From the Guidelines
Physical therapy techniques such as visceral mobilization, myofascial release, and gentle abdominal massage are recommended to break up intestinal adhesions, as they can improve mobility and function of abdominal organs, reduce inflammation, and restore proper intestinal function. These techniques are typically performed 2-3 times weekly for 4-6 weeks, with sessions lasting 20-30 minutes 1. Visceral mobilization involves gentle manual techniques that target specific abdominal organs to improve their mobility and function. A physical therapist typically applies light to moderate pressure in circular or gliding motions over the abdomen, following the natural movement patterns of the intestines. Myofascial release focuses on stretching and releasing tension in the connective tissue surrounding the abdominal organs. Gentle abdominal massage can help stimulate peristalsis and break down adhesions through rhythmic pressure.
Some key points to consider when using these techniques include:
- Increasing blood flow to adhesion sites, promoting tissue elasticity, and encouraging normal organ movement 1
- Reducing inflammation, improving tissue pliability, and restoring proper intestinal function 1
- Avoiding these techniques during acute inflammation or immediately after abdominal surgery
- Ensuring that these techniques are performed by therapists with specialized training in visceral manipulation
It is also important to note that while laparoscopic surgery may be an option for some patients with intestinal adhesions, it is not without risks and should be carefully considered by a qualified healthcare professional 1. The use of adhesion barriers can also reduce recurrence rates in case of a small bowel obstruction caused by adhesions 1. However, the most effective approach will depend on the individual patient's needs and circumstances. Overall, a comprehensive treatment plan that incorporates physical therapy techniques, such as visceral mobilization and myofascial release, can help to break up intestinal adhesions and improve patient outcomes.
From the Research
Physical Therapy Techniques for Breaking Up Intestinal Adhesions
- Manual soft tissue physical therapy has been used to reverse adhesion-related partial small bowel obstructions, with successful treatment and sustained results observed in patients treated 2
- This technique focuses on decreasing adhesions and can be an alternative to surgical intervention
Medical Treatment of Intestinal Obstruction Due to Adhesions
- Medical treatment has been successful in many cases of intestinal obstruction due to adhesions, with 47% of episodes resolving without the need for surgical intervention 3
- Volume entrapment during the first hours was correlated with the need for surgical treatment, and recurrences were not different between medical and surgical patients 3
Conservative Management of Adhesive Small Bowel Obstruction
- Up to 70% of adhesive small bowel obstruction cases can be successfully treated with conservative management, in the absence of strangulation and bowel ischemia 4
- Conservative management includes nonoperative therapy, such as bowel rest, fluid resuscitation, and pain management
- However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective 4
Timing of Surgical Intervention
- The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8-24 hours 4
- Operative management with early adhesiolysis has shown to be associated with an overall long-term survival benefit compared to conservative management 4
- Patients with small bowel obstruction secondary to adhesions should be operated upon early (within 24 hours) but may be treated nonoperatively for 24 to 48 hours, provided that no signs of strangulation are present or develop 5