Recurring Small Bowel Obstruction Treatment Frequently Asked Questions

Consult our Physician Guide to Services booklet for an overview of this manual physical therapy designed to decrease or eliminate adhesions. As well as explaining the therapy, the inner pages contain QR codes linking to published, peer-reviewed studies on this therapy. The back cover is our Referral Sheet, showing cautions and contraindications. 

What is the history of this therapy?

In 1984, our physical therapist director had debilitating adhesion pain from pelvic surgery and radiation therapy. Told by her MDs that another surgery would create more adhesions, she and her spouse spent 30+ years developing and refining an effective non-surgical treatment to decrease or eliminate adhesions.

While treating patients with abdominopelvic adhesion pain, they were surprised to learn the therapy was clearing fallopian tubes that were totally blocked by adhesions. Seeing potential benefits to medicine, a gynecologist-surgeon helped them follow the ‘scientific method’ to measure effectiveness via dye test. 

Published results in well over 100 women showed a high level of effectiveness. Adverse events were mild and temporary, mainly some soreness during the week of therapy. The group began publishing data in peer-reviewed journals. 

In 2009, the therapists turned their attention to clearing larger tubes – small bowel obstructions (SBO). Independent x-ray studies show bowels cleared in obstructions caused by strictures and adhesions. A phase 2 controlled study co-authored by unaffiliated physicians at Stanford and Washington University show the therapy decreased recurrent SBO by roughly 15 times the norm (p=0.0001).

Describe the process; what do patients experience?

We begin with a thorough review of each applicant’s medical history to 

• determine appropriateness for therapy, 
• rule out contraindications, and 
• estimate the amount of therapy that will be needed. 

Therapy generally occurs in 2-hour blocks twice a day (4 hours a day) over five days (M-F). We start Monday morning with a thorough physical therapy evaluation. Each session thereafter consists of a site-specific manual soft tissue designed to decrease adhesions in the abdomen and pelvis. We include self-treatment training and provide tools for a home program designed to maintain and improve results. Therapy generally ends Friday afternoon after 20 hours of treatment.

Patients often describe therapy as a slow, deep point-specific pressure they have not experienced in any other format. We work with patients to stay within their comfort level at all times.

Physiologically, how does that clear the bowel? 

We know we cannot break the strong collagen fibers that comprise adhesions. We believe the therapy dissolves the molecular-collagenous bonds that are core to adhesion formation (crosslinking). As collagen fibers pull away from each other and the underlying structures, the body appears to return to an earlier state of mobility and function. To the therapist, it feels like slowly pulling out the run in a three-dimensional sweater. 

Would you use this on an area that is identified as an ileus potentially an SBO? 

No. We are generally effective decreasing adhesions – a major cause of SBO. We have no evidence that we can improve an ileus.

How many treatments does it take to be effective? Do some patients need more than 20 hours of therapy? 

Most patients require only 20 hours of therapy, given over a 5-day period (M-F). The sessions include instructions in self-treatment to help patients maintain or improve on the results gained in the clinic. 

Roughly 15% of patients return within 90 days after a 20-hour session for a ‘tune-up’ of 8 to 12 hours over 2-3 days. Patients with history of several invasive surgeries, severe trauma, burst appendix or peritonitis may require an additional week of therapy. 

Is there a limit to how many times patients can have this therapy?

While there is no limit, there is generally no need for more therapy beyond that stated above unless another trauma, surgery or infection causes more adhesions.

Is there anyone who shouldn’t have this procedure? 

We cannot treat within 90 days after a surgery in the area. Cautions and contraindications are listed on our Physician Referral and Clearance, which is also the back cover of our Physician Guide to Services booklet.

Some doctors ask if we treat patients with

• colostomy/ileostomy (OK to treat)

• short gut syndrome (OK to treat)
• a cancerous mass in their bowel? While active cancer is a contraindication to therapy, we sometimes treat end-of-life cancer patients with SBO as compassionate care, to return quality of life.

What are the potential side effects that my patients could experience from this therapy? 

No serious adverse events have occurred. The main side effect is temporary soreness during the week of therapy, generally relieved with Epsom Salt bath, or anti-inflammatory medication. 

How do I know if it’s not being effective?

We don’t have much experience with therapy not being effective. As shown in the controlled study published in the World Journal of Gastroenterology, therapy decreases recurring total bowel obstructions by roughly 15 times the norm. 

Are there physician concerns about SBO surgery?

Physicians are generally reluctant to perform an SBO surgery unless it is clearly life-threatening. SBO is the 2^nd most common emergency surgery in the USA, and has the highest complication rate (JAMA). Besides that, surgery is widely recognized as the primary cause of recurring SBO.

When adhesions are extensive, it can be difficult for the surgeon to see through adhesions blocking or attached to the bowel. Thus, even the most skilled doctors can create an inadvertent enterotomy when they cut into or through a nearby organ or other structure, an event that has been described as “too common” in published literature.

Describe your typical patient

We treat patients with recurring bowel obstructions. Most of these patients have had more than one emergency room visit with SBO diagnosis. Many have been told by their physician that the doctor does not want to perform another surgery due to the difficulties inherent in SBO surgery. Nearly all have had one or more surgeries to the bowel or nearby structures. 

Where is therapy given?

Treatment is given at Clear Passage locations throughout the USA and in England. Patients travel to our clinics from around the world. Most arrive in on a weekend, are treated for five days and then return home the following weekend. We suggest SBO patients wait a day after therapy before flying or going to altitude.