“A scar from surgery is like an iceberg in that only 10% of it is visible at the surface. Think about and investigate all the deeper levels which have been cut and sewn together!” -Jean-Pierre Barral, D.O.
Adhesions are fibrous bands that cause internal abdominal or pelvic tissues to stick together. The adhesions form in a way that bind tissues together that should otherwise naturally slide and glide. Adhesions form due to infection, inflammation, injury, and are a common complication from surgery. Adhesions may vary from thin strands or wide webs to dense fibers. These adhesions can cause abdominal and pelvic pain, fertility issues, bowel obstruction, trapped fluid, negatively affect the surrounding organs (bladder and intestines) and even change how the cells of an organ act via mechanotransduction (the conversion of mechanical stimuli into chemical activity). Severe adhesions can also affect posture. The body will “hug” lesions in the body. I’ve seen people side-bend around deep abdominal adhesions because it was a more comfortable position for them.
During a C-Section, a surgeon must first cut through nine different types of tissue layers before even getting to the uterus! The layers consist of the skin, superficial fascia (fatty and fibrous layer), deep fascia, rectus sheath, rectus abdominis, transversalis fascia, extraperitoneal connective tissue, and peritoneum. These layers don’t necessarily run in the same direction as the incision. Therefore adhesions can form in complex webs. That’s why skin rolling over scar tissue may not be enough to affect the deeper and surrounding complex layers in a precise enough way. Each person is unique (tissue health, constitution, load patterns, nutrition, inflammation, past trauma, etc.) and each surgery has a different set of circumstances which influences suture patterns and how adhesions form and to what extent they form. The surgeon may or may not suture the peritoneum closed.
How can you tell if you have adhesions? “Adhesion occur in more than 90% of the patients following major abdominal surgery and in 55-100% of the women undergoing pelvic surgery. Small-bowel obstruction, infertility, chronic abdominal and pelvic pain, and difficult reoperative surgery are the most common consequences of peritoneal adhesions. Despite elaborate efforts to develop effective strategies to reduce or prevent adhesions, their formation remains a frequent occurrence after abdominal surgery.” Source
In the study titled, A reliable way to predict intraabdominal adhesions at repeat cesarean delivery: scar characteristics, they found that the appearance of the scar (flat, raised, depressed, or pigment of the scar) is an indicator of the severity of intraabdominal adhesions.
When to receive treatment: once the incision heals, typically 6-8 weeks, but that timeframe may be longer for some people, so check with your doctor to make sure it’s ok to receive abdominal therapy. In the meantime, don’t forget that you have a natural internal release mechanism called the breath. Often times we avoid breathing into areas of pain or trauma. It’s our way of “not going there”, but that area needs our gentle presence. Gentle full breaths naturally allow the tissues to move, even as far down as the pelvic area.
If you missed my first article on Abdominal Adhesions, you can read it HERE.