Nurses and Abdominal Adhesions

As a nurse, I’m working on increasing our sensitivity to recognizing the symptoms of abdominal adhesions. Let’s help reduce the amount of chronic pain and the number of bowel obstructions!

The first Abdominal Workshop of the year is almost here! (It starts next Saturday.) There is still space and I’d love to see you in it! There are scholarships available, please contact me for details.

Video Transcript:

Hello again!

So this video is for the nurses out there who want a little bit of guidance on when to maybe start thinking about abdominal adhesions as a potential assessment to work up. Or talk to the clinician about when you see a patient coming in with abdominal symptoms. Generally for chronic pain in the abdomen it’s really hard for providers when they’ve worked through all of the tools that they have at their fingertips and nothing’s working, and then they feel like they have nothing to offer to patients.

So I feel like nurses are really a critical piece of recognizing these patterns that come up and helping the clinical staff understand that there may be more that we can approach than this. I just want to walk you through this really quick and try to make it as clinically relevant as possible.

I came up as a clinic nurse. The only hospital experience I have was during nursing school when we did our hospital rotations. And so you hospital nurses will have a better idea of how this fits in for you. And on the clinical side of it, I just want to say I do know that it can be really hard to sort of implement new assessments depending on how open minded your clinic is about these types of things and how good of working relationships you have with the providers. Most of the time I think they’re very good relationships. And I think a lot of times with abdominal, repeated,particularly abdominal distress, providers are really open to thinking about it and talking more about it. So this can be something that you bring to them.

Usually the symptoms that we’re seeing are bowel obstructions, one or more. Pain. It can certainly be acute and it can be related to a recent surgery like in the last three months. I think of recent surgery as in the last year. But this can also be really historical.

And often the pain that comes from post-surgical adhesion starts really subclinically. People will have little, maybe like sharp stabbing pains or aches or things like that that come and go so intermittently they don’t even think about bringing it up during an appointment with the doctor or the provider until it sort of explodes into something much more persistent and present and the intensity has ramped up. Often a bowel obstruction has happened.

So we want to, as much as possible, be trying to catch those early reports of like, I had this weird pain in my belly. Find out if they’re post-surgical in any way from the abdomen, including C-sections. I feel like those kind of get written off as not an abdominal surgery somehow, but they are. Appendectomies, hernia repairs. A lot of these gallbladder removals, because they’re outpatient, I think we don’t appreciate enough how much scar tissue that can produce for people.

And it doesn’t take a lot of scar tissue to create some really powerful adhesive symptoms.So anyway, keep that in mind with the pain. If they report that they’ve had a following surgery it doesn’t have to be a follow up to the first surgery but just some other sort of surgery where the surgeons noted the presence of abdominal adhesions. And a lot of times those adhesions will make that subsequent surgery more difficult. So keep your ear attuned to that.

If there’s been any change in organ function particularly urinary they’ll kind of physically restrict the bladder and so it can’t expand as well. And so people have urgency or frequency without a UTI and they’ve been worked up for other things. They’re just having this sort of inexplicable urgency/frequency that’s not horrible, but it’s really different for them.That can often be adhesion and we can do a lot with that to turn that around.

And also, of course, bowel function in any direction towards constipation or towards loose stool, that gets a little trickier. But certainly adhesion can affect that.

Decreased fertility. This shows up in the research a lot. This is much more difficult because fertility is so hormonally based and it’s such a more complex thing, but it does show up in the literature so I wanted to bring it up here.

And then overall, just a decreased quality of life. With adhesions that are symptomatic, people can really feel like they just cannot participate in their daily life anymore. And we really want to be listening for that and starting to think about adhesions, particularly if they have been worked up for everything else and nothing’s showing up.

So we know from research that adhesions affect 54% of people who have had abdominal surgery. And these authors even note, they’re pretty sure that this is a much higher number actually because the only adhesions that were counted in this study were those that were seen during a following surgery. And so if somebody hasn’t had a following surgery to visualize those adhesions and they weren’t counted in this statistic. And there’s a lot more people than 54% of post-surgical clients who have adhesions.

And then another huge one. I brought this up before I hammer on it a lot because bowel obstructions are so terrible. We now know, thanks to this 2017 study, that 65% of bowel obstruction cases adhesive small bowel obstruction are caused by intra-abdominal adhesions. That is a massive number. And so again, we want to be thinking abdominal adhesions when we hear that somebody has had a bowel obstruction.

Now, of course, there are non adhesive reasons to have bowel obstructions. And that doesn’t necessarily rule out abdominal adhesions. It just means that whatever their bowel obstruction was maybe it’s more straightforward why it happened, an inflammation, neoplasm, hernia, things like that. But there are other things, of course, that can cause bowel obstruction. But if it’s not particularly, if it’s not those things, really start to think about abdominal adhesions.

This CLAS tool, Clinical adhesion score, is probably the most straightforward tool that we have at this point. But I do want to point out this is not fully validated yet. But it does include all of the things that I just talked about. And if you want to see these research items just go to my website: surgeryrecoveryclinic.com/research. I keep resources all of a list of all of my references. So you can see these anytime.

And then I just want to throw out there, I’ve talked a lot about post-surgical, but one of the original landmark studies on adhesions back in 1973 was a cadaver study. And it showed that 28% of people with no surgery ever had adhesions. Now these were cadavers. We don’t know what their patient report was so they could have been completely asymptomatic. But based on what I have seen over the last 20 years,

 a huge number of this 28% are symptomatic. And we just haven’t quite figured out what to do with them yet.

So particularly when you’re listening to folks talk about their abdominal pain, we want to know has there been surgery, has there been radiation, mostly related to cancer, and then blunt force trauma is there a history of blunt force trauma and I think as nurses we often think DV and that can be the case. But in my practice it has been a huge percentage of martial artists. It’s been like 60/40 maybe 60% martial artists and 40% people who have taken really unfortunate falls. And so most of the time it’s somebody standing on a chair reaching for something, the chair or their feet slips and they end up wrapped over the back of that hard backed chair, their belly wraps over it. And that kind of blunt force trauma can create certainly enough inflammation and enough inflammation to draw the forces in the body that create fibrotic tissue.

So these are some big ones to think about when we’re wondering if somebody might benefit from knowing more about whether or not they have abdominal adhesions.

If this starts to sound familiar to you and you want to know what to do about that there are some really great studies again in that research and I’ll put the link below so you just can click straight through to my resource list.

Soft tissue manipulation is one of the most reliable ways to work with abdominal scar tissue. And it’s just like the rehab that happens orthopedically. So we know that manual manipulation, massage of the scars after orthopedic surgery is supported and it’s taught and I think about mastectomies a lot as well. By and large, most health systems at this point, to my knowledge, do teach people range of motion exercises massaging the scars, exercises, all of that kind of thing. The same thing applies to post abdominal surgery. We just don’t teach it.

And so if you want to know more about that, I am offering a workshop that starts mid February and you are very welcome as nurses, PTs, LMTs … I would love to have you in that workshop.

I am just trying to get more and more people used to thinking about and palpating for the potential for abdominal adhesions so that we can start moving in to teaching people how to rehab really effectively.

Okay, I hope that helps. See you next time.

Author Profile

Isabel Spradlin

Isabel Spradlin is a Registered Nurse (RN), Licensed Massage Therapist (LMT), and CLWT abdominal adhesion specialist in Portland, OR. She specializes in educating people about manual treatment (massage) for abdominal pain and dysfunction, especially when it is adhesion related. Please see the "Programs" page to see her offerings.

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