Effectiveness of abdominal massage on chronic constipation in adults: A systematic review and meta-analysis.

Background: Chronic constipation is a common distressing symptom. Abdominal massage is a safe, noninvasive, and comfortable intervention. However, it is rarely used in formal clinical practice as its' effectiveness for chronic constipation remains unclear.

Objective: This systematic review aimed to investigate the effectiveness of abdominal massage on defecation frequency, stool consistency, colonic transit time, constipation symptoms, quality of life, laxative use, and adverse events in adults. Additionally, we aimed to compare the effectiveness of abdominal massage in chronic constipation with different etiologies and types of abdominal massage techniques.

Methods: Data from eight English and Chinese electronic databases until May 15, 2024, including randomized controlled trials (RCT) and quasi-experimental studies, were used. The risk of bias was assessed using the Cochrane risk-of-bias tool. Results were synthesized using a random-effect model. This study was registered on the 7th of January 2023 to the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023385243).

Results: A total of 23 studies with 1431 participants were eligible for the meta-analysis. Abdominal massage statistically significantly increased weekly defecation frequency (MD = 1.59; 95 % CI 1.06, 2.11; df = 10; I = 82 %), decreased gut transit time (MD = -21.53 h; 95 % CI -35.94, -7.12; df = 3; I = 65 %), and decreased constipation symptoms (SMD = -1.06; 95 % CI -1.33, -0.80; df = 18; I = 79 %) as compared to the control group; however, it did not reduce laxative use (OR: 0.43, 95 % CI 0.14, 1.34, p = 0.15; I = 74 %). In subgroup analysis, the effectiveness of defecation frequency appeared to be greater for functional constipation (SMD = 1.23; 95 % CI 0.87, 1.60; df = 6; I = 86 %) as compared to opioid-induced constipation (SMD = 1.06; 95 % CI 0.61, 1.50; df = 5; I = 5 %) or neurogenic bowel dysfunction (SMD = 0.68; 95 % CI 0.26, 1.10; df = 4; I = 51 %). There were statistically significant differences in defecation frequency between the functional constipation and neurogenic bowel dysfunction groups (p = 0.075). Acupressure and aromatherapy massage had a greater effect on defecation frequency (SMD = 1.63; 95 % CI 1.06, 2.21; df = 3; I = 86 %) than circular massage (SMD = 0.90; 95 % CI 0.57, 1.22; df = 10; I = 68 %) or electric device massages (SMD = 0.83; 95 % CI 0.15, 1.51; df = 1; I = 82 %); however, high heterogeneity and a limited number of articles were encountered. No adverse reactions were observed in the non-neurogenic bowel dysfunction group.

Conclusion: This study reveals the efficacy of abdominal massage in alleviating symptoms of chronic constipation, as well as the differences in the effectiveness of different constipation types and massage techniques. Patients, caregivers, and health professionals can select abdominal massage techniques based on their effectiveness in specific type of constipation or troublesome symptoms.

Tweetable Abstract: Abdominal massage is effective for chronic constipation, increasing defecation frequency and improving symptoms. Users can tailor massage technique to specific constipation type for optimal results. #ConstipationRelief #GutHealth.