Reduce Abdominal Adhesions without Surgeryhttp://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 SurgeryUntil 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, and2. 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: SurgerySurgery 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 SurgeryUntil 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, and2. 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 TherapySM clinics is designed to reduce 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 PainChronic 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.

TraumaAccording 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 causesBladder, 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 PainMost 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 complaintsMost 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 privacyWe 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 Treatmentby 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 ADHESIONSThe 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 (Pinyin)

TCM FunctionsUses and Potential

Applications

Achyranthes(niuxi/chuanniuxi)

vitalize blood circulation, disperse swelling

blood stasis mass in the abdomen, abdominal pain

Arca shell(walengzi)

vitalize blood circulation, disperse masses, control pain

blood stasis and phlegm mass in abdomen

Carthamus(honghua)

vitalize blood, disperse stagnant blood

blood stasis mass in the abdomen, traumatic injury, abdominal pain due to stagnated blood

Cnidium(chuanxiong)

vitalize blood, promote qi circulation, control pain

abdominal pain, fibrosis

Frankincense vitalize blood, control pain traumatic injury, abdominal

(ruxiang) pain

Myrrh(moyao)

vitalize blood, remove stagnant blood, control pain

blood stasis mass in the abdomen, abdominal pain

Persica(taoren)

vitalize bloodblood stasis mass in the abdomen, traumatic injury

Red peony(chishao)

vitalize blood, disperse stagnant blood, control pain

abdominal pain, accumulation in abdomen

Salvia(danshen)

vitalize bloodinhibit fibrin deposition, promote fibrinolysis

Sparganium(sanleng)

vitalize blood, promote qi circulation, disperse mass, control pain

blood stasis mass in the abdomen, abdominal pain

Succinum(hupo)

vitalizes blood, disperses stagnant blood

abdominal pain due to obstruction

Tang-kuei(danggui)

vitalizes bloodabdominal pain, promotes fibrinolysis

Turtle shell(biejia)

disperse stagnant blood, soften hardness, disperse accumulations

blood stasis mass in the abdomen

Zedoaria(ezhu)

vitalize blood, promote qi circulation, control pain

blood stasis mass in the abdomen, abdominal pain

SAMPLE FORMULATIONS AND TREATMENT STRATEGYThe 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 adhesionsAbdominal 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 1Discuss 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 2Visit 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 4Consider 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 5Gently 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 6Ask 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 7Plan 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 Theoryo 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 Dieto 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

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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 Adhesionso 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 Herbso 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 Changeo 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 http://www.ehow.com/way_5640479_alternative-treatments-abdominal-adhesions_.html#ixzz1Ywq9H7lj