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Reduce Abdominal Adhesions without Surgery

http://www.clearpassage.com/pain/pelvic-abdominal/pelvic-pain.php

Abdominal adhesions refer to scarring or tissue repair that occurs anywhere in the abdomen.
They form as the first step in the healing process after any surgery, trauma, infection, or
inflammation. Wherever they form, adhesions join structures with strong glue-like bonds that
can last a lifetime (see our general adhesions page for more detail.)
The abdomen contains several major organs, including those which digest food, create or filter
blood, or assist elimination. Abdominal adhesions frequently occur within the 7½ to 12 feet
length (Abdominal Imaging, 1984)1 of the small intestines. To maintain its length in this small
area, the small bowel has dozens of loops and folds. These help absorb nutrients en route from
the stomach to the large intestines. However, the close sinews of these folds are perfect places
for abdominal adhesions to form.
When adhesions form around the abdomen, intestines, or digestive tract,
dysfunction such as constipation or abdominal pain may result. Abdominal
adhesions can contribute to irritable bowel syndrome, or cause total blockage of the
intestines. Since the patient cannot eat or eliminate food, this blockage is
considered a life-threatening condition and must be treated by a physician
Treating Abdominal Adhesions with Surgery
Until recently, lysis of adhesions was the only choice medical science offered to treat abdominal
adhesions. This involves cutting or burning the abdominal adhesions under general anesthesia,
via laparoscopy or laparotomy (open surgery).
While lysis of abdominal adhesions can be effective, surgery has two major drawbacks:

1. it carries risks from anesthesia and infection, and


2. despite the best skills of the finest surgeon, the body creates more abdominal adhesions
as it heals from the surgery designed to remove them.

A study in Digestive Surgery showed that more than 90% of patients develop adhesions
following open abdominal surgery and 55% to 100% of women develop adhesions following
pelvic surgery.2 Another study reported that 35% of all open abdominal or pelvic surgery
patients were readmitted to the hospital more than twice to treat post-surgical adhesions during
the 10 years after their original surgery.3 Thus, abdominal surgery itself has been implicated as
a major cause of adhesion formation and many patients become trapped in a cycle of surgery-
adhesions-surgery – with no end in sight.
Causes of adhesions: Surgery
Surgery is a primary cause of adhesions. A study in Digestive Surgery showed that more than
90% of patients develop adhesions following open abdominal surgery and 55% to 100% of
women develop adhesions following pelvic surgery.2 As noted above, surgery to remove
adhesions has itself been implicated as a major cause of adhesion formation. Other surgeries
that may cause adhesions or scars to form in and around organs include:

 bowel obstruction repair


 appendectomy
 episiotomy or C-section
 laparoscopy or laparotomy
 hysterectomy
 back or hip surgery
 abortion
 complete or partial removal of organs
 gastric bypass
 plastic surgery

Adhesions can form wherever we heal from injury, surgery, or inflammation. Abdominal adhesions join structures
with strong glue-like bonds that can last a lifetime.

Treating Abdominal Adhesions with Surgery


Until recently, lysis of adhesions was the only choice medical science offered to treat abdominal
adhesions. This involves cutting or burning the abdominal adhesions under general anesthesia,
via laparoscopy or laparotomy (open surgery).
While lysis of abdominal adhesions can be effective, surgery has two major drawbacks:

1. it carries risks from anesthesia and infection, and


2. despite the best skills of the finest surgeon, the body creates more abdominal adhesions
as it heals from the surgery designed to remove them.

A study in Digestive Surgery showed that more than 90% of patients develop adhesions
following open abdominal surgery and 55% to 100% of women develop adhesions following
pelvic surgery.2 Another study reported that 35% of all open abdominal or pelvic surgery
patients were readmitted to the hospital more than twice to treat post-surgical adhesions during
the 10 years after their original surgery.3 Thus, abdominal surgery itself has been implicated as
a major cause of adhesion formation and many patients become trapped in a cycle of surgery-
adhesions-surgery – with no end in sight.
Treating Abdominal Adhesions with the Wurn
Technique
Belinda Wurn, PT treats a patient with her manual
physical therapy which has been shown to reduce
adhesions, decrease pain, and improve function, in
peer-reviewed medical journals.

We know abdominal adhesions well. We faced


this situation 20 years ago when the physical
therapist director of Clear Passage Physical
Therapy , Belinda Wurn, developed severe
®

adhesions after pelvic surgery and radiation


therapy to her abdomen. Unable to work due
to the pain, and having seen the devastating
and debilitating effects of abdominal
adhesions in her own patients, she was
determined to find a non-surgical way to address abdominal adhesions.
With her husband, massage therapist Larry Wurn, Belinda took a much deeper look at the
etiology and biomechanics of adhesion formation. They found that the chemical bonds that
attached each of the tiny collagen fibers to its neighbor appeared to dissipate or dissolve when
placed under sustained pressure over time. With this knowledge, they developed the Wurn
Technique to unravel the bonds between the crosslinks that comprise adhesions.
The “hands-on” work practiced at Clear Passage Physical Therapy clinics is designed to reduce
SM

or eliminate adhesions, crosslink by crosslink. It has been shown in peer-reviewed medical


journals to reduce adhesions, decrease pain, and improve soft tissue mobility, without the risks
of surgery or drugs.
We treat men, women and some children for abdominal adhesions. Visit our “what treatment is
like” web page for more information, or click the link at the bottom of this page now, to
complete a medical history questionnaire and apply for a free, in-depth consultation.

Because of its unique location, complexity, and vulnerability, the pelvis is a frequent site of
recurring pain. Pelvic pain is often caused by adhesions – tiny glue-like bonds that form to help
the body heal from lifetime events (e.g. surgery, trauma, accident, infection). Pelvic pain and
dysfunction can cause great frustration, in part, because most adhesions do not appear on
diagnostic tests. Laparoscopic surgery may help a physician view or remove some adhesions,
but adhesions that form due to the diagnostic or “clean up” surgery can cause the pain to
return – sometimes worse than before. Clear Passage Physical Therapy has over two decades
®

of experience and has seen excellent results (some published in major medical journals)
evaluating and treating chronic pelvic pain. All treatment is without surgery or drugs.
Adhesions can form
wherever healing takes
place from injury, surgery,
or inflammation. Pelvic
adhesions join structures
with strong glue-like bonds
that can last a lifetime and
cause chronic pelvic pain.

Adhesions
and Chronic
Pelvic Pain
Chronic pelvic pain can
refer to any number of
acute or chronic
conditions, and may
stem from various
causes. The pain can
originate from
gynecologic organs
(cervix, uterus, or
ovaries) or other areas
of the pelvis.
The causes of acute
pain are generally
easier to diagnose than
chronic pelvic pain, and
may include infection,
a cyst, or even an ectopic pregnancy – one which occurs outside the uterus. Women with acute
pelvic pain should consult a doctor, especially if the pain disrupts daily life or gets worse over
time.
Chronic pelvic pain is defined as pelvic pain which lasts longer than six months. We often find it
is associated with the adhesive process that occurs after an infection or inflammation (such as
endometriosis), or from a surgery or trauma.
Trauma
According to the American College of Gynecology, 40% to 50% of women with chronic pelvic
pain have experienced the trauma of physical or sexual abuse.1 Many people have had bad falls
onto their tailbone, back, or hips, especially during sports activities. Any of these events can
cause adhesions to form, which may later cause chronic pelvic pain.
Medical causes
Bladder, vaginal, and yeast infections, and inflammations such as chlamydia, pelvic
inflammatory disease (PID) or endometriosis may cause chronic pelvic pain. The body’s healing
response to all of these conditions is to create adhesions. Once any area has become adhered,
the adhesions often remain in the body as a permanent scar, binding nearby structures
together. We find that adhesions within and between the structures of the pelvis are a frequent
cause of chronic pelvic pain. See our adhesions page for a full explanation of adhesions.
Treating Chronic Pelvic Pain
Most physicians will attempt to treat chronic pelvic pain non-surgically, with medication or
conventional physical therapy. If the patient does not fully respond to these methods, a
physician may suggest surgery to view the interior environment and clean out any adhesions or
endometriosis.

Therapy at Clear Passage, the Wurn Technique®, can feel like a deep stretch; other times, the
work can be very light, as it follows the subtle rhythm within the sheath that surrounds the
spinal cord. Depending on the diagnosis and treatment area, the therapist may work to improve
motility – subtle organ movements. At other times, therapists may ask the patient to flex large
muscles, or move in certain ways, to improve the body’s symmetry and function. We keep good
communication with patients at all times, to maintain their comfort level, and to make sure they
understand our intent, and our findings. We educate most patients in techniques to prevent
reinjury, and to maximize results.

Our therapists have unique skills and training, unavailable anywhere else in the world. They are
screened for experience and excellent manual skills before being accepted for training. In fact,
we typically accept and train less than one percent of therapists who apply. Every therapist
undergoes required pre-training coursework, which can take a year or more to complete. They
study a 600 page Therapist Training Manual we wrote; then, they must attend extensive on-site
training at our home-office. Only therapists who pass our certification test at the end of the
training period become certified Clear Passage® therapists.
We have helped many women overcome infertility, and adults of both sexes to relieve their
pain, obstruction, or dysfunction - often without surgery or drugs. Our directors and instructors
have spent decades studying advanced manual physical therapy techniques, then developing
and researching new protocols to restore patients’ bodies to a state of increased balance,
mobility, and function. Along with these increases, patients generally note greatly reduced or
totally eliminated pain by the end of five days of treatment.

Your treatment begins with a thorough review of your history and a (roughly one-hour) on-site
physical evaluation by your evaluating therapist. We relate our findings to you, and ask you for
any comments or input you would like to share with us. We invite (but do not require) your
active participation with the team that is creating your results.
In your very first hour, we use our hands to locate adhered tissues in and around the organs,
muscles, connective tissue and support structures of your body. We apply gentle, specific
pressure in affected areas. This pressure is designed to reduce the adhesions that formed in
your body over time, and return your structures to normal mobility, tone, and function.
Treatment sessions are individualized to you – based on your history, goals and physical
evaluation. We explain our ongoing findings and our work on you; we listen deeply to you, and
appreciate your feedback. Your therapy is always one-on-one, performed by a Wurn Technique
certified therapist in a lovely private treatment room.
During your visits, your evaluating therapist will feel and treat deeply in your body, finding
areas that healed and became adhered years, or even decades ago. We find and treat the
compensatory pattern of adhesions which formed in your body due to trauma, surgery,
inflammation, infection or poor posture over the course of your life. We always work within your
tolerance and comfort level. Our intent is to slowly and meticulously break down the tiny,
powerful cross-links that are the building blocks of adhesions.
Patients regularly describe our therapy as a deep or profound relief, or “something my body has
needed for a long time.” We often hear “you have found the area I’ve been telling my doctor(s)
about for years – but they couldn’t find anything.”
Sometimes, you will notice a pattern of pain, such as, “when you push there, I feel it in my low
back, my leg, the base of my skull.” This tells us exactly where the “run” exists in your fascial
sweater – the system that surrounds and separates all of your muscles and organs. Patients
often express deep relief and joy to finally understand the pattern of pain or dysfunction that
has plagued them for years – or decades.
Treatment sessions are generally scheduled in one to two-hour sessions, less 10-15 minutes per
hour for paperwork and chart review. This equates to 45+ minutes per hour of uninterrupted
manual therapy per hour. All of our therapists love to treat, but keeping good records of your
history, response, and changing patterns during treatment is vital to your success, and can help
with your insurance reimbursement.
Patients with pain complaints
Most patients find treatment sessions interesting, informative, and relaxing. Patients who arrive
with pain complaints often notice significant changes within the first few hours of therapy. We
work to decrease your pain (if any), restore alignment, balance, and mobility to your pelvis,
sacrum, thoracic, and lumbar spine, your back and hip muscles, connective tissues,
abdominopelvic organs and any areas giving you symptoms. We work with you to improve your
function, your range of motion, and your tolerance for physical activity so we can return you to
an active, productive lifestyle.
As your pain decreases and function begins to return, we educate you in a lifelong preventive
and restorative exercise program to improve flexibility, strength, lifting ability and endurance
levels. Profound enhancement of personal and professional life often follows as a result. We
invite you to be an active member of the team that treats you, creating and achieving your
goals together. We are glad to work hand in hand with your physician, if you and she/he are
interested in that.
Personal privacy
We follow the ethical guidelines of the American Medical Association (AMA) and American
College of Obstetrics and Gynecology (ACOG) regarding patient draping and right to a
chaperone. We provide coverings - blankets, gowns, towels and pillowcases - for those who
wish to use them. We invite you to bring your partner to therapy with you, but therapy is
individual, and partners need not attend.
As manual therapists who often work in delicate or personal areas, we are sensitive to your
physical and emotional comfort level. We respect your personal privacy. We keep good contact
with you and your comfort level at every stage of therapy. In fact, we regard you as an expert
on your own body, so we seek and appreciate your thoughts, feelings, and input. We feel your
input can give us a better result. We like to keep you fully informed in every step of treatment,
so we take the time to explain our theories and techniques while we are working with you. We
are happy to explain our findings about your body and the ongoing changes we notice in terms
you can understand (and generally feel in your body), every single session.
Abdominal Adhesions: Prevention and Treatment
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

http://www.itmonline.org/arts/adhesions.htm

Adhesions are strands or of scar tissue (fibrin bands; see illustration, below) that form in
response to abdominal surgery and extend beyond the specific site of incision, sometimes
forming separately from the incision site within the peritoneum. Scar tissue that mends the
incision is normal, but the adhesions form additionally under some circumstances that are not
fully understood. There are specific features of a surgical procedure that help induce the
formation of adhesions. For example, drying of the tissues during surgery increases adhesion
formation, a situation remedied by paying attention to the arid conditions and correcting them
during then procedures. Intentional drying of the tissues, by applying gauze, is an otherwise
desirable procedure to aid the surgeon's view of the area, but because of increased adhesions, it
must be minimized. Tissues that become dry should be quickly moistened and air (carbon
dioxide) that is passed over the surgery site to maintain cleanliness also must contain adequate
moisture to prevent rapid drying of the exposed fluids. Laparotomy (open abdominal surgery) is
more likely to produce adhesions than surgery performed via laparoscopy in which a small scope
with attached microsurgical instruments is inserted through a slit in the abdomen (1-3).

Left: a representation of a normal peritoneum, the transparent membrane that wraps the pelvic
and abdominal organs. Right: after surgical trauma, fibrous bands of collagen grow as part of the
normal healing process and form adhesions. Adhesions connect tissues or structures that are
normally separate. Adhesions in the abdomen or pelvic area can lead to infertility, pelvic pain,
small bowel obstruction, or the need for repeat surgery (1).

The incidence of adhesions following abdominal surgery is cumulative with multiple


surgeries and female gynecological surgeries give a particularly high rate of adhesions. In one
study, autopsy investigations indicated a 90% incidence of adhesions in patients with multiple
surgeries, 70% incidence of adhesions in patients with a gynecologic surgery, a 50% incidence of
adhesions with appendectomy, and a greater than 20% incidence of adhesions in patients with no
surgical history. Adhesions may occur as the result of tissue damage to the abdomen besides
surgery, including traumatic injury, inflammatory disease, intraperitoneal chemotherapy, and
radiation therapy (1).

The most frequent problem with adhesions is a constriction of the small intestine, producing
constipation (sometimes complete bowel blockage, requiring emergency treatments). Abdominal
pain is another common symptom, caused when the bands of scar tissue bind up the internal
organs so that movements pull on them. Linkage of menstruation to changes in bowel function
(e.g., inducing diarrhea) may occur as the result of scar tissue attaching the uterus to the
intestine. Adhesions may also impair fertility in women by causing blockage of the fallopian
tubes. It has been estimated that:

 At least one-third of women who suffer from pelvic pain have adhesions as a cause
of or contributor to the pain.
 Adhesions involving the ovaries or fallopian tubes are responsible for 15-20
percent of female infertility cases.
 Small bowel obstruction is often a surgical emergency and is particularly common
after gynecological surgery.

To prevent adhesion formation, surgeons may now apply a fine fabric barrier to surround
the organs, thus isolating them from the scar tissue strands (the barrier dissolves after the
surgery). Although adhesions can be removed by surgical intervention (adhesiolysis) using a
laparoscopic technique (4), recent studies suggested that such surgery produces limited benefits
that are often short-term. Many patients are treated with multiple adhesiolysis procedures in an
attempt to improve the symptoms of adhesions. Each year, 400,000 adhesiolysis procedures are
performed in the U.S., costing the health care system about $2 billion in hospitalization and
surgeon expenses.

Most times, adhesions cause few, if any, notable effects. But, for those who do suffer from
their adverse effects, the question arises as to whether the adhesions can be reduced or eliminated
by methods other than further surgery.

CHINESE HERB MEDICINE FOR ADHESIONS


The problem of developing abdominal adhesions is noted in the Chinese medical literature. Dr.
Fu Kezhi, at the Harbin office of ITM, carried out a literature search, yielding several studies
summarized here.
Chinese medicine has been applied both to prevention of adhesions and to their treatment
when they cause bowel blockage. The preventive measure involves relatively immediate post-
surgical intervention. The basis of the preventive therapy is to treat the abdominal stasis that
occurs following surgery. Normally, after an abdominal surgery, the bowels are virtually
paralyzed for many hours, up to two days in older patients and complicated surgeries. Doctors
and nurses check for the return of bowel sounds (indicating movements) after the surgery, to
make sure recovery is proceeding. Since obstructive constipation is one of the primary responses
to developing adhesions, concern about bowel stasis is a clear concern. In China, an herbal
formula used for treating constipation is administered about 6 hours after surgery, to assure the
action of the bowels in a relatively short time with continued bowel responsiveness, indicating
lack of adhesion formation.

The formulas are usually a derivative of the ancient prescription Da Chengqi Tang (Major
Rhubarb Combination). The traditional formula has four ingredients: rhubarb and mirabilitum as
purgatives and chih-shih and magnolia as qi regulating herbs. The modifications of the formula
usually involve adding additional qi regulating herbs (notably saussurea) and blood vitalizing
herbs (especially persica, red peony, and salvia) to promote the circulation of qi and blood in the
abdomen and prevent formation of adhesions, which are seen as the result of prolonged stasis.
An example is the administration of a formula called Tao Zhi Zhi Po Fang, comprised of
rhubarb, magnolia, chih-ko (in place of chih-shih), saussurea, persica, carthamus, leech, and
salvia, provided 6 hours after abdominal surgery (5). Compared to a control group not treated
with these herbs, bowel sounds and bowel functions resumed many hours earlier and the
incidence of adhesions (determined by typical symptoms of adhesions appearing within the next
three years) was significantly lowered.

In another report (6), a modified Major Rhubarb Combination was administered after
surgery while during surgery a protective barrier fluid was used to isolate the organs and prevent
adhesions. The authors noted:
Treatment by integrating traditional Chinese medicine and western medicine has
been adopted in many surgical departments, especially the application of Modified
Major Rhubarb Combination. The formula has the properties of inducing purgation,
promoting qi circulation, resolving blood stagnation, and assuring that the hollow
viscera remain unimpeded; specifically, stomach-qi can move downward freely to
eliminate fullness and distention, the qi in the abdomen can circulate freely, and the
bowels remain open; it can stimulate early peristalsis of the bowels after surgery.
When using the Modified Major Rhubarb Combination soon after surgery for
adhesive bowel obstruction, it can markedly shorten the time period of intestine
paralysis.

Because the herbal treatment within hours after surgery is impractical for Western patients
(and the use of purgatives would be objected to by the medical profession on grounds of it
possibly causing damage), the question about treating existing adhesions arises. In Chinese
investigations of this matter, the patients are usually those who have come to the hospital with a
severe disorder, usually bowel blockage, for which surgery would be utilized. Patients may first
be treated with herbs to see if this is successful in relieving the blockage, while surgery can be
used as a back-up.
The non-surgical treatment of adhesion-induced medical crisis is similar to that used for the
preventive measure after surgery, at least in cases involving bowel blockage. For example, in one
evaluation (7), patients were treated with a derivative of Major Rhubarb Combination made with:
rhubarb (15 g), magnolia (10 g), chih-shih (10 g), mirabilitum (20 g), persica (10g), red peony
(15 g), and stir-fried raphanus (45 g). Raphanus (radish seed) is used to aid the downward flow
of qi, normalize digestion, and alleviate abdominal pain. The herbs were administered in 1-2
batches a day, orally or through a stomach tube. Of 250 patients treated this way, 88% were able
to avoid surgery. As with the method for preventing adhesions in the first place, there is some
doubt that this approach would be used in the West, as there is concern about using strong
purgative treatments when bowel blockage exists. In China, the patients are carefully monitored
while pursuing this treatment as an inpatient and are referred to surgery if the problem is not
promptly resolved.

Another report of this type of treatment approach involved use of two slightly different
decoctions, depending on the differential diagnosis (8); these were:

 Modified Major Rhubarb Combination: rhubarb (10-30 g), mirabilitum (6-15 g),
magnolia (20 g), chih-shih (10 g), persica (10 g), red peony (10 g), and stir-fried
raphanus seed (30g)
 Adhesion Lysis Decoction: cassia leaf (10g), mirabilitum (6-10 g), magnolia (10
g), lindera (10 g), persica (10 g), red peony (10 g), and stir-fried raphanus seed (10
g).

These formulations could be modified: for severe pain, add 10 grams each of corydalis,
frankincense, and myrrh; for a case with vomiting, add 10 grams pinellia and 30 grams raw
hematite.

As in the previous study, these formulas prevented the need for surgery in about 86% of
cases. Presumably, these therapies could be applied to Western patients suffering from
constipation that has not developed into full obstruction requiring hospitalization; the formulas
are not inherently different from traditional herb prescriptions now administered for acute
constipation. For example, Major Rhubarb Combination is routinely sold as a dried extract
granule by several Chinese herb suppliers worldwide.

A limitation of the purgative herb therapy is that while it relieves the immediate crisis, the
problem can return, because the adhesions are not gone. An attempt to resolve this dilemma was
designed on the basis of using Chinese herb therapy to treat the obstructive crisis and then using
laparoscopic surgery to remove the adhesions to prevent further occurrences. By so doing, one
can usually avoid emergency surgery as a result of intestinal obstruction; instead, the surgery can
proceed at a time when the intestinal functions have normalized and a less invasive surgical
technique (laparoscopic surgery) can be utilized. In one study using this two-stage method (9),
patients received one of three basic herb therapies for the intestinal obstruction:

 Modified Major Rhubarb Combination: rhubarb, mirabilitum, chih-shih, magnolia,


persica, red peony, and stir-fried raphanus seed;
 Euphorbia Obstruction-relieving Decoction: euphorbia (gansui), rhubarb,
magnolia, saussurea, persica, achyranthes, and red peony; or
 Entero-adhesion Lysis Decoction: cassia leaf, mirabilitum, magnolia, saussurea,
lindera, persica, red peony, and stir-fried raphanus

In these formulations, rhubarb, euphorbia, and cassia leaf all serve the same function of
inducing peristalsis. The purgative herb is the central ingredient in treatment, while the others are
supportive; in one study (10), euphorbia was used as a single herb to treat intestinal obstruction
due to adhesions in order to prevent the need for surgery.

The desire of most patients would be to alleviate the problem of adhesions before a crisis of
bowel obstruction occurs, and to treat other manifestations of adhesions, such as abdominal pain
and reduced fertility. The Chinese literature appears silent on this issue, but there are some
possibilities to be considered.

CAN ADHESIONS BE MODIFIED OR REMOVED WITHOUT SURGERY?


Doctors and researchers are aware that scar tissue is difficult to remove or alter. One method of
degrading undesirable scar tissue that has shown promise is to apply hyaluronidase, a mucolytic
enzyme. Hyaluronidase breaks down hyaluronic acid, an ingredient of connective tissue. It is
injected into the scar and may work best if the scar if physically degraded by surgical means and
then treated by the enzyme to prevent reformation of the original scar mass. A new application of
hyaluronidase is to provide it during surgery: protective barriers infused with hyaluronidase are
being tried in an effort to further reduce the formation of the adhesions.

Hyaluronidase is a body component that is normally present but


may be produced in large quantities in response to some stimuli. It
primarily acts on hyaluron, the structural component of the extracellular
matrix, comprised of hyaluronic acid (pictured left; these units repeat in
long chains), one of several glucosaminoglycans (GAGs) that comprise
connective tissues. Hyaluronidase is an important component in natural
repair processes of tissues, where hyaluron is broken down and
reformed.

Hyaluronidase can be viewed as a softening and flow-promoting enzyme. Hyaluronidase is


excreted by bacteria as a means of helping breakdown and penetrate cellular barriers so that
infection can proceed. Tumor cells may take advantage of hyaluronidase, secreting it as a means
of penetrating into the surrounding tissues and aiding metastasis. The enzyme is used
pharmaceutically in administering certain drug therapies to help the drugs penetrate cells more
easily.

The fact that existing scars may be degraded somewhat by the enzyme action suggests the
possibility that herbal therapies could contribute to alleviating adhesion symptoms by stimulating
the body's production of hyaluronidase (or other enzymes of similar function) to perform this
task. Even if scar tissue is not removed, if it can be softened (made more elastic), there may be
relief from its physical manifestations such as bowel blockage, pain, and some cases of
infertility. Herbs that are reputed to aid healing of injuries, soften abdominal masses, and
alleviate abdominal pain of various origins may act, in part, by breaking down undesirable
collagens to alleviate the symptoms. Antifibrotic and mass reducing herbs are used to treat
abdominal disorders such as uterine fibroids and liver fibrosis, and are also used to treat skin
masses in scleroderma; it is possible that they function by increasing the degradation of fibrous
tissue via hyaluronidase. Key herbs for reducing fibrosis and masses are listed in Table 1 (11).

TABLE 1. Key Herbs for Reducing Fibrosis and Masses.


Herb Common Name Uses and Potential
TCM Functions
(Pinyin) Applications
Achyranthes vitalize blood circulation, blood stasis mass in the
(niuxi/chuanniuxi) disperse swelling abdomen, abdominal pain
Arca shell vitalize blood circulation, blood stasis and phlegm mass
(walengzi) disperse masses, control pain in abdomen
blood stasis mass in the
Carthamus vitalize blood, disperse abdomen, traumatic injury,
(honghua) stagnant blood abdominal pain due to
stagnated blood
Cnidium vitalize blood, promote qi
abdominal pain, fibrosis
(chuanxiong) circulation, control pain
Frankincense traumatic injury, abdominal
vitalize blood, control pain
(ruxiang) pain
Myrrh vitalize blood, remove stagnant blood stasis mass in the
(moyao) blood, control pain abdomen, abdominal pain
Persica blood stasis mass in the
vitalize blood
(taoren) abdomen, traumatic injury
Red peony vitalize blood, disperse abdominal pain, accumulation
(chishao) stagnant blood, control pain in abdomen
Salvia inhibit fibrin deposition,
vitalize blood
(danshen) promote fibrinolysis
vitalize blood, promote qi
Sparganium blood stasis mass in the
circulation, disperse mass,
(sanleng) abdomen, abdominal pain
control pain
Succinum vitalizes blood, disperses abdominal pain due to
(hupo) stagnant blood obstruction
Tang-kuei abdominal pain, promotes
vitalizes blood
(danggui) fibrinolysis
Turtle shell disperse stagnant blood, soften blood stasis mass in the
(biejia) hardness, disperse abdomen
accumulations
Zedoaria vitalize blood, promote qi blood stasis mass in the
(ezhu) circulation, control pain abdomen, abdominal pain

SAMPLE FORMULATIONS AND TREATMENT STRATEGY


The herbs from the table above are ingredients in traditional and modern formulas used in
resolving problems that are relevant to fibrous masses and adhesions. For example, a traditional
formula for treating pain due to old trauma, which may reflect existence of adhesions, is Sanleng
Heshang Tang (12). It is comprised of 12 herbs for regulating circulation of qi and blood and
alleviating pain; the formula includes sparganium, zedoaria, myrrh, frankincense, and tang-kuei.
A formula for "movable or immovable mass in the abdomen," Huoluo Xiaoling Dan, is made
with just four herbs: salvia, myrrh, frankincense, and tang-kuei. A modern formula developed for
treating uterine fibroids, Gong Zheng Tang, includes sparganium, zedoaria, achyranthes, tang-
kuei, and persica (13). A modern treatment for endometrial cysts is Nei Yi Wan (14), which
includes succinum and turtle shell. Herbs used to relieve skin hardening in scleroderma include
tang-kuei, red peony, and salvia (15). These same herbs were commonly applied to treatment of
liver fibrosis secondary to hepatitis (see: Treatment and prevention of liver fibrosis).

A treatment for existing adhesions would follow the pattern of treating any other abdominal
mass or fibrotic condition, namely a high dose therapy administered for a period of 3-6 months.
During this treatment, an effort to stretch the scar fibers, possibly stimulating the local response
to softening the fibers, might be pursued via exercises and massage therapy. Care must be taken
not to induce any damage during such efforts.

REFERENCES

1. Women's Surgery Group, Adhesions,


http://www.womenssurgerygroup.com/conditions/Adhesions/overview.asp
2. Khaitan E, Scholz S, Richards WO, Laparoscopic adhesiolysis and placement of
Seprafilm: a new technique and novel approach to patients with intractable
abdominal pain, Journal of Laparoendoscopy and Advanced Surgical Techniques
2002; 12(4): 241-247.
3. Kavic SM, Adhesions and adhesiolysis: the role of laparoscopy, Journal of the
Society of Laparoendoscopic Surgeons 2002; 6(2): 99-109.
4. Shayani V, Siegert C, and Favia P, The role of laparoscopic adhesiolysis in the
treatment of patients with chronic abdominal pain or recurrent bowel obstruction,
Journal of the Society of Laparoendoscopic Surgeons 2002; 6(2): 111-114.
5. Su Fachun, et al., Clinical observation on Tao Zhi Zhi Po Fang used for preventing
intestinal adhesion after surgical operation, Chinese Journal of Surgery by
Integrating Traditional Chinese Medicine and Western Medicine; 2000; 6(6): 404-
405
6. Sun Dechun, et al., A report on 6 cases of adhesive bowel obstruction treated with
Major Rhubarb Combination and sodium hyaluronate, Chinese Journal of Surgery
with Integrated Traditional and Western Medicine, 2001; 7(1): 32-33.
7. Chen Guifeng, 250 cases of adhesive intestinal obstruction treated by integrating
Traditional Chinese Medicine and Western Medicine, Chinese Journal of Surgery
with Integrated Traditional and Western Medicine, 2000; 6 (5): 325.
8. Zhang Jinfang and Wang Zhiqiang, Analysis on 102 cases of adhesive bowel
obstruction treated by integrating Traditional Chinese Medicine and Western
Medicine, Chinese Journal of Surgery with Integrated Traditional and Western
Medicine 2001; 7(3): 160.
9. Wang Zhenyu, et al., Laparoscopy and combination of traditional Chinese
medicine and Western medicine in adhesive intestinal obstruction, Chinese Journal
of Surgery with Integrated Traditional and Western Medicine 2002; 8(1): 3-5.
10. Liang Desen, et al., Curative effect of Gansui (Euphorbia kansui root) in treating
adhesive bowel obstruction, Chinese Journal of Surgery with Integrated Traditional
and Western Medicine 2001; 7(1): 33-34.
11. Hsu HY, et al., Oriental Materia Medica, 1986 Oriental Healing Arts Institute,
Long Beach, CA.
12. Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of
Traditional Chinese Medicine, vol. 2, 1993 Heilongjiang Education Press, Harbin
13. Wu Dingyuan, Preliminary report of 136 cases of uterine myoma treated by
traditional Chinese medicine, Journal of the American College of Traditional
Chinese Medicine 1982 (1): 64-70.
14. Wang DZ, Wang ZQ and Zhang ZF, Study on the treatment of endometriosis with
removing blood-stasis and purgation method, Chinese Journal of Integrated
Traditional and Western Medicine 1991; 11(9): 524-526.
15. Fruehauf H, Treatment of Difficult and Recalcitrant Diseases with Chinese
Herbs, Institute for Traditional Medicine 1997, Portland, OR.

How to Treat Abdominal Adhesion

Misha Safranski is a Michigan-based writer. Specializing in topics related to pregnancy and


childbirth, she has been writing for various online publications since 2008. Safranski studied
journalism and communications at Macomb Community College. By Misha Safranski, eHow Contributor



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Peritoneum with and without adhesions


Abdominal adhesions can be a painful condition and cause quality of life issues for people affected
by them. Adhesions are webs of scar tissue that usually result from surgery or other abdominal
trauma. They are commonly worse following surgical procedures which require a fully open incision,
as opposed to the less invasive laparoscopy, which involves a few small incisions. Adhesions are
also worsened by prolonged surgery and failure to keep the exposed internal organs moist enough
during the operation. Many times, patients don’t realize that their pain is being caused by adhesions.
If you are aware of the problem, there are steps you can take to minimize the pain and symptoms.

Difficulty:

Moderately Challenging

Instructions
1.

o 1
Discuss your symptoms with your doctor. The first step in treating adhesions is to determine
if they are the most likely cause of your pain. Laparoscopic surgery may be recommended to
see how extensive the adhesions are.

o 2
Visit a Maya Abdominal Massage therapist. Maya Abdominal Massage is a gentle massage
technique that helps to break up adhesions and guide organs into their proper positions.
Scar tissue can trap lymph fluid below the incision line. Maya Massage can help to get this
fluid flowing again, improving your overall health and wellness.

o 3
Seek alternative treatments for pain, such as acupressure and acupuncture. Research has
shown that these methods can be effective in providing pain relief.

o 4
Consider requesting laparoscopic surgery about a week after having your surgical
procedure. In the days following surgery, adhesions which are just forming are soft and lack
a blood supply. They are easier to break up through laparoscopy during this time.

o 5
Gently massage your scar with lotion or oil in the weeks following any surgical procedure.
Adhesions can be minimized by keeping the blood and lymph fluid flowing in the area and by
gently breaking them up as they are beginning to form.

o 6
Ask your physician about using an adhesion barrier, such as Seprafilm, during your surgical
procedure. Such products, which are now widely used, contain an enzyme called
hyaluronidase. This substance helps to break down connective tissue, thus discouraging the
formation of adhesions. Anti-adhesion products have been shown to reduce adhesion
formation by up to 50 percent.

o 7
Plan ahead. The best defense is a good offense. If you’re prepared for the likelihood of
adhesions forming during a surgical procedure, you can take measures to help prevent them.

Read more: How to Treat Abdominal Adhesion | eHow.com


http://www.ehow.com/how_2365028_treat-abdominal-adhesion.html#ixzz1Ywnjz4pJ
Diet for People With Abdominal Adhesions

TS Jordan is an Ohio licensed attorney living and practicing out of the Cleveland area. In
addition to his Juris Doctorate, he holds a Bachelors' Degree in Information Systems. He has
been writing professionally for less than a year. By TS Jordan, eHow Contributor




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According to information from the National Digestive Diseases Information Clearinghouse,


abdominal adhesions are tissues that form in the abdominal cavity that connect the intestines to the
organs, causing them to adhere to one another. Surgery is the most common cause of adhesions,
with operations on the hips and abdomen increasing the risk of their development. As adhesions can
cause the intestines to twist into unnatural positions, they can result in bowel obstruction,
necessitating a specialized diet to avoid digestive complications until the problem can be surgically
corrected.

1. Abdominal Adhesion Diet Theory


o Knowing the basics behind the abdominal adhesion diet can help you better understand why
such a diet is necessary. Where the intestinal tract becomes partially blocked through the
influence of adhesions, adherence to a low-residue diet can help circumvent the intestinal
obstruction by allowing food to still pass through the narrowed opening. While an abdominal
adhesion diet cannot correct the condition, it can help allow a patient to subsist more
comfortably until surgery can be performed.

Abdominal Adhesion Diet


o Consume a diet low in both fiber and "residue" of all kinds to cope with abdominal adhesions.
According to information from the Mayo Clinic, a low-residue diet is a short-term solution to
the problem of abdominal adhesions, as the diet itself cannot provide a sufficient level of
vitamins and nutrients for long-term subsistence. Therefore, a low-reside diet is just a
stopgap measure, which is useful in the period from when adhesions result in bowel
obstruction until surgery is possible. Foods on a low-residue diet include the following: rice,
white flour items (breads, pastas, crackers, and chips), fruit and vegetable juice, tender
protein items (seafood, poultry, and meat), oils (olive, canola, palm, fish, flax, etc.),
condiments such as butter, syrup, jelly, honey, and mayonnaise, salad dressing free from
solid ingredients, and strained soup. These foods will likely pass the bowel obstruction
caused by abdominal adhesions without issue, allowing you to minimize symptoms and
affording you some level of nutritional support until the issue can be fully addressed
Read more: Diet for People With Abdominal Adhesions | eHow.com
http://www.ehow.com/way_5607614_diet-people-abdominal-adhesions.html#ixzz1Ywo7c6po

http://www.ehow.com/way_5640479_alternative-treatments-abdominal-adhesions_.html

Following just about any type of surgery, scar tissue will form. Scar tissue is composed of collagen
that forms fibrous bands. This tissue is beneficial and necessary for the body to heal a surgical
wound properly. However, there are incidences where too much scar tissue forms and creates
additional problems for the patient. This is the case with abdominal adhesions.

1. Formation of Abdominal Adhesions


o Abdominal adhesions form when scar tissue becomes overgrown. The scar tissue then
connects areas around the surgical procedure that would not normally be connected within
the abdomen. These adhesions usually only cause mild pain and do not need medical
attention. However, if enough scar tissue forms at the site, the small intestine can become
strangled. These types of abdominal adhesions become medical emergencies because they
keep you from being able to move your bowels.
Abdominal adhesions are most likely to form on those who have had some type of abdominal
surgery in the past, especially when the surgery was performed by actually opening up the
abdominal wall. Those who have had abdominal surgery laparoscopically are not likely to
develop abdominal adhesions. Patients who have multiple abdominal surgeries are the most
likely candidates to develop abdominal adhesions, followed by female patients who have had
some sort of gynecological surgical procedure. Patients who have appendectomies are only
slightly more prone to developing these adhesions of the abdomen than those individuals
who have had no prior abdominal surgery.

2. Chinese Herbs
o Sometimes, surgical treatment is required for abdominal adhesions because of blockage of
the small intestine. However, this is rarely the case. A majority of the time these adhesions
only cause mild pain that is bearable. When treatment is necessary, there are some
alternative treatments available as well.
One of the alternative treatments for abdominal adhesions is the administration of Chinese
herbs. When a patient is given a combination of rhubarb, mirabilitum, chih-shih, and
magnolia, the concoction may help with the treatment of abdominal adhesions. Some believe
that this combination can even prevent surgery when the adhesions have obstructed the
bowels in some way.
3. Diet Change
o Another alternative treatment is a change in diet. If you have been diagnosed with abdominal
adhesions, this is the first thing you should consider as treatment. Typically, a change in diet
means that you should switch to a nearly all liquid diet or a low-residue diet. This is a diet
where the food that is eaten can be more easily digested within your system and includes
lots of dairy products and food items that are low in fiber.

Read more: What Are Alternative Treatments for Abdominal Adhesions? | eHow.com
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adhesions_.html#ixzz1Ywq9H7lj