Abdominal Adhesions & Scar Tissue
After Surgery
Surgery can affect more than the visible incision. As the body heals, scar tissue forms to repair damaged tissues, but changes in the connective tissues, including fascia, may influence how comfortably those tissues move.
For many people, the goal is simply to move more freely, feel comfortable in their body again, and return to everyday activities without persistent pain, pulling, or restriction.
When recovery doesn't feel complete
Your incision has healed, your surgeon may be pleased with the outcome, and your scans may not reveal an obvious problem. Yet something still doesn't feel right.
For some people, symptoms persist long after surgery. For others, they become more noticeable months or years later.
Recovery isn't always straightforward. The circumstances leading to surgery, the procedure itself, or a difficult healing process can also have a lasting impact on someone's physical and emotional well-being.
What are abdominal adhesions?
Abdominal adhesions are bands of fibrous, scar-like connective tissue that can form between internal organs or between organs and the abdominal wall. They most commonly develop following abdominal or pelvic surgery, although inflammation and certain medical conditions can also contribute.
Not all adhesions cause symptoms, but some may be associated with persistent abdominal pain or complications, including bowel obstruction.
Discomfort following surgery can have several possible causes. Adhesions are one consideration, not an automatic explanation.
Understanding scar tissue and fascia
When surgery or injury disrupts the normal organization of connective tissue, the body lays down new collagen to repair and strengthen the area. Initially, these fibers are less organized than the original tissue. Over time, the scar remodels, but it never completely recreates the structure that was there before.
Fascia is an interconnected system of connective tissue that surrounds, supports, and connects structures throughout the body. It plays an important role in how tissues move and glide in relation to one another.
Scar formation can affect multiple tissue layers, including fascia, potentially altering their pliability and mobility even when the visible scar appears well healed. These restrictions are not limited to the abdomen.
Although a scar will always differ from the original tissue, persistent pain, pulling, or restricted movement should not simply be accepted as an inevitable consequence of healing.
What might you notice after surgery?
Following surgery, you may experience:
- A pulling or tethered sensation, either around or beyond the surgical incision
- Difficulty straightening up, lying flat, stretching, bending, or twisting due to pain, tightness, or pulling sensations
- Sensitive or painful surgical scars
- A feeling of restriction or tension deep within the abdomen or pelvis
- Persistent bloating, abdominal fullness, or discomfort after eating
- Changes in bowel habits, including constipation or difficulty passing gas
These symptoms don't necessarily indicate internal adhesions. Scar-related restrictions, muscular tension, and other medical conditions may also contribute.
Why don't abdominal adhesions always show up on scans?
Abdominal adhesions can be difficult to distinguish from surrounding tissues and are often not directly visible on conventional CT or MRI scans. Someone may therefore continue experiencing symptoms even when imaging doesn't reveal an obvious explanation.
Cine MRI, also known as dynamic MRI, offers a different approach. Rather than relying solely on static images, it captures movement within the abdomen and assesses how organs and surrounding tissues move in relation to one another. Reduced movement, sometimes referred to as restricted visceral slide, may suggest the presence of adhesions.
However, imaging findings do not always correspond with what a surgeon observes during an operation. Adhesions may be present despite unremarkable imaging, while suspected adhesions may not be confirmed surgically. Even when adhesions are identified, they are not necessarily responsible for someone's symptoms.
Looking beyond the visible scar
My assessment begins with understanding your medical and surgical history, your symptoms, and how your body has responded throughout recovery.
Through gentle, hands-on assessment, I consider tissue firmness, pliability, mobility, and tenderness alongside what you experience. Sometimes moving tissue in one area produces a familiar pulling sensation elsewhere. These responses help guide my clinical reasoning, although palpation cannot confirm the presence or location of internal adhesions.
The circumstances surrounding surgery also matter. A medical emergency, repeated procedures, complications, or a difficult recovery can be physically and emotionally challenging, sometimes traumatic. These experiences may influence how the nervous system responds to touch, movement, and sensation, and are an important part of my individualized approach.
Working with the body's response
My treatment incorporates myofascial release (MFR), visceral manipulation, and other specialized manual therapy techniques, adapted to your individual needs and responses.
Rather than forcing tissues to change, I use gentle, sustained hands-on contact, allowing time for the body to respond. Treatment is guided by what I perceive through my hands and what you experience, including changes in familiar sensations of pulling, discomfort, or restriction.
Sometimes symptoms ease before I notice a change in tissue resistance or tone. I may continue maintaining gentle contact, allowing time for further responses to develop.
I consider the relationship between connective tissues, the nervous system, and your individual experience throughout treatment. Your comfort and participation are central to how I work.
What if you've had several surgeries or a history of bowel obstruction?
Repeated abdominal or pelvic surgeries can create a complex healing history. My experience includes working with people following bowel resections, adhesiolysis, gynecological procedures, and recurrent small bowel obstruction attributed to adhesions.
Understanding your surgical history, complications, and current symptoms is particularly important when considering whether manual therapy may be appropriate. Treatment is individualized and takes your ongoing medical care into account.
Manual therapy is not appropriate during an active bowel obstruction. Any suspected obstruction requires prompt medical evaluation.
Can treatment be helpful years after surgery?
Yes. Even when surgery took place many years ago, hands-on treatment may still be worth exploring.
The age of a scar alone doesn't determine whether treatment may be helpful. Your current symptoms, medical history, movement, and response to assessment are more relevant when considering whether manual therapy is appropriate.
Considering an appointment?
If you're experiencing persistent pain, pulling, tightness, or restricted movement following surgery or injury, I welcome the opportunity to learn more about your experience.
I offer a complimentary 15-minute phone consultation if you'd like to discuss your concerns and whether my approach may be appropriate for you.