater – the system that surrounds and separates all of your muscles and organs. Patients
often express deep relief and joy to finally understand the pattern of pain or dysfunction that
has plagued them for years – or decades.
Treatment sessions are generally scheduled in one to two-hour sessions, less 10-15 minutes per
hour for paperwork and chart review. This equates to 45+ minutes per hour of uninterrupted
manual therapy per hour. All of our therapists love to treat, but keeping good records of your
history, response, and changing patterns during treatment is vital to your success, and can help
with your insurance reimbursement.
Patients with pain complaints
Most patients find treatment sessions interesting, informative, and relaxing. Patients who arrive
with pain complaints often notice significant changes within the first few hours of therapy. We
work to decrease your pain (if any), restore alignment, balance, and mobility to your pelvis,
sacrum, thoracic, and lumbar spine, your back and hip muscles, connective tissues,
abdominopelvic organs and any areas giving you symptoms. We work with you to improve your
function, your range of motion, and your tolerance for physical activity so we can return you to
an active, productive lifestyle.
As your pain decreases and function begins to return, we educate you in a lifelong preventive
and restorative exercise program to improve flexibility, strength, lifting ability and endurance
levels. Profound enhancement of personal and professional life often follows as a result. We
invite you to be an active member of the team that treats you, creating and achieving your
goals together. We are glad to work hand in hand with your physician, if you and she/he are
interested in that.
Personal privacy
We follow the ethical guidelines of the American Medical Association (AMA) and American
College of Obstetrics and Gynecology (ACOG) regarding patient draping and right to a
chaperone. We provide coverings - blankets, gowns, towels and pillowcases - for those who
wish to use them. We invite you to bring your partner to therapy with you, but therapy is
individual, and partners need not attend.
As manual therapists who often work in delicate or personal areas, we are sensitive to your
physical and emotional comfort level. We respect your personal privacy. We keep good contact
with you and your comfort level at every stage of therapy. In fact, we regard you as an expert
on your own body, so we seek and appreciate your thoughts, feelings, and input. We feel your
input can give us a better result. We like to keep you fully informed in every step of treatment,
so we take the time to explain our theories and techniques while we are working with you. We
are happy to explain our findings about your body and the ongoing changes we notice in terms
you can understand (and generally feel in your body), every single session.
Abdominal Adhesions: Prevention and Treatment
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon
http://www.itmonline.org/arts/adhesions.htm
Adhesions are strands or of scar tissue (fibrin bands; see illustration, below) that form in
response to abdominal surgery and extend beyond the specific site of incision, sometimes
forming separately from the incision site within the peritoneum. Scar tissue that mends the
incision is normal, but the adhesions form additionally under some circumstances that are not
fully understood. There are specific features of a surgical procedure that help induce the
formation of adhesions. For example, drying of the tissues during surgery increases adhesion
formation, a situation remedied by paying attention to the arid conditions and correcting them
during then procedures. Intentional drying of the tissues, by applying gauze, is an otherwise
desirable procedure to aid the surgeon's view of the area, but because of increased adhesions, it
must be minimized. Tissues that become dry should be quickly moistened and air (carbon
dioxide) that is passed over the surgery site to maintain cleanliness also must contain adequate
moisture to prevent rapid drying of the exposed fluids. Laparotomy (open abdominal surgery) is
more likely to produce adhesions than surgery performed via laparoscopy in which a small scope
with attached microsurgical instruments is inserted through a slit in the abdomen (1-3).
Left: a representation of a normal peritoneum, the transparent membrane that wraps the pelvic
and abdominal organs. Right: after surgical trauma, fibrous bands of collagen grow as part of the
normal healing process and form adhesions. Adhesions connect tissues or structures that are
normally separate. Adhesions in the abdomen or pelvic area can lead to infertility, pelvic pain,
small bowel obstruction, or the need for repeat surgery (1).
The most frequent problem with adhesions is a constriction of the small intestine, producing
constipation (sometimes complete bowel blockage, requiring emergency treatments). Abdominal
pain is another common symptom, caused when the bands of scar tissue bind up the internal
organs so that movements pull on them. Linkage of menstruation to changes in bowel function
(e.g., inducing diarrhea) may occur as the result of scar tissue attaching the uterus to the
intestine. Adhesions may also impair fertility in women by causing blockage of the fallopian
tubes. It has been estimated that:
At least one-third of women who suffer from pelvic pain have adhesions as a cause
of or contributor to the pain.
Adhesions involving the ovaries or fallopian tubes are responsible for 15-20
percent of female infertility cases.
Small bowel obstruction is often a surgical emergency and is particularly common
after gynecological surgery.
To prevent adhesion formation, surgeons may now apply a fine fabric barrier to surround
the organs, thus isolating them from the scar tissue strands (the barrier dissolves after the
surgery). Although adhesions can be removed by surgical intervention (adhesiolysis) using a
laparoscopic technique (4), recent studies suggested that such surgery produces limited benefits
that are often short-term. Many patients are treated with multiple adhesiolysis procedures in an
attempt to improve the symptoms of adhesions. Each year, 400,000 adhesiolysis procedures are
performed in the U.S., costing the health care system about $2 billion in hospitalization and
surgeon expenses.
Most times, adhesions cause few, if any, notable effects. But, for those who do suffer from
their adverse effects, the question arises as to whether the adhesions can be reduced or eliminated
by methods other than further surgery.
The formulas are usually a derivative of the ancient prescription Da Chengqi Tang (Major
Rhubarb Combination). The traditional formula has four ingredients: rhubarb and mirabilitum as
purgatives and chih-shih and magnolia as qi regulating herbs. The modifications of the formula
usually involve adding additional qi regulating herbs (notably saussurea) and blood vitalizing
herbs (especially persica, red peony, and salvia) to promote the circulation of qi and blood in the
abdomen and prevent formation of adhesions, which are seen as the result of prolonged stasis.
An example is the administration of a formula called Tao Zhi Zhi Po Fang, comprised of
rhubarb, magnolia, chih-ko (in place of chih-shih), saussurea, persica, carthamus, leech, and
salvia, provided 6 hours after abdominal surgery (5). Compared to a control group not treated
with these herbs, bowel sounds and bowel functions resumed many hours earlier and the
incidence of adhesions (determined by typical symptoms of adhesions appearing within the next
three years) was significantly lowered.
In another report (6), a modified Major Rhubarb Combination was administered after
surgery while during surgery a protective barrier fluid was used to isolate the organs and prevent
adhesions. The authors noted:
Treatment by integrating traditional Chinese medicine and western medicine has
been adopted in many surgical departments, especially the application of Modified
Major Rhubarb Combination. The formula has the properties of inducing purgation,
promoting qi circulation, resolving blood stagnation, and assuring that the hollow
viscera remain unimpeded; specifically, stomach-qi can move downward freely to
eliminate fullness and distention, the qi in the abdomen can circulate freely, and the
bowels remain open; it can stimulate early peristalsis of the bowels after surgery.
When using the Modified Major Rhubarb Combination soon after surgery for
adhesive bowel obstruction, it can markedly shorten the time period of intestine
paralysis.
Because the herbal treatment within hours after surgery is impractical for Western patients
(and the use of purgatives would be objected to by the medical profession on grounds of it
possibly causing damage), the question about treating existing adhesions arises. In Chinese
investigations of this matter, the patients are usually those who have come to the hospital with a
severe disorder, usually bowel blockage, for which surgery would be utilized. Patients may first
be treated with herbs to see if this is successful in relieving the blockage, while surgery can be
used as a back-up.
The non-surgical treatment of adhesion-induced medical crisis is similar to that used for the
preventive measure after surgery, at least in cases involving bowel blockage. For example, in one
evaluation (7), patients were treated with a derivative of Major Rhubarb Combination made with:
rhubarb (15 g), magnolia (10 g), chih-shih (10 g), mirabilitum (20 g), persica (10g), red peony
(15 g), and stir-fried raphanus (45 g). Raphanus (radish seed) is used to aid the downward flow
of qi, normalize digestion, and alleviate abdominal pain. The herbs were administered in 1-2
batches a day, orally or through a stomach tube. Of 250 patients treated this way, 88% were able
to avoid surgery. As with the method for preventing adhesions in the first place, there is some
doubt that this approach would be used in the West, as there is concern about using strong
purgative treatments when bowel blockage exists. In China, the patients are carefully monitored
while pursuing this treatment as an inpatient and are referred to surgery if the problem is not
promptly resolved.
Another report of this type of treatment approach involved use of two slightly different
decoctions, depending on the differential diagnosis (8); these were:
Modified Major Rhubarb Combination: rhubarb (10-30 g), mirabilitum (6-15 g),
magnolia (20 g), chih-shih (10 g), persica (10 g), red peony (10 g), and stir-fried
raphanus seed (30g)
Adhesion Lysis Decoction: cassia leaf (10g), mirabilitum (6-10 g), magnolia (10
g), lindera (10 g), persica (10 g), red peony (10 g), and stir-fried raphanus seed (10
g).
These formulations could be modified: for severe pain, add 10 grams each of corydalis,
frankincense, and myrrh; for a case with vomiting, add 10 grams pinellia and 30 grams raw
hematite.
As in the previous study, these formulas prevented the need for surgery in about 86% of
cases. Presumably, these therapies could be applied to Western patients suffering from
constipation that has not developed into full obstruction requiring hospitalization; the formulas
are not inherently different from traditional herb prescriptions now administered for acute
constipation. For example, Major Rhubarb Combination is routinely sold as a dried extract
granule by several Chinese herb suppliers worldwide.
A limitation of the purgative herb therapy is that while it relieves the immediate crisis, the
problem can return, because the adhesions are not gone. An attempt to resolve this dilemma was
designed on the basis of using Chinese herb therapy to treat the obstructive crisis and then using
laparoscopic surgery to remove the adhesions to prevent further occurrences. By so doing, one
can usually avoid emergency surgery as a result of intestinal obstruction; instead, the surgery can
proceed at a time when the intestinal functions have normalized and a less invasive surgical
technique (laparoscopic surgery) can be utilized. In one study using this two-stage method (9),
patients received one of three basic herb therapies for the intestinal obstruction:
In these formulations, rhubarb, euphorbia, and cassia leaf all serve the same function of
inducing peristalsis. The purgative herb is the central ingredient in treatment, while the others are
supportive; in one study (10), euphorbia was used as a single herb to treat intestinal obstruction
due to adhesions in order to prevent the need for surgery.
The desire of most patients would be to alleviate the problem of adhesions before a crisis of
bowel obstruction occurs, and to treat other manifestations of adhesions, such as abdominal pain
and reduced fertility. The Chinese literature appears silent on this issue, but there are some
possibilities to be considered.
The fact that existing scars may be degraded somewhat by the enzyme action suggests the
possibility that herbal therapies could contribute to alleviating adhesion symptoms by stimulating
the body's production of hyaluronidase (or other enzymes of similar function) to perform this
task. Even if scar tissue is not removed, if it can be softened (made more elastic), there may be
relief from its physical manifestations such as bowel blockage, pain, and some cases of
infertility. Herbs that are reputed to aid healing of injuries, soften abdominal masses, and
alleviate abdominal pain of various origins may act, in part, by breaking down undesirable
collagens to alleviate the symptoms. Antifibrotic and mass reducing herbs are used to treat
abdominal disorders such as uterine fibroids and liver fibrosis, and are also used to treat skin
masses in scleroderma; it is possible that they function by increasing the degradation of fibrous
tissue via hyaluronidase. Key herbs for reducing fibrosis and masses are listed in Table 1 (11).
A treatment for existing adhesions would follow the pattern of treating any other abdominal
mass or fibrotic condition, namely a high dose therapy administered for a period of 3-6 months.
During this treatment, an effort to stretch the scar fibers, possibly stimulating the local response
to softening the fibers, might be pursued via exercises and massage therapy. Care must be taken
not to induce any damage during such efforts.
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Instructions
1.
o 1
Discuss your symptoms with your doctor. The first step in treating adhesions is to determine
if they are the most likely cause of your pain. Laparoscopic surgery may be recommended to
see how extensive the adhesions are.
o 2
Visit a Maya Abdominal Massage therapist. Maya Abdominal Massage is a gentle massage
technique that helps to break up adhesions and guide organs into their proper positions.
Scar tissue can trap lymph fluid below the incision line. Maya Massage can help to get this
fluid flowing again, improving your overall health and wellness.
o 3
Seek alternative treatments for pain, such as acupressure and acupuncture. Research has
shown that these methods can be effective in providing pain relief.
o 4
Consider requesting laparoscopic surgery about a week after having your surgical
procedure. In the days following surgery, adhesions which are just forming are soft and lack
a blood supply. They are easier to break up through laparoscopy during this time.
o 5
Gently massage your scar with lotion or oil in the weeks following any surgical procedure.
Adhesions can be minimized by keeping the blood and lymph fluid flowing in the area and by
gently breaking them up as they are beginning to form.
o 6
Ask your physician about using an adhesion barrier, such as Seprafilm, during your surgical
procedure. Such products, which are now widely used, contain an enzyme called
hyaluronidase. This substance helps to break down connective tissue, thus discouraging the
formation of adhesions. Anti-adhesion products have been shown to reduce adhesion
formation by up to 50 percent.
o 7
Plan ahead. The best defense is a good offense. If you’re prepared for the likelihood of
adhesions forming during a surgical procedure, you can take measures to help prevent them.
TS Jordan is an Ohio licensed attorney living and practicing out of the Cleveland area. In
addition to his Juris Doctorate, he holds a Bachelors' Degree in Information Systems. He has
been writing professionally for less than a year. By TS Jordan, eHow Contributor
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Following just about any type of surgery, scar tissue will form. Scar tissue is composed of collagen
that forms fibrous bands. This tissue is beneficial and necessary for the body to heal a surgical
wound properly. However, there are incidences where too much scar tissue forms and creates
additional problems for the patient. This is the case with abdominal adhesions.
2. Chinese Herbs
o Sometimes, surgical treatment is required for abdominal adhesions because of blockage of
the small intestine. However, this is rarely the case. A majority of the time these adhesions
only cause mild pain that is bearable. When treatment is necessary, there are some
alternative treatments available as well.
One of the alternative treatments for abdominal adhesions is the administration of Chinese
herbs. When a patient is given a combination of rhubarb, mirabilitum, chih-shih, and
magnolia, the concoction may help with the treatment of abdominal adhesions. Some believe
that this combination can even prevent surgery when the adhesions have obstructed the
bowels in some way.
3. Diet Change
o Another alternative treatment is a change in diet. If you have been diagnosed with abdominal
adhesions, this is the first thing you should consider as treatment. Typically, a change in diet
means that you should switch to a nearly all liquid diet or a low-residue diet. This is a diet
where the food that is eaten can be more easily digested within your system and includes
lots of dairy products and food items that are low in fiber.
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