Objective To investigate the effect of the frequency of Foley balloon placement after hysteroscopic transcervical resection of adhesion （TCRA） on re-adhesion in patients with severe intrauterine adhesions （IUA）. Methods The clinical data of 128 patients with severe IUA who underwent TCRA at the hospital from January 2022 to January 2025 were reviewed. According to the number of Foley balloon insertions after surgery， they were divided into a control group （single insertion， n = 68） and an observation group （two insertions， n = 60）. The clinical efficacy， IUA scores before and after treatment， menstrual changes， postoperative re-adhesion， and pregnancy status were compared between the two groups. Results The total effective rate reached 90.00% （54/60） in the observation group， which was higher than 76.47% （52/68） in the control group （P < 0.05）. After treatment， the American Fertility Society （AFS） Score of the observation group （3.12 ± 1.06） was lower than that of the control group （4.35 ± 1.21）. The improvement value of IUA score （6.70 ± 1.57） was higher than that of the control group （5.26 ± 1.62） （P < 0.05）. After treatment， menstrual blood volume of the observation group ［（40.22 ± 3.91） mL］ was larger than that of the control group ［（37.39 ± 4.10） mL］， and menstrual period ［（5.06 ± 1.12） d］ was longer than that of the control group ［（4.41 ± 1.20） d］ （P < 0.05）. There was a statistically significant difference in the incidence of re-adhesion between the two groups （15.00% vs. 32.35%， P > 0.05）. Conclusion The placement of Foley balloons twice after TCRA surgery in patients with severe IUA can effectively alleviate the degree of IUA， increase menstrual flow， improve menstruation， and reduce the risk of re adhesion. It is worthy of clinical research.