MARCH 27th, 2011
Massage has been used for constipation since the nineteenth century: how effective is it?
In this article
A review of the literature on abdominal massage to relieve constipation;
Why abdominal massage is effective to relieve constipation;
An abdominal massage technique.
Authors
Doreen McClurg is research fellow, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University; Andrea Lowe-Strong is senior lecturer, School of Health, University of Ulster, Belfast
Abstract
McClurg D, Lowe-Strong A (2011) Does abdominal massage relieve constipation? Nursing Times; 107: 12, 20-22.
Background Abdominal massage has been used to treat constipation since the 19th century, yet questions remain over its effectiveness and which patient groups benefit from it the most.
Aim To determine whether abdominal massage is effective for the relief of constipation.
Method A review of observational studies, case reports and randomised controlled trials was carried out to determine whether abdominal massage is effective in relieving constipation.
Results Abdominal massage can relieve constipation of various physiological causes. It stimulates peristalsis, decreases colonic transit time and increases the frequency of bowel movements. It also reduces discomfort and pain, induces relaxation and improves quality of life. No adverse effects have been reported.
Conclusion Abdominal massage should be considered when treating patients with constipation. It has no adverse side-effects and can easily be taught to patients and carers so they can undertake it themselves.
Keywords: Constipation, Abdominal massage
This article has been double-blind peer reviewed
5 key points
Constipation can be caused by dietary and exercise patterns, medication and disease
If untreated, chronic constipation can lead to serious complaints, such as faecal impaction, incontinence and bowel perforations
Abdominal massage is thought to encourage rectal loading by increasing intra-abdominal pressure. IN neurological cases, it can produce rectal waves that stimualte bowel sensation
Abdominal massage appears to stimualte peristalsis, reduce colonic transit time and increase the frequency of bowel movements
Patients and careres can be taught abdominal massage techniques
In the late 19th century, Garry wrote in The Lancet: “During the past few years I have seen a large number of cases of constipation successfully treated by massage and I believe it to be the most reliable method yet brought before the notice of the profession for this obstinate condition” (Garry, 1889).
The use of abdominal massage reached a peak in the early 20th century, forming part of the core curriculum for physiotherapy students, yet had almost disappeared by 1950. Massage therapy for constipation has since undergone a revival in clinical practice, especially in palliative care, oncology and hospice environments (Cole and Stanley, 1998; Trevelyan, 1996).
Constipation
Constipation disproportionately affects women and older adults; around 20% of older people in the community have constipation (Kamm, 2003).
Laxatives are used to treat the problem in primary care, costing an estimated £46m a year in England alone in prescription costs (Department of Health, 2001).
Constipation can have functional idiopathic causes, or be due to a variety of factors, including dietary and exercise patterns, medication and disease processes.
Constipation is often seen as a benign, easily treated condition, with short-term treatment being relatively straightforward.
However, chronic constipation is associated with complications that can develop into serious bowel complaints if left untreated, such as faecal impaction, incontinence and bowel perforations.
There are implications for healthcare costs and the patient’s health-related quality of life (HR-QoL). Evidence suggests HR-QoL is lower in patients with constipation than in non-constipated individuals, and treatments for constipation improve HR-QoL (Mason et al, 2002).
There is also evidence that constipation or laxative use increases the risk of colon cancer (Watanabe et al, 2004).
Abdominal massage
Abdominal massage is thought to encourage rectal loading by increasing intra-abdominal pressure. In some neurological cases, massage can produce rectal waves that stimulate the somato-autonomic reflex and bowel sensation (Liu et al, 2005).
It has also been found to increase weight gain in preterm infants by increasing vagal activity and gastric motility (Diego et al, 2007).
Emly (2001) found abdominal massage to be effective for relieving constipation as part of a bowel care programme, with an associated reduction in laxative use and improved HR-QoL.
Literature review
All four clinical trials in a systematic review conducted in 1999 of observational studies, case reports and controlled clinical trials on abdominal massage for the relief of constipation had methodological flaws. They were inconsistent in the types of patients used, massage technique and trial design, and only one trial was randomised (Ernst, 1999).
The review found no sound scientific evidence for the effectiveness of abdominal massage for relieving constipation but the trials did show enough positive results, such as decreased constipation and improved patient wellbeing, to warrant more rigorous randomised, controlled trials with larger numbers of patients (Ernst, 1999).
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