Abdominal Adhesions: How to Identify and Treat Them

Your Step-By-Step Guide to Treating Abdominal Adhesions Naturally

• Abdominal Adhesions: Signs & Symptoms|
• The SIBO Connection|
• Treatment for Severe Abdominal Adhesions|
• Step-by-Step Natural Treatment Guide|
• Finding Relief|

If you’ve had abdominal surgery, you’re at greater risk for developing abdominal adhesions. However they aren’t all that common, don’t usually cause symptoms, and can often resolve on their own. 

That said, if you experience unexplained abdominal pain (especially in a specific area), difficult to clear SIBO, and/or painful sexual intercourse, and you have a risk factor for adhesions (especially a history of abdominal surgery), you may want to consider abdominal adhesions as a cause. 

In this article we’ll break down what you need to know about abdominal adhesions, including common signs and symptoms, how they’re diagnosed, and potential side effects. We’ll also lay out a step-by-step guide for natural treatment.

What Are Abdominal Adhesions?

Abdominal adhesions are a normal response to an injury or surgery, and are irregular bands of scar tissue that form between two bowel structures that aren’t usually bound together [1].

To get a better picture of abdominal and/or pelvic adhesions, think about what happens when you step on a garden hose to obstruct its flow. The scar tissue is like your foot putting pressure on and obstructing the hose that is your intestine. This pressure can affect your gastrointestinal motility, leading to a variety of negative symptoms, but can also lead to bowel obstructions.

Some causes of abdominal adhesions include: 

• Abdominal or pelvic surgery (the major cause of adhesions, representing 90% of all abdominal adhesions cases)  [1, 2, 3]
• Infection [1]
• Trauma (C-section, hysterectomy, or impact trauma) [1]
• Radiation therapy to the abdomen and/or pelvis [4]
• Inflammatory conditions of the abdomen (Crohn’s disease, pelvic inflammatory disease, peritonitis, endometriosis, and inflammatory bowel disease) [4, 5, 6]
• Congenital conditions (adhesions that form in the organs during development are very rare) [7]

Abdominal surgery is by far the greatest risk factor for developing adhesions. One 2014 systematic review found 54% of all abdominal surgical procedures resulted in abdominal adhesions [2].

What Are the Signs and Symptoms of Abdominal Adhesions?

While most patients with abdominal adhesions don’t experience any symptoms, some patients can experience complete or partial bowel obstruction, chronic abdominal pain, chronic pelvic pain, and female infertility. In addition, abdominal adhesions can complicate future surgeries [1].

Other symptoms that may occur with abdominal adhesions include [4]:

• Chronic bloating
• Abdominal cramping and abnormal bowel sounds
• Constipation or frequent loose stools 
• Nausea
• Rectal bleeding and painful defecation during menstruation

How Are Abdominal Adhesions Diagnosed?

Abdominal adhesions aren’t common, they normally don’t cause any symptoms, and they often resolve on their own [7]. But, if you’ve had abdominal or pelvic surgery and begin to experience pain, tenderness, difficult to treat SIBO (small intestinal bacterial overgrowth), and/or painful intercourse, you may want to consider abdominal adhesions.

If your provider suspects abdominal adhesions, a physical exam and lab testing may be utilized. But the only way to directly confirm the presence of adhesions is through invasive and costly procedures such as laparoscopy (a diagnostic surgical procedure using a thin lighted tube or laparoscope) or laparotomy (an open surgery allowing the surgeon to view the abdominal organs) [1].

Since abdominal adhesions are difficult to diagnose and aren’t all that common, it’s best to consider other factors that could be causing your abdominal pain before exploring adhesions. After all, there are many digestive disorders and conditions that can have overlapping symptoms.

Abdominal Adhesions Are the Most Common Cause of Bowel Obstructions

Approximately 65% of small bowel obstructions are a result of intra-abdominal adhesions [8].

Essentially, the intestines kink or twist in areas where adhesion formation occurs, and this can completely or partially obstruct the small bowel [7].

During a partial obstruction, small amounts of fluid or gas can still flow through the intestines, but in the case of a complete blockage, nothing can pass through, which can create an emergent, life-threatening situation (but this is extremely rare).

Symptoms of intestinal obstruction can include:

• Nausea
• Vomiting
• Cramping
• Severe constipation
• Pain around the belly button area (every four to five minutes)
• Severe abdominal pain

Obstruction can lead to gas and fluid buildup, increasing the risk of bacterial overgrowth (SIBO), abdominal distention, abdominal swelling, the cutting off of blood flow and a perforated bowel, low blood pressure, dehydration, and electrolyte imbalances. In addition, malnutrition can occur [9].

The Abdominal Adhesions-SIBO Connection

Small intestinal bacterial overgrowth (SIBO) is an overgrowth of bacteria in the small intestine that can cause gas, bloating, abdominal pain or distention, and either constipation, diarrhea, or both. 

When food doesn’t move through the intestinal tract at an appropriate pace, it can get stagnant and allow bacteria to overgrow. Abdominal adhesions are thought to be one anatomic cause of SIBO, due to the physical obstruction of intestinal motility [4, 10].

While abdominal adhesions may be a contributor, one small 2011 observational study found there wasn’t a statistically significant difference in the incidence of SIBO between patients with a history of abdominal or pelvic surgery when compared to those without. Interestingly, SIBO was common in both groups, 82% and 75% respectively [11].

SIBO can be the result of numerous factors like diet, lifestyle, and the use of certain medications. SIBO treatment, including nutrition and lifestyle changes along with antimicrobials, is often very successful. But if you’ve gone through a SIBO treatment protocol and still haven’t been able to measurably improve your symptoms, abdominal adhesions may be a consideration — especially if you have a history of abdominal or pelvic surgery, abdominal trauma, or one of the other risk factors for abdominal adhesions.

Treatment Options for Severe Abdominal Adhesions and Bowel Obstructions 

Some bowel obstructions can be severe and require surgery, which involves adhesiolysis (cutting and/or removal of adhesions) through laparoscopy (preferred method) or open laparotomy. However, the vast majority of bowel obstructions caused by intra-abdominal adhesions (70-90%) can be managed without surgery with the use of conservative treatments [7, 12]. Unless life-threatening symptoms are present, it’s important to start with the least-invasive measures first. 

Recommendations for the management of adhesive small-bowel obstructions are [13]:

• Reduction or cessation of food/fluid intake
• Nasogastric or long-tube decompression (a tube is inserted through the nose and advanced into the stomach or small intestine)
• Pain medication
• Intravenous fluids to address fluid and electrolyte imbalances
• Nutritional support

Research is limited on alternative treatments for abdominal adhesions, but the following treatments are worth exploring due to their low potential for side effects:

• Soft tissue mobilization (STM) is a type of physical therapy wherein manual methods like massage are used in areas where adhesions are formed to break up scar tissue and restore the proper movement of tissues against one another. One 2019 systematic review of nine studies found STM applied shortly after surgery to be the most effective way to improve pain and function from abdominal adhesions. In addition, STM applied to chronic post-surgical abdominal adhesions may improve pain, function, and mobility [14].
• Diet therapy utilizing a low-fiber/low-residue diet (restricts indigestible foods) may be helpful for abdominal adhesions [4, 15].

Natural Treatments for Non-Severe Abdominal Adhesions

In the clinic, we use a foundations-up approach, meaning we start with the basics of nutrition and lifestyle and then move in a stepwise fashion through a series of protocols to attain the optimal outcome for you. 

If you or your doctor suspect non-severe abdominal adhesions, start with step 1. If your symptoms resolve, great! If not, move to the next step in the process until your symptoms improve. 

Step 1: Nutrition and Lifestyle

If you’ve read Healthy Gut, Healthy You, you’re already aware of the importance of changing your diet and lifestyle when it comes to improving your overall health and how you feel. 

Let’s start step 1 with learning the principles of a healthy diet:

• A diet low in allergens/intolerances
• A diet that contains the appropriate amount of bacterial feedings (prebiotics and FODMAPs)
• A diet that regulates blood sugar and contains the appropriate amount of carbohydrates
• A diet that focuses on fresh, whole, and unprocessed foods

There are several options when it comes to dietary plans. We usually recommend starting with the Paleo diet for a few weeks. This meal plan is greatly effective since it helps to remove many common allergens and inflammatory foods, without being overly restrictive. 

If your symptoms don’t improve, you can move to a standard low FODMAP or Paleo low FODMAP diet, which will help to starve bacterial overgrowths. 

Remember to allow yourself a few weeks on the Paleo diet to notice improvement. If no significant change occurs with regard to your symptoms, then move to the next dietary plan. 

Lifestyle changes to relieve your symptoms are pretty straightforward. Some of the most important lifestyle changes to consider include:

• Avoiding toxins to the best of your ability
• Obtaining appropriate sun exposure
• Spending time in nature
• Exercising enough but not too much
• Walking as much as you can
• Getting enough sleep
• Mitigating stress and/or practicing stress management
• Nurturing healthy relationships and social connections

If you implement the above strategies but still have some lingering symptoms, move on to step 2.

Step 2: Probiotic Therapy

Probiotics are incredibly safe and research indicates they’re beneficial for a variety of health issues, from obesity and diabetes to irritable bowel syndrome and autoimmunity. Among other benefits, probiotics can help clear gut infections, resolve microbial imbalances, enhance the effectiveness of antibiotics, stimulate the immune system, and enhance the protective gut mucous membrane.

While human research on probiotics and abdominal adhesions is lacking, one 2020 study in rats found probiotics effectively reduced post-surgical abdominal adhesions. The probiotics reduced fibrosis (scar tissue formation), inflammation, and improved microbial balance [16].

In the clinic, we often use a triple therapy approach when it comes to probiotics:

1. Lactobacillus/Bifidobacterium blend, which has been well-studied and has been shown to help a wide variety of conditions.
2. Saccharomyces boulardii, a probiotic yeast that has many impressive benefits, including correcting dysbiosis.
3. Soil-based probiotics, which may help to replace what we’re missing due to our reduced contact with soil and natural environments.

If you’ve changed your diet and lifestyle and added probiotics but still haven’t achieved your desired results, step 3 focuses on more specialized gut support.

Step 3: Specialized Gut Therapies 

• Herbal antimicrobials are powerful and many have been used by cultures around the world to treat digestive diseases. For people who don’t respond to diet, lifestyle, and probiotics, antimicrobial treatments can be very helpful for clearing out unwanted bacteria that can cause inflammation. 
• Elemental diets can be incredibly reparative, antibacterial, and anti-inflammatory for your gut. Using this type of liquid diet gives your gut a break and can aid in healing. We use elemental diets in one of three general ways in terms of length:

1. Short term, as a reset. The elemental formula is used exclusively for two to four days.
2. Exclusive liquid nutrition for one to three weeks. This is very safe, but should be monitored by your healthcare provider.
3. Longer term, with intermittent/hybrid use that allows you to get some of your calories from an elemental/semi-elemental formula and the rest of your calories from normal food.

• Soft tissue mobilization (STM) has been found to improve pain, function, and mobility for chronic post-surgical abdominal adhesions [14].

After working through this step-by-step guide, you should hopefully see your signs and symptoms of abdominal adhesions abate. If you’re still feeling unwell though, it’s probably time to consider medical attention with a formal exam and treatment for abdominal adhesions.

Natural Treatments May Provide Relief for Symptomatic Abdominal Adhesions

Abdominal adhesions usually don’t cause symptoms and many other digestive disorders share the symptoms of adhesions. If you’re experiencing the signs and symptoms of adhesions, but don’t have a history of abdominal surgery (or one of the other risk factors), it’s important to work through our step-by-step guide before exploring abdominal adhesions. 

If you’ve had abdominal surgery and/or can’t seem to resolve a diagnosis of SIBO, you may need to explore specific treatment for abdominal adhesions. If your symptoms aren’t severe, try our step-by-step guide to see how you fare. But if your symptoms persist and/or become severe, it’s important to seek out a more personalized plan.

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