Adhesions are bands of scar tissue that form internally, often connecting organs or tissues that are normally separate within the body. This formation is a natural part of the body’s healing process following tissue disturbance, such as surgery, infection, injury, or radiation. They commonly form in the abdominal or pelvic area, causing surfaces to stick or “adhere” to one another. Therapeutic approaches aim to manage and resolve these restrictive bands to restore normal function and alleviate discomfort.
Understanding Adhesions
Adhesions vary in appearance, ranging from thin, sheet-like structures to thick, fibrous bands. They develop when the body’s repair mechanism, involving inflammation and fibrin deposition, fails to dissolve the temporary fibrin scaffold, allowing it to mature into permanent scar tissue. This process is common after abdominal surgery, with up to 93% of patients developing some degree of adhesions.
Adhesions restrict the mobility of internal organs or tissues that are meant to glide freely. This restriction can cause chronic pain, often described as a deep, pulling, or cramping sensation that may worsen with movement. In severe abdominal cases, adhesions can twist or narrow the small intestine, leading to a small bowel obstruction. Adhesions in the pelvis can also interfere with reproductive function, sometimes causing infertility.
Manual and Movement Therapies
Conservative treatments focus on non-invasive techniques designed to improve tissue mobility and promote the remodeling of the scar tissue structure. These methods apply controlled, sustained pressure and tension to the adhesion sites over time, aiming to restore the natural movement and flexibility of the affected connective tissues.
Manual Techniques
Physical therapy (PT) often incorporates specialized manual techniques, such as soft tissue mobilization (STM) and myofascial release. STM involves a therapist applying pressure to the tissue to improve pliability and mobility. Myofascial release targets the fascia, the connective tissue surrounding muscles and organs, using sustained pressure to stretch and release tension.
Another specific technique is visceral mobilization, which uses gentle manual pressure to directly target abdominal organs and improve their function. These hands-on therapies are often complemented by active release techniques (ART), where the therapist pins down restricted tissue while the patient moves the body part through a full range of motion. This combination encourages the elongation of scar tissue fibers.
The goal of these professional treatments is to stimulate tissue remodeling, where the body gradually realigns and softens the stiff collagen fibers of the adhesion. Research shows that these manual therapies can improve scar mobility and may reverse adhesion-related partial small bowel obstructions in some patients. Consistent stretching and mobilization exercises are prescribed to maintain the gains achieved during therapy sessions.
Self-Care and Home Exercises
Patients can perform self-care techniques at home to support the work done in therapy. Targeted stretching and movement exercises help challenge the stiffness and encourage full range of motion. For superficial scar sites, such as external incisions, self-massage can be performed using circular or cross-friction motions to improve the tissue’s pliability. Tools like foam rollers or massage balls can be utilized on accessible areas to apply sustained pressure and aid in releasing fascial restrictions.
Surgical and Minimally Invasive Treatments
When conservative management is insufficient, or when adhesions create a medical emergency like a complete bowel obstruction, surgical intervention becomes necessary. The procedure designed to cut or remove adhesions is called adhesiolysis. This aims to restore the free movement of organs and relieve the mechanical pulling that causes pain or obstruction.
Adhesiolysis can be performed using two main approaches: open surgery (laparotomy) or laparoscopic surgery. Open adhesiolysis involves making a single, larger incision to access the abdominal cavity directly. This method is reserved for complex or severe cases where the adhesions are dense, widespread, or when an acute obstruction requires extensive visualization.
The preferred method is often laparoscopic adhesiolysis, a minimally invasive technique. Surgeons make a few small incisions and use a laparoscope—a thin tube with a camera—to visualize and precisely cut the adhesions using specialized instruments. Laparoscopic procedures generally result in a shorter hospital stay, less blood loss, and a quicker recovery time compared to open surgery.
Surgery is often considered a last resort because adhesiolysis carries a significant risk of causing new adhesions to form, sometimes requiring repeat operations. The procedure also carries risks such as inadvertent injury to adjacent organs like the bowel, which occurs in up to 10% of cases, along with the risks of bleeding and infection.
Surgeons carefully evaluate the indications for adhesiolysis, typically only recommending it when symptoms are severe, persistent, and significantly impacting quality of life. The goal is to maximize the benefit of relieving the current problem while minimizing the risk of repeat adhesion formation. Adhesion barriers, placed during the surgery, may be used to prevent newly cut surfaces from sticking together again.