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Abdominal massage for chronic constipation

Clinical bottom line: There is insufficient evidence of effect of abdominal massage for chronic constipation. The trials were small and of poor methodological quality.


Chronic constipation is common. Observational studies and case reports show that massage may be helpful.

Systematic review:

Ernst E. Abdominal massage for chronic constipation: A systematic review of controlled clinical trials. Forsch Komplementärmed 1999;6;149-151.

Date review completed: June 1997

Number of trials included: Four

Number of patients: Total 54 patients

Control groups: phase of no massage or treatment with laxatives.

Main outcomes: total gastrointestinal/colonic transit time, stool frequency, number of days with bowel movements, episodes of faecal incontinence, number of enemas given, stool consistency, patient well-being.

Inclusion criteria were: controlled clinical trial; active treatment phase (abdominal massage) compared with a control phase (no massage or treatment with laxatives); patients with chronic constipation.

Medline, Embase, CISCOM and the Cochrane Library (all years to June 1997) and the reviewer's own database of alternative therapies were searched to identify controlled trials of massage treatment for chronic constipation. A number of relevant search terms were used and experts were contacted for other published/unpublished information. Referenece lists of retrieved reports were checked for additional citations and no language restrictions were made. A controlled trial was defined as having a nonmassage treatment group. Study quality was assessed using a validated scale. Data were extracted in a standardised, predefined manner. A descriptive analysis was conducted.

Findings:

Four trials were included. The patient population was: chronic constipation, no further details (21 patients), 48 year old female with chronic constipation (1), disabled, institutionalised adults with severe chronic constipation (32). One study was randomised, none were blind. The randomised study (32 patients) found no significant difference in outcomes (gastrointestinal transit time, stool frequency & consistency, number of enemas given, patient well-being) between the different treatment phases (three weeks run-in, regular massage for seven weeks, one week wash-out, laxatives for seven weeks). Two trials (21 patients) found no significant difference between massage and control phases for total colonic transit time and stool frequency; one also reported massage therapy to cause significant improvement in the number of days with bowel movements, episodes of faecal incontinence and number of enemas given. One N-of-1 (one patient) trial reported improved stool frequency and consistency with massage compared with the control phase.

Adverse effects

Adverse effects were not mentioned.

 

Comment

As stated by the reviewer, these trials were of poor quality and were methodologically flawed. The studies were small (the largest had 32 patients), assessed different outcomes and durations of treatment, and provided no definition of constipation (other than transit time in one study) or abdominal massage. None of the included trials were blind and were open to observer bias. Only one study was randomised - this showed no effect of abdominal massage on constipation. Three studies were not randomised and were open to selection bias. The studies were likely to be of poor validity and incapable of producing a true result. No sound scientific evidence exists to determine whether massage is effective in patients with chronic constipation.

Further reading

Further reading

Related topics


Related topics

Identifier

AT043-5873 ABDOMINAL MASSAGE FOR CHRONIC CONSTIPATION: Jul-2000