Adhesions are bands of internal scar tissue that bind organs or tissues together, and getting rid of them is notoriously difficult. Surgery is currently the only way to physically remove adhesions, but the procedure itself can trigger new ones to form, with recurrence rates ranging from 20% to 60%. That catch-22 makes prevention, physical therapy, and symptom management just as important as removal.
Why Adhesions Are Hard to Eliminate
When tissue inside your body is damaged, whether from surgery, infection, or inflammation, your body kicks off a repair process that starts with blood clotting proteins forming a sticky, web-like scaffold at the injury site. Normally, your body dissolves this scaffold once healing is underway. But when that cleanup system underperforms, the scaffold sticks around, attracting repair cells that lay down permanent structural fibers like collagen. Blood vessels grow into the new tissue, and what started as a temporary patch becomes a lasting band of scar tissue connecting surfaces that should move freely against each other.
This is why adhesions are so persistent. They aren’t simply “stuck” tissue. They’re living, organized structures with their own blood supply and collagen framework. And this is also why they tend to come back after surgical removal: the surgery itself creates new tissue damage, restarting the same inflammatory cycle.
Why Adhesions Are Difficult to Diagnose
Standard imaging tests like CT scans, X-rays, and ultrasounds typically cannot show adhesions directly. According to the National Institute of Diabetes and Digestive and Kidney Diseases, these scans are mainly useful for detecting complications that adhesions cause, such as bowel obstruction, rather than the adhesions themselves. A CT scan can help pinpoint the location and severity of an obstruction, and X-rays with a contrast liquid can help determine whether surgery is needed. But the adhesions themselves are often invisible until a surgeon looks inside during a procedure.
This means many people live with adhesion-related pain or digestive symptoms for a long time before getting a clear diagnosis. If your symptoms point toward adhesions but imaging looks normal, that doesn’t rule them out.
Surgical Removal: Adhesiolysis
The primary medical treatment for adhesions is adhesiolysis, a procedure where a surgeon cuts or separates the scar tissue bands. This can be done through open surgery (a larger incision) or laparoscopically (through small incisions using a camera). A randomized clinical trial published in JAMA Surgery compared the two approaches in 100 patients with adhesion-related small bowel obstruction and found no significant difference in obstruction recurrence, hernia rates, or quality of life over five years. The recurrence rate of bowel obstruction was about 3.4% at one year and 11.1% at five years in both groups.
One concern with laparoscopic surgery is that the smaller viewing window may leave adhesions outside the immediate area untreated. Some retrospective data suggest this could lead to slightly higher recurrence, though the randomized trial did not find a statistically significant difference.
The bigger issue is that adhesions re-form after removal at high rates. Studies on intrauterine adhesions report recurrence between 20% and 63%, with worse outcomes in patients who had more severe adhesions to begin with. For patients with mild adhesions, recurrence was around 10%, while those with severe adhesions saw rates as high as 35%. Each additional surgery can worsen the problem, making it important to consider non-surgical options alongside or instead of repeated procedures.
Barrier Products That Prevent Re-Formation
Surgeons can place barrier materials over exposed tissue during surgery to physically separate healing surfaces and reduce the chance of new adhesions forming. Two widely used products are Interceed (made from oxidized cellulose) and Seprafilm (a film combining hyaluronic acid and carboxymethylcellulose). Both are FDA-cleared and dissolve on their own over days to weeks.
Interceed has shown strong results in several contexts. In one study of patients after laparoscopic fibroid removal, 60% of those who received the barrier were adhesion-free at follow-up, compared to just 12% in the control group. After ovarian cyst surgery, 76% of treated ovaries were adhesion-free versus 35% untreated. In a study of cesarean sections, 74% of the barrier group had no adhesions at a later surgery, compared to 22% without the barrier.
Seprafilm has been more inconsistent. It performed well after fibroid surgery, with 46% of patients remaining adhesion-free compared to 10% of controls. But in a large multicenter trial of cesarean sections, it made essentially no difference: about 75% of patients in both the Seprafilm and control groups developed adhesions. So while barriers can help, they don’t guarantee prevention, and results vary depending on the type and location of surgery.
Manual and Physical Therapy
Hands-on physical therapy, sometimes called visceral manipulation, involves a therapist applying gentle, sustained pressure and movement to the abdomen or pelvis to mobilize tissues that may be restricted by adhesions. This approach has clinical support, though the evidence base is still growing.
In an animal study modeling postoperative adhesions, manual therapy significantly reduced the size and frequency of the most problematic type of adhesion (cohesive adhesions, where organ surfaces are directly bound together). While all untreated animals developed these adhesions, only 40% of treated animals did. The therapy was most effective when started soon after surgery. Clinical reports have also suggested that this type of therapy may help with chronic pelvic pain, constipation, and even fertility issues related to adhesions, though large-scale human trials are limited.
If you’re dealing with adhesion-related pain or restricted movement, a physical therapist trained in visceral or myofascial techniques can assess whether hands-on treatment might help your specific situation.
Stretching and Movement for Symptom Relief
Gentle stretching won’t dissolve adhesions, but it can reduce the pulling, tightness, and pain that adhesions cause by improving the flexibility of surrounding tissues. For abdominal and pelvic adhesions, several floor-based exercises are commonly recommended:
- Child’s pose: Kneel on all fours, spread your knees wide with toes touching, and lower your hips toward your heels while reaching your arms forward along the floor. Hold when you feel a gentle stretch through your abdomen and lower back.
- Child’s pose with side bend: From the same starting position, walk your hands to one side before lowering, creating a stretch along the opposite side of your torso. This targets lateral adhesion restrictions.
- Gentle trunk rotations: Lying on your back with knees bent, slowly let both knees fall to one side while keeping your shoulders on the floor. This creates a gentle twist through the abdomen.
Consistency matters more than intensity. Doing these stretches daily, holding each position for 20 to 30 seconds without forcing through pain, can gradually improve comfort and range of motion over weeks.
Diet for Managing Adhesion Symptoms
If you have known abdominal adhesions, dietary choices can help prevent the most dangerous complication: bowel obstruction. Adhesions account for roughly 65% of all small bowel obstructions, making this a real concern for people with significant post-surgical scarring.
Many sources recommend a low-fiber diet (under 10 grams per day) for people at risk, advising no more than 1 to 2 grams of fiber per serving. The logic is that bulky, fibrous foods like raw vegetables, beans, and whole grains can get caught at points where adhesions have narrowed the intestine. Patients with intestinal narrowing after abdominal surgery commonly avoid these foods as a precaution.
That said, the evidence is not conclusive. One self-controlled study found that a low-fiber diet did not significantly reduce the risk of adhesion-related bowel obstruction. The practical takeaway is to pay attention to which foods cause you symptoms. If you notice bloating, cramping, or pain after eating high-fiber or hard-to-digest foods, reducing those specific items makes sense. But a blanket low-fiber diet may not be necessary for everyone with adhesions.
Eating smaller, more frequent meals and chewing food thoroughly are simple habits that reduce the volume of material passing through any narrowed sections of intestine at one time.
When Adhesions Become an Emergency
Most adhesions cause chronic, manageable symptoms or no symptoms at all. But a complete bowel obstruction is a medical emergency. Warning signs include severe abdominal cramping that comes in waves, inability to pass gas or have a bowel movement, vomiting (especially if it becomes dark or fecal-smelling), and a visibly swollen, rigid abdomen. If you experience these symptoms together, you need emergency care. A complete obstruction can cut off blood supply to part of the intestine, which becomes life-threatening within hours.