Endometriosis is a largely “mechanical” condition in which the tissues that normally exit a woman during her menstrual cycle are found inside the body, often adhered to the reproductive and/or digestive structures. Like the tissues that form in the uterus, these endometrial tissues, often bound to internal structures, swell with each menstrual cycle. Unable to leave the body, they remain or grow during a woman’s life, causing pain or dysfunction — including infertility.
The mechanical problems caused by endometrial implants are increased significantly by adhesions — internal scars that can form powerful bonds and are frequently found with endometriosis. Between the mechanical implantation of the endometrial tissue and the adhesive bonds that so frequently form at these tissues, endometrial implants can cause pain or infertility, and disrupt the normal function of abdominopelvic organs. To remedy these problems, surgery is often recommended for women with endometriosis.
Over the last decade, a manual physical therapy has been shown to be effective at detaching the adhesive bonds that accompany endometriosis. When the tissues swell each month, the therapists feel that the swelling can pull on the adhesive bonds, causing significant pain or dysfunction. By detaching or breaking these bonds, the therapy appears to improve fertility and decrease or eliminate the pain associated with menstrual cycles. Published studies show that the therapy has decreased pain significantly and improved fertility at a rate equivalent to surgical techniques.
Description of endometriosis surgery. The intent of endometriosis surgery is to find and burn or surgically excise endometrial implants and adhesions, returning the body to an earlier state of mobility and function. In a laparoscopy, the physician puts the patient under general anesthesia, then cuts several holes (ports) in the body. One of the ports is used to fill the cavity with a gas to separate the organs so that the surgeon can create a path through which s/he can visualize the structures s/he needs to remove or repair. Using the other ports, the doctor will insert a light, camera, and surgical instrument(s) with which they can cut or burn adhesions and endometrial implants. You can observe a laparoscopy to decrease endometriosis by clicking here.
When adhesions are extensive, the physician may elect to perform an open surgery called a laparotomy. In that surgery, the physician cuts the body open via a long incision and then separates the sides with a metal retractor. Next, the surgeon enters with a scalpel, laser or other surgical instrument to cut or burn any adhesions s/he may find. S/he will repair or cauterize any bleeding that occurs and will often check for other problems before exiting the body and sending the patient to a room for post-surgical recovery.
Direct visualization. The surgeon can directly see the area and visually assess the internal condition. In some cases, s/he may not be able to see through thick blankets of adhesions. This can lead to problems (inadvertent enterotomy) noted below.
Observe nearby areas. In addition to treating the adhered area, the physician can see and assess the condition of nearby structures, noting any areas that may be of concern.
Operative report. The doctor will dictate a report that describes what s/he observes and the procedures s/he performs during the surgery.
Anesthesia complications. Recent studies note concerns about neurotoxicity, with mild to moderate brain damage, for patients who undergo one or more sessions of general anesthesia. (Perousanksy & Hemmings, 2009)
Inadvertent enterotomy. When a patient has significant adhesions, it can be difficult for the doctor to see the structures beneath them. Thus, a surgeon can unintentionally cut into a nearby healthy organ or other structure – called an inadvertent enterotomy (IE). An IE can cause serious problems or death. In a study from the Journal of the Society of Laparoscopic Surgeons, authors note that:
- “IE in laparoscopic abdominal surgery is underreported.”
- “Death from IE is not uncommon.”
- “IE was the most common laparoscopic complication at our hospital.” (Binenbaum & Goldfarb, 2006)
Hospitalization during recovery. Most surgeries are followed by a hospital stay, during which patient recovery can be monitored for post-surgical complications or infections.
New adhesions generally form after surgery. It is a well-accepted medical fact that nearly all surgeries in the abdomen or pelvis cause new adhesions to form. Thus, pain and adhesions can recur – sometimes worse than before the surgery to remove them.
There is no cure for endometriosis. In addition to post-surgical adhesions, endometriosis can and often does recur after surgery. Thus, surgery or therapy may need to be repeated.
A note about surgical philosophies: The medical community has varied philosophies about the best surgical approaches to treating endometriosis and adhesions. While some are diligent about doing the least damage possible, e.g. by using lasers that only burn one cell deep, others are more aggressive. Before agreeing to a surgery, we encourage you to ask your surgeon his/her philosophy or surgical approach, to see if it aligns with your philosophy and goals.
Description of the procedure. The Clear Passage Approach® is a manual physical therapy; it uses no drugs or surgery. It has been cited in numerous studies and peer-reviewed medical journals for its ability to decrease the pain and dysfunction caused by endometriosis. In a ten-year study with hundreds of participants, its fertility success rates for women with endometriosis equaled those of surgery.
The therapy is ‘all natural’ in that it is 100 percent ‘hands-on.’ While some patients describe it as feeling like a very deep massage, others note that it can sometimes be much lighter, depending on the area and depth being treated. Physical therapists use their hands to deform and detach the tiny strands that comprise adhesions – similar to pulling out the strands of a nylon rope or pulling out the run in a sweater. They describe it as “pulling out salt-water taffy, in very slow motion.”
The therapy is very site-specific for adhesions and endometrial implants. The physical therapists certified to perform this work are experts at palpating and manipulating the soft tissues of the body – where endometrial implants and adhesions generally form. They use data from the patient’s history, direct feedback from the patient during therapy, and a thorough training and understanding of methods developed over 30 years to deform and detach the molecular/chemical bonds that bind endometrial implants to the underlying structures. In releasing those bonds, the body tends to return to an earlier state of mobility and function.
The usual protocol, cited in the published studies, consists of 20 hours of therapy spaced over five or more days. You can view a short video of a Clear Passage therapy session by clicking below.
No hospitalization. Therapy is performed in a private treatment room, one-on-one with a highly skilled physical therapist certified in the work. You are invited to bring a partner or family member along for company, if you like.
No anesthesia. The patient is awake and communicative during theprocedure, so there is no risk of neurotoxic damage to the brain or body. Patient involvement is actively encouraged. We believe that by educating the patient and getting her feedback during therapy, we help make her an active member of the team that is treating her. In doing so, we achieve better results.
Decreased risk. Risk is minimal because there is no cutting or burning. There is no risk from anesthesia and no risk of inadvertently cutting through a nearby structure, such as the bowel.
No foreign bodies are introduced. No stitches, staples, films or meshes are inserted into the body. No cameras, gas, lights or surgical instruments enter the body.
Side effects are mild and transient. The most common side effects patients report are temporary tenderness, aching, fatigue and hip or back pain. When they occur, these symptoms pass within a few days.
Improvements in other areas of the body. Because therapy focuses on detaching adhesions throughout the body, it is common for patients to report significant increases in flexibility and range of motion after therapy. In addition, many report decreased pain and/or increased function in areas near the site where they are being treated. Some report this phenomenon in areas they had forgotten or had not realized they were having a problem with, until therapy relieved the pain or tightness.
Therapists cannot visualize the adhesions. Initially, we deduce the likelihood of adhesions by conducting a thorough review of your history and symptoms. To gain further insights, we may require diagnostic tests or documentation from your physician.
During therapy, we palpate the areas of your body related to your symptoms and other areas where we note spasm, asymmetry, thickened tissues or increased temperature. Because our therapists have been doing this work for an average of over 25 years each, they are experts at palpating the body. In some locations, we will use an ‘adheremeter’ – a validated test to measure the presence and location of adhesions in the body prior to initiating therapy.
Costs of therapy are generally a fraction of the cost of surgery; as with surgery, insurance reimbursement may vary based upon your insurer and your plan. Clear Passage is an out-of-network provider for your insurer.
Travel and time are a consideration. Therapy generally takes five days (e.g., Monday – Friday); it is only provided by trained, certified therapists in several cities in the U.S. and U.K. The 5-day program is designed for out-of-town and out-of-country patients.
Screening every patient for appropriateness and contraindications before therapy or surgery is a necessary part of pre-treatment workup.
Screening before surgery. Your surgeon should consult with you to review the goals, risks and potential rewards you can expect from the procedure. They may order diagnostic tests to help rule out contraindications, such as active infection, and to help identify problem areas in the body for that should be assessed during surgery.
Screening before therapy. Clear Passage directors and staff consult applicants to review goals, risks and potential benefits that they can expect from therapy. We conduct a thorough review of your history of healing events (prior surgery, trauma, infection, endometriosis, etc.) to determine if and where adhesions have likely formed and how they might be causing problems. In addition, we may require additional tests or correspondence from your physician before we can accept you for therapy.