Manual Therapy and Abdominal Adhesions

Abdominal Adhesions are fibrous bands that can form between abdominal tissues and internal organs due to abdominal or pelvic infections, surgery or serious injury. Surgery being the biggest cause. In this article, when I say abdominal adhesions, I’m also talking about pelvic adhesions.


adhesions surrounding the liver

Internal organs have slippery surfaces that enable them to slide and glide against other organs and tissues. When adhesions are present the tissues no longer glide and the internal organ’s motility is inhibited, organ function is affected, pain may result and larger movements of the body may be inhibited. 

How are abdominal adhesions diagnosed? 

Unfortunately, most adhesions can’t be seen with imaging tests and are usually found during surgery. Although imaging is improving. This study is relevant to adhesions around the uterus and bladder after c-sections and may not apply to adhesions elsewhere. “With the improving resolution of ultrasound, ever smaller pathologic structures may be visualized, particularly if they are considered in the differential diagnosis.” (source)

It’s also not possible to diagnose abdominal or pelvic adhesions through palpation, but a trained manual therapist can feel restrictions. A restriction is when the organ loses its ability to partially or fully move which may or may not be due to adhesions.

Can abdominal adhesions be broken up with massage?

Some perhaps, but I wouldn’t recommend vigorously “breaking up” adhesions. When adhesions are torn, it creates wounding and more adhesions can form.

What can be done?

I take an indirect approach when working with restrictions to avoid further wounding. As a manual therapist trained in Visceral Manipulation™, I tune into the tissues to feel for restrictions, being as precise as possible, and then I work with the tissues gently to increase the natural motility and mobility of the organs and then I let the body do its thing. Your body knows what to do, I just give it a little nudge and then you self-correct for a couple of weeks and then reevaluate and nudge again if needed. What I mean by self-correct is that your body has built-in mechanisms to keep the organs moving. For instance, every time you breathe (if you aren’t just upper chest breathing) you massage the internal organs. That’s a gentle internal massage that happens about 30,000 times each day! Visit this page (click) to see a cool video of the interactions of the respiratory diaphragm and the internal organs.

Another example of the bodies intelligence is the natural innate motility which keeps tissues sliding, improves blood and oxygen delivery and helps with lymph flow. Motility and mobility are required for optimal physiological function. Life requires movement, internally (on the cellular level and intrinsic visceral movement) as well as your whole body in relationship to your environment. Varied full body movement is another way to decrease restrictions, so I include natural movement coaching in my sessions. Natural movement and proper breathing mechanics are built-in fascia release mechanisms.

Good to know 

There are different degrees of adhesions and if you’ve ever seen someone break a thick adhesion with a scalpel or other means during a dissection, you will quickly realize there is no way adhesions of that severity could be broken up manually during an abdominal massage, or would it be advisable to try. Even if the adhesions can’t resolve (and there is no way to know for sure unless you did exploratory surgery before and after treatment), the manual therapy should be helpful in reducing the symptoms of pain and in improving organ function. 

Adhesions after appendectomy

Adhesions after appendectomy

Severe adhesions can be very serious and may cause small bowel blockage. This would warrant a medical emergency and may require surgery or other medical intervention. Other symptoms of adhesions may be, but not limited to, fertility challenges, chronic pain, bloating and constipation. 

If you are experiencing severe symptoms like obstructed bowel, intense abdominal pain, or hard distended belly please see your doctor to rule out other serious conditions and get permission to receive Visceral Manipulation™ if it is indicated.  Some Osteopaths also practice manual therapy. 

If you do require surgery for (c-section, appendectomy, etc.) it may be appropriate and beneficial to receive Visceral Manipulation™ 6-8 weeks post surgery or when you have been cleared by your physician.

You may find a practitioner who practices Visceral Manipulation™ in your area by visiting the Barral Institute website.

If you live in the Portland OR area, you can schedule an appointment with me on my website

View some pretty amazing images and learn more about abdominal adhesions in the article Notes on visceral adhesions as fascial pathology by Gil Hedley.

Other articles that may be of interest to you:

Rib flare and adhesions in the costodiaphragmatic recesses

Visceral Manipulation™ The Thorax

C-Section Scar and Adhesions

Free The Belly Online Course


Free Womb Care ebook!

Subscribe to the Alignment Monkey newsletter to get the Womb Care ebook for FREE!

You have successfully subscribed. Your ebook should arrive within a few minutes.

Pin It on Pinterest

Share This