Decreasing Post-Surgical Adhesions that cause Recurrent Small Bowel Obstructions with a Conservative Manual Physical Therapy (pp. 113-124)
Authors: (Amanda D. Rice, C. Richard King, III, Clear Passage Physical Therapy, Gainesville, Florida, USA)
Abstract: Small bowel obstruction (SBO) is a common complication typically
caused by adhesions that form after abdominal surgery, in response to
inflammation associated with post-surgical healing. Adhesion formation
occurs in an estimated 50-100% of abdominal or pelvic surgery patients
and is the most common etiology of SBO. In the United States, adhesionrelated
SBO is a major health care expenditure annually.
Treatment options for adhesive SBO range from supportive care,
consisting of bowel rest and intravenous fluids, to surgical intervention.
While the non-invasive treatment options are effective at treating the
current obstructive episode, the underlying cause of the obstructions –
adhesions -- is not addressed. Surgical intervention is effective in treating
the adhesions causing the current obstruction; however, surgery is the
primary cause of adhesion formation and, thus, patients with a history of
adhesion formation are at risk for developing additional adhesions and
subsequent obstructions requiring additional surgeries. There continues to
be research -- with limited success -- into methods of adhesion formation
reduction in surgical techniques, medications and adhesion barriers.
Manual physical therapy has been demonstrated to deform adhesions
within the abdomen and pelvis, allowing the pelvic and abdominal tissues
and to function more normally. The manipulation of soft tissues to
generate systemic functional benefits is not a new concept. In the field of
osteopathic manual therapy, skilled manipulation of the soft tissues has
long been believed to affect biomechanical change in adhesions such that
the involved tissues exhibit increased pliability and independence of
mobility. We have demonstrated a high rate of success treating postsurgical
adhesions that cause recurrent obstructions. Patients report long
term benefits from treatment and improvements in overall quality of life.
Treatment with manual physical therapy compared to standard treatments
will be discussed in the context of recurrent small bowel obstructions.