Everyone has experienced an injury of some nature whether it’s a simple paper cut or a surgical procedure. Overall the healing process runs the same course and as a result scar tissue or adhesions are created. Adhesions are unnecessary tissue connections between two locations. Think of them like futile bridges within the body that shouldn’t be there and can wreak havoc.
Adhesions are formed by a multitude of factors including trauma and surgery, but things like infection, chemical irritation and endometriosis can also be a culprit. Post-operative adhesions are extremely common. Adhesions within the abdomen pose a lifetime risk for small bowel obstruction from their ability to limit normal organ movement.
Secondary infertility in women is caused primarily because of adhesion formation. It accounts for 20-40% of cases. Adhesions are believed to impair fertility in several ways: by changing the alignment of the tube which captures the egg and carries it to the uterus, constricting the blood supply to the ovaries inhibiting egg development, and/or by disrupting endometrial cycles including implantation. Some researchers have theorized that adhesions decrease normal pelvic organ mobility and lead to chronic pelvic pain.
Complications due to adhesions hasn’t changed in recent years despite latest surgical advances. Fortunately their prevalence has reduced and re-operation can help to reduce problematic areas where adhesions cause pain or dysfunction. Sequential operations don’t always achieve the desired results however and prevention of adhesion formation is preferable. Unfortunately most researchers and clinicians can’t agree on best practices for prevention and more research is needed in this area.
Manual therapy techniques has been reported clinically to help with pain management and improving organ mobility after surgery. There has been little high quality research in this area making it difficult to prove its effectiveness. Anecdotally manual therapy, in particular visceral mobilization, has been successfully used with various movement exercises to decrease pain, improve digestive tract mobility and decrease symptoms associated with things like constipation. Visceral mobilization is a newer developed strategy used in post-operative care and initial studies are promising. The challenge for research is developing a strategy that works for everyone but in the clinic individualized treatment gets the best results.
Body Harmony Physical Therapy has qualified physical therapists that have completed training in visceral mobilization as well as other techniques to improve organ mobility within the abdomen and pelvis. Clinically we have seen positive results with our patients. Our therapists have successfully aided in pain management of patients with chronic pelvic pain, impaired digestive mobility and infertility. Send us your questions or give us a call if you would like more information.
Clinical implications of post-surgical adhesions. http://www.barralinstitute.com/docs/articles/clinical-impact-of-postsurgical-adhesions.pdf. Accessed 12/2/2017.
Attenuation of postoperative adhesions using a modeled manual therapy. https://www.ncbi.nlm.nih.gov/pubmed/28574997. Accessed 12/2/2017.
Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study . https://www.ncbi.nlm.nih.gov/pubmed/11986017/. Accessed 12/2/2017.