If you have unrelenting IBS, SIBO, dysbiosis, abdominal cramping and abnormal BM’s, addressing potential adhesions is something that you should make a part of your treatment plan. When I first began my journey to address intestinal adhesions, I felt SO lost due to how spread out across the internet the information is. So I’ve made a point of putting together the most comprehensive information pack on adhesions that I could. In this article I’ll talk about the root causes, nutritional and supplemental support and various forms of treatment including manual therapies, photobiomodulation and vibration therapy.
Adhesions are the body’s mechanism for healing itself – an internal version of scar tissue that forms in response to an injury. For example, if you got punched in the stomach or crashed your snowboard into a tree and the impact created a small internal tear, the body would create an adhesion to protect that tear, to hold it together and to allow it to heal. The same would apply to Endometriosis, tripping and falling, falling off a horse, playing a contact sport, abusive relationships, car accidents (even minor), surgeries, and even chronic inflammation can all cause adhesions. Even SIBO, Crohns and Ulcerative Colitis, related surgeries, abdomino-pelvic radiation or dysbiosis can lead to adhesions.
Abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery. Abdominal adhesions also occur in 10.4% of people who have never had surgery.
Many people remain asymptomatic to adhesions, however, the trouble for our digestion starts when they prevent normal movement and digestive flow. They can have a domino effect throughout the body, pulling fascia in surrounding areas; the fascia surrounds and integrates with cells, tissues and organs, therefore the resultant contraction can have serious long term effects. For example, a C-section scar can lead to many years down the line a knee or hip problem or a painful back.
Abdominal adhesions may span two or more abdominal organs and/or the inner abdominal wall (i.e. peritoneal membrane), connecting organs and surfaces that wouldn’t normally be connected. An adhesion can squeeze the structures and fascia that it surrounds, inhibiting movement and circulation. If the fascia is not moving freely the whole area will experience pressure, malnourishment and ultimately painful restriction in movement and at rest. Nerve endings may become entrapped within a developing adhesion.
So, how do you know if you have adhesions? They have no characteristic laboratory features and are not readily visible by currently available imaging methods, which can make their diagnosis challenging. By allopathic standards, the only solid method of diagnosis would be through surgery, and whether laproscopic or not, surgery can result in further adhesions. At the most, you may be able to identify blockages through having a Barium Swallow X-Ray. Officially, the most non-invasive method of “diagnosis” is through assessing symptoms and lifetime history of events. One may also want to see an experienced PT, RMT, DO or DC who can identify them for you.
Symptoms of Adhesions:
In general, any of the following symptoms may be seen in association with/due to intra-abdominal adhesions:. Chronic (persistent or intermittent) bloating.. Abdominal cramping. Altered bowel habits, including constipation or frequent loose stools (e.g. from development of small intestinal bacterial overgrowth).. Nausea with or without early satiety.. Bowel obstruction, which may be transient, partial, or complete (and may cause the aforementioned symptoms).. Female infertility and pain during sex.. Pain after eating, particularly fibrous foods. Rectal bleeding and painful defecation, particularly during menses
Treatment for Adhesions
Surgical Methods:AdhesiolysisIn around 70 percent of cases, surgery to remove the original adhesions will cause more adhesions to develop. Discuss the risks, benefits and alternatives to surgery thoroughly with your doctor before you make a decision. Balloon DilationIf your inflammation has become a small stricture your doctor might be able to open it up with a procedure called balloon dilation. Another term for this procedure is “endoscopic dilation.” Your doctor performs this procedure with a long, thin tube with a very small camera, a light, and a small balloon. The camera lets your doctor see inside your digestive tract. The scope is inserted via your rectum and travels through your colon. Once it has reached the stricture, the balloon is inflated. As it inflates, it opens up the area that has gotten narrow. Some patients with small strictures can avoid surgery this way. However, 70% of those who receive dilation for strictures require repeat treatment or go on to have surgery.
There is evidence that manual therapy works, however the mechanism is debated. Most evidence says we can’t break up scar tissue with our hands. Depending on the type of therapy, it act as an input to the nervous system that decreases perceived threat, which then results in relaxation of high tone tissues; restores nerve function including numbness, pain and sensitivity; Enhances movement of the surrounding tissues and fascia, to reduce pulling and sticking; liberates and re integrates tissue back into the 3D web of fascia.
Every case is different, so you may find yourself needing to explore a variety of therapies and practitioners before you find the right mix for you. You may need to look into therapies practiced by a Physiotherapist, Registered Massage Therapist, Osteopath or Chiropracter.
When I first began researching where I should go to receive manual therapy for my own adhesions, the only company I could find that actually advertised that they could fully treat intestinal adhesions was Clear Passage. The $6000.oo USD price tag on a week of treatment meant that visiting them wasn’t an ideal option, so I had to keep looking. It took a few tries, but eventually I found practitioners who, even though hadn’t advertised that they treated intestinal adhesions, were fully capable of doing so due to their training in one or multiple of the following.
. Visceral Manipulation (check the Barral Institute website for certified practitioners). Active Release Technique: Treatment via Active Release Techniques (ART) combines various techniques to manage scar tissue, adhesions and fibrous tissues, as well as nerve entrapments.. Myo-fascial release: A massage which incorporates various positions of the treated area while the therapist glides overlying tissues in order to release fascia. Fascia is the tough connective tissue which wraps muscles, tendons and ligaments. Having fascial mobility permits your structures to work normally.. Arvigo Abdominal Massage: Techniques of Maya Abdominal Therapy are a non-invasive, external, massage technique. When applied, they guide internal abdominal organs into their proper position for optimum health and well being.. Graston Technique: instrument-assisted soft tissue mobilization used to break down scar tissue, fascia restrictions, and adhesions.. Deep Tissue: A deep tissue massage focuses on the deep structures of the body to break up and eliminate scar tissue from previous injuries. The massage therapist applies different types of pressure to your muscle fibers for long-lasting results.. Cross Fiber Friction: The therapist uses varying depths and speeds of massage against the direction of the muscle, tendon or ligament. This breaks up adhesions and scar, while encouraging the tissue to lengthen as the adhesions release.. Trigger Point: Trigger point therapy targets the tight and uncomfortable muscles that can’t be relieved by regular massage methods. Your massage therapist will apply pressure to specific points to relieve tension and restore functionality in that area. It will also break up scar tissue and muscle adhesions.
There are a few different techniques for applying vibration. One can use a full body vibration machine or have a practitioner apply targeted vibration to the area with a Percussion Instrument. There are specific speeds that work best for adhesions, so make sure you speak to a practitioner before you get started.
Success story: We have a client at our clinic who due to having 27 abdominal surgeries has adhesions all throughout her abdomen and digestive tract. She swears that daily use of her full body vibration machine helps “keep things straight.”
Photobiomodulation ie. Laser Therapy
Low-level laser therapy was demonstrated in this trial to be an effective instrument for the treatment and early rehabilitation of patients with abdominal adhesions. Another trial found high-intensity laser therapy to be an effective method of pain alleviation, reducing adhesions, and improving the quality of life in women with endometriosis.
In my experience, laser can be either really helpful to a patient with adhesions, or they might not notice a thing. Most of the time, a minimum of 5-6 treatments would be needed.
Castor Oil Packs
https://static.usrfiles.com/html/870e32_0d24958ddb911dfd3c687d52eea66b64.htmlYou can place a castor oil pack on the adhered area to increase circulation within the scar tissue. It also promotes healing of the tissues and organs underneath the skin. It is often used to relieve pain, increase lymphatic circulation, reduce inflammation, stimulate the liver, and improve digestion. Just remember to use a cold-pressed castor oil and 100% cotton flannel (or wool) – no synthetics. You can use either a hot water bottle or a heating pad as the heat source. Also beneficial would be to massage DMSO or Essential Oils into the area before applying the pack.https://static.usrfiles.com/html/870e32_92d4443165f20e07fc6ad05cba0af9d1.html
Essential oils for scar tissue
A number of essential oils have been identified as having superior skin repair qualities, including some that are
Two important oils to treat scar tissue:Frankincense (Boswellia carteri)Myrrh (Commiphora myrrha)Copaiba can reduce inflammation and improve skin health
If you are predisposed to bowel obstructions or are experiencing alot of pain due to adhesions you may want to try a low-fibre diet like the one here until you have improved. For more severe cases, an elemental or semi-elemental diet may be helpful.
You’ll likely have deficiencies of various minerals and micronutrients including the omega-3 oils, for example, which help maintain flexibility of the cell membranes. Vitamins A and D, along with vitamin E, and other fatty substances are also needed.
Selenium, silicon and zinc actually give substances a slippery, smooth texture that tends to undo some adhesions. The skin of fish such as sardines, for example, is high in selenium that is needed for the fish to navigate or slip through the water without much resistance. It also helps the body tissues slip along each other without adhering.https://static.usrfiles.com/html/870e32_e3a48afd4669c435c87673917c2cd6d8.htmlIf you are taking a stool softener or laxative and still experience symptoms of impaired motility, try taking one without a bulking agent. I personally found taking high doses of digestive bitters, such as Maria’s Alcohol Free Swedish Bitters to be extremely effective.
At home techniques: Ball Rolling, Yoga and Breathwork
Purchase yourself a foam roller or lacrosse ball for a targeted release. Roll on the foam roller/ball until you feel a “trigger point” or “hot spot.” You’ll know you found one when it hurts. When you find a trigger point, stop and just rest on the foam roller for 10 to 20 seconds. Contrary to popular belief, it’s the pressure, not the rolling, that smooths fascia.Avoid applying pressure on bones and joints. Just muscle. See this Video Here for further instruction
Yoga encourages rehydration of your internal surfaces, especially when practiced with breath awareness. When you practice yoga, the constant squeeze and release action in the abdominal area (often called massaging the internal organs), along with diaphragm movement can help release tension in the area and can enable better organ positioning and improved cellular function throughout, allowing your organs to function more efficiently. Yoga can also help address poor posture, fascial adhesions that may be causing imbalances within the body and help to put the body back into alignment, all of which, as discussed above, can affect digestion.
Chronic stress can be a contributor to unhealthy fascia. Yoga aids by switching our autonomic nervous system from Sympathetic (fight or flight) to Parasympathetic (rest, relax, repair, digest).
Try doing some cobra, upward dog, sphynx or seated twists while doing deep belly breathes. When you move into your cobra pose move as slowly as you can, so that you can easily identify areas of tightness. Try looking over each shoulder with a slight twist in order to target adhesions on the side of your abdomen.
Hopefully this information gets you on your way to tackling your adhesions. Once I had my diagnosis it took a month of trying practitioners and alternative therapies before I found the ones that were able to help most. I’ve experienced first drastic improvement and then gradual improvement ever since. If you find a practitioner who helps you let me know and I’ll add them to my list!Wishing you speedy healing. – K
Capable practitioners on Vancouver Island/Vancouver, BC
Attila Apt at Total Body Health
Melissa at Synergy Health
Genoa Laser Therapy, Duncan
Harmony Osteopathy, Vancouver, BC
Foundation for Integrated Health, North Vancouver
Dr Roberts at Advanced Naturopathic in Calgary
Lifepath Massage Therapy, Calgary
Evolve Chiropractic, Calgary
Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: A practical review of an often overlooked entity. Ann Med Surg (Lond). 2017;15:9-13. Published 2017 Jan 31. doi:10.1016/j.amsu.2017.01.021
Rice AD, King R, Reed ED, Patterson K, Wurn BF, Wurn LJ. Manual Physical Therapy for Non-Surgical Treatment of Adhesion-Related Small Bowel Obstructions: Two Case Reports. J Clin Med. 2013;2(1):1-12. Published 2013 Feb 4. doi:10.3390/jcm2010001
Scar Massage and Tissue Release https://www.massagetherapies.co.uk/scar-massage-and-tissue-release
Vopr Kurortol Fizioter Lech Fiz Kult. (2013 Jul-Aug) The role of laser therapy in combined rehabilitation of patients presenting with abdominal adhesions(4):15-7.
Ali Abd El-Monsif Thabet and Mansour Abdullah Alshehri.Photomedicine and Laser Surgery.Jul 2018.ahead of printhttp://doi.org/10.1089/pho.2017.4419