Abdominal Massage for Functional Constipation in Adults

Is abdominal massage an effective treatment for functional constipation in adults?

Abdominal massage can be used as a treatment for functional constipation in adults. (Strength of Recommendation [SOR]: B, small randomized controlled trials [RCTs].) Compared with patients in control groups, patients in massage groups demonstrate a 28% to 55% greater reduction in constipation severity using the Constipation Severity Instrument (CSI). (SOR: B, small RCTs.) Massage also results in an 18% to 27% greater improvement in constipation-associated quality of life, as measured by the Patient Assessment of Constipation Quality of Life (PAC-QoL) questionnaire. (SOR: B, small RCTs.)

A 2022 RCT (N = 74) evaluated abdominal massage for functional constipation. Patients were younger than 65 years (mean age = 35 years) with constipation as defined by the Rome IV criteria. Exclusion criteria were concurrent severe illness, contraindications to massage such as open wounds or recent surgery, and regular use of medication or supplements that treated or induced constipation. Patients in the intervention group received 10-minute abdominal massages from experienced physical therapists three times weekly for 4 weeks. Patients in the comparison group received 15-minute placebo ultrasound therapy twice weekly for 4 weeks.¹

The primary outcome was change in CSI score. The CSI is a validated self-report tool with 16 scored items in the three domains of obstructive defecation, colonic inertia, and pain (range = 0-73; higher scores indicate worse symptoms). Secondary outcomes were changes in the PAC-QoL score (range = 28–140; higher scores indicate worse symptoms), stool diary (stools/week, defecation time), and classification on the Bristol Stool Scale. Between-group effect sizes were estimated using Cohen d, with effect sizes categorized as large (> 0.8), medium (0.5–0.8), or small (< 0.5).¹

Compared with placebo treatment, abdominal massage resulted in large reductions in CSI scores (Cohen d = 2.0; P < .001), increased defecation frequency (Cohen d = 1.9; P < .001), reduced defecation time (Cohen d = 1.3; P < .001), looser stool consistency (Cohen d = 2.3; P < .001), and lower PAC-QoL score (Cohen d = 1.7; P < .001). Limitations included a lack of participant blinding and short follow-up.¹

A 2024 three-arm, single-blind RCT (N = 66) studied abdominal massage, abdominal kinesiology taping, and lifestyle recommendations for functional constipation treatment. Patients were females younger than 65 years (mean age = 34 years) with a chronic constipation diagnosis based on Rome IV criteria. Exclusion criteria involved concurrent serious illness, colon or gastrointestinal problems (eg, gastrointestinal bleeding, acute inflammation, difficulty defecating, anorectal dyssynergia, secondary constipation), body mass index greater than 35 kg/m², recent treatment for constipation with physiotherapy, and laxative treatment up to 4 weeks previously.²

Patients in the experimental treatment groups received lifestyle recommendations plus abdominal massage or abdominal kinesiology taping three times weekly for 4 weeks. Patients in the comparison group received lifestyle recommendations only.²

The primary outcome was change in CSI score. Secondary outcomes were negative changes in bowel diary, Bristol Stool Scale classification, and PAC-QoL score. After treatment, all groups demonstrated within-group improvements in CSI (mean difference [MD] for massage = −22; P < .05; MD for taping = −18; P < .05; MD for control = −7.1; P < .05). Between-group analysis showed the massage group had a 28% greater reduction in CSI score than the lifestyle group (P < .001). PACQoL scores also improved within each group (MD for massage =–29; P < .05; MD for taping = −21; P < .05; MD for control = −9.5; P < .05), with greater improvements in the experimental groups compared with the control group (P < .001). Limitations included unknown allocation concealment.²