OMM: Post-Operative Ileus

00:00 Post-operative ileus is another presentation that potentially could be treated with OMM.

00:06 Post-operative ileus usually arises secondary to the incision and manipulation of the gut. So, our intestines respond to a mechanical motion and movement. When we eat, that bolus of food causes a dilation of the gut and because the gut becomes dilated it then propels the food along.

00:28 So usually pre-op patients are not eating for 24 hours before the surgery and then there is a lot of manipulation of the gut itself mechanically and so post-operatively patient’s GI system may shut down and there may be a lack of bowel motility. Pain also will decrease the amount of contraction because of hypersympathetic tone. Inflammation also plays a part, sometimes analgesia in terms of pain medications. So opioids are a common pain medication given post-operatively and that also could potentially contribute to decreasing GI motility and function. So, usually there is excessive sympathetic nervous system input which contributes to post-op ileus. So osteopathic findings, again we want to double check and look for any regions of facilitation, possible viscerosomatic reflexes, for example looking at L1 to L3 especially on the left side looking for potential descending colon viscerosomatic reflexes. You want to check for proper functioning of the lymphatics, the diaphragms and the mesentery. You want to check for proper parasympathetic balance. So remember parasympathetics is rest and digest and we want to promote that and so treating any sort of somatic dysfunctions of the upper cervical region, the cranial region. Also looking at the sacrum is really key for balancing parasympathetic tone. You want to check for possible Chapman reflexes especially along the IT bands for the colon and also checking for Zink patterns and then again checking for any postural dysfunctions that may contribute to the entire abdominal container. So, with osteopathic treatment, we want to treat any somatic dysfunctions that we find, treating facilitative segment first to help decrease facilitation, decrease pain. One thing of note is to really look at the possible somato-somatic reflexes also. So, incision sites will usually span a certain dermatome and if you check that dermatome region posteriorly, a lot of times there might be corresponding somato-somatic reflexes that increases the patient’s pain in sympathetic level. So, be sure to look for that and address those things. Techniques that you utilize will really depend on the patient and tolerance. Remember, they just recently had surgery so there is usually an incision site you have to really be wary of. They may have possible drainages and lines. So really, make sure that the area and region that you want to treat and the patient could tolerate the treatments.

03:21 Thoracolumbar inhibition is a good technique to utilize to try to decrease facilitation and decrease some of the tension of the muscles and also it's a key area to address because the thoracolumbar junction is associated with the abdominal diaphragm. Performing sacral rock technique could help loosen up the sacrum and treat the SI joints. Mesenteric lifts are good technique if the patient could tolerate and there are no abdominal incisions that would prevent you from performing it and again treating Chapman points could help. Other treatments that you could use include rib raising, addressing diaphragm and pelvic diaphragm restrictions by using gentle doming techniques or pelvic diaphragm release techniques. So, here is a closer look at performing the mesenteric lift. This technique could help to decrease any sort of strain in the abdominal region.

04:16 Remember the mesentery all hang from the diaphragm and so initially it's good to treat the osseous structures that the diaphragm attaches to, treat the diaphragm itself and then perform the lift. The lift is to try to decrease any sort of tension, twist, restrictions, pulse in the fascia surrounding the mesentery and so you're going to kind of scoop your fingers right above the ASIS underneath the mesentery and you're going to kind of bring everything towards the right upper quadrant. So remember we talked about the posterior attachment of the mesentery to the posterior wall and so because of the diagonal way that the mesentery hangs of, that posterior wall, you want to bring everything up to the right upper quadrant and so you tend to want to stand on the right side of the patient so that you could bring everything to the upper right quadrant. Patient is going to lie down and when they have their knees bent, that helps to decrease the tension along the anterior abdominal wall allowing it to kind of scoop and get further in to really lifting the mesentery. So you're going to start in the lower quadrants, place your fingers medial to the ASIS and a little bit above and then again gently scoop your hands underneath the abdominal contents and bring everything up to the right upper quadrant. When you hold it there, you could also add sometimes a lymphatic wave or pump with your other hand or you could just kind of hold that there until you feel a fascial release and then you could repeat with the other side. So here's a schematic of the large intestine, Chapman points. So remember that the Chapman points are reflected on to the IT bands on the leg and so make sure you screen and look for any potential large intestine Chapman points along the IT bands bilaterally and if you do find a viscerosomatic reflex there to treat it with gentle inhibitory pressure with a little bit of a circular motion and that will help resolve and treat those points to help decrease facilitation.