Treating Small Bowel Obstruction with a Manual Physical Therapy: A Prospective Efficacy Study

Abstract

Small bowel obstructions (SBOs) caused by adhesions are a common, often life-threatening postsurgical complication with few treatment options available for patients. This study examines the efficacy of a manual physical therapy treatment regimen on the pain and quality of life of subjects with a history of bowel obstructions due to adhesions in a prospective, controlled survey based study. Changes in six domains of quality of life were measured via ratings reported before and after treatment using the validated Small Bowel Obstruction Questionnaire (SBO-Q). Improvements in the domains for pain (p = 0.0087), overall quality of life (p = 0.0016), and pain severity (p = 0.0006) were significant when average scores before treatment were compared with scores after treatment. The gastrointestinal symptoms (p = 0.0258) domain was marginally significant. There was no statistically significant improvement identified in the diet or medication domains in the SBO-Q for this population. Significant improvements in range of motion in the trunk (p ≤ 0.001), often limited by adhesions, were also observed for all measures. This study demonstrates in a small number of subjects that this manual physical therapy protocol is an effective treatment option for patients with adhesive small bowel obstructions as measured by subject reported symptoms and quality of life.

Manual physical therapy clears adhesive bowel obstruction and strictures in a patient with Crohn’s disease

“…[26][27][28][29][30][31][32][33] Furthermore, the manual physiotherapy regimen utilized in the current study, CPA, has previously been shown effective in disrupting adhesions, decreasing pain, and improving the overall quality of life in patients with recurrent SBO. [34][35][36][37] CPA integrates techniques from an array of manual modalities to optimize individualized treatment, focusing intently on the patient's specific areas of restriction. Application of a variety of sitespecific pressures across restrictive bands of adhered tissues and structures are employed, progressing from superficial to deep tissues.…”

“…Preferring to pursue non-operative management, she sought out alternative therapy via an Internet search. She came across a manual physiotherapy known as the Clear Passage Approach (CPA) which has previously been shown to decrease abdominopelvic adhesions [34][35][36][37].…”

Attenuation of postoperative adhesions using a modeled manual therapy

“…It has been suggested that manual therapy can reverse infertility, treat small bowel obstruction, and reduce chronic pelvic pain [48–51]. In these approaches, there is no knowledge of the type of adhesion towards which the treatment is directed, nor whether movement is being induced between the desired structures.…”

Abdominal Manual Therapy Repairs Interstitial Cells of Cajal and Increases Colonic c-Kit Expression When Treating Bowel Dysfunction after Spinal Cord Injury

“…Neurogenic bowel dysfunction after spinal cord injury leads to the accumulation of feces and luminal dilatation, which in turn aggravates the damage to intestinal morphology and functions [ 30 ]. AMT to the abdomen could provide an appropriate mechanical stimulus to promote the movement of the intestinal tract, increasing defecation and thus preventing further damage to the cells regulating gastrointestinal motility, such as ICCs [ 35 – 37 ]. On the other hand, the enhanced proliferation and functions of ICCs may also be a direct result of the mechanical stimulus during AMT [ 35 – 37 ].…”