The Effects of Abdominal Massage on Functional (Primary) Chronic Constipation
Condition: Constipation
MeSH terms: Constipation
Study type: Interventional

Summary: 
      The aim of the present study is to investigate the efficacy of abdominal massage in patients
      with functional (primary) chronic constipation. The present study is designed as a randomized
      placebo controlled. Since the placebo group is included in the research design, if there is a
      greater improvement of symptoms of constipation and quality of life in the massage group when
      compared to the control group, it will be determined that this effect is not related to a
      placebo effect. If the efficacy of Abdominal Massage is revealed with a placebo controlled
      design, the therapist effect will be eliminated and further evidence on a well-known massage
      technique in functional (primary) chronic constipation, a common gastrointestinal problem,
      will be provided. The results of the present placebo controlled randomized trial will
      indicate that the need for pharmacological agents and the side effects associated with these
      agents will be reduced. According to the literature, there are studies that investigate the
      effects of abdominal massage on symptoms of constipation and quality of life. However, it has
      generally been used for secondary constipation or two applications have been compared. In
      addition, there is no randomized placebo-controlled study investigating the effect of
      abdominal massage on severity of chronic constipation and quality of life.
    

Detailed description: 
      Constipation is a subjective symptom that defines as inadequate defecation including several
      symptoms as follows: the sensation of incomplete bowel evacuation, hard stool, straining, and
      difficulty in defecation. The general prevalence of constipation in adults is 16%. The
      pre-defined risk factors are women gender, advanced age, non-white ethnicity, low
      socio-economic level, decreased physical activity underlying diseases, and medications.
      Chronic constipation affects quality of life and causes problems such as anxiety, depression,
      somatization, sleep disorders, sexual dysfunctions, school/work absenteeism. In the following
      periods, it causes serious comorbidities including dyspnea, gastro-esophageal reflux,
      hypertension, thyroid diseases, vaginitis, dyspareunia, diabetes, and fibromyalgia.

      In the treatment of chronic constipation, conservative approaches (lifestyle change and
      physiotherapy applications) are used at the first phase. If conservative approaches are not
      helpful for patients pharmacological and surgical treatment can be performed based on the
      characteristics of patients, respectively. Pharmacological treatments aim to increase the
      frequency of spontaneous bowel movements, to reduce abdominal pain and swelling, and to
      improve stool consistency. However, side effects such as abdominal bloating, abdominal
      cramping, abdominal pain, stomach gas, nausea, diarrhea, headache and dyspnea are reported by
      patients in the following period. Furthermore, medications for constipation management are
      not cost-effective. Therefore, the level of evidence on conservative approaches with low
      cost, non-invasive and no-side effects in constipation treatment should be increased.

      Physiotherapy approaches to alleviate chronic constipation symptoms include such as
      defecation training, abdominal massage, connective tissue massage, electrical stimulation,
      Kinesio-taping, anorectal biofeedback, and exercise training. Abdominal massage application
      in constipation is used in constipation management since the early 1870s and it is popular in
      recent years. The benefits of abdominal massage are known as follows: reduction in the
      abdominal muscle tension, improvement of local circulation, and stimulation of peristaltic
      movements. The technique of abdominal massage consists of 5 stages as follows: abdominal
      muscle stroking, colon stroking, colon kneading, colon stroking, and abdominal muscle
      stroking.
    

Intervention name(s): Standard bowel management; Abdominal massage; Placebo Ultrasound
Intervention type(s): Other; Other; Other
Intervention description(s): Lifestyle advices such as increasing fluid and fibre intake, improving physical activity level, and taking the ideal posture for defecation (squatting position) with a two-pages document.; Abdominal massage will be performed three days a week for four weeks. Each session will last around 15-20 minutes.; Placebo ultrasound (US) will be applied to the abdominal region for four weeks, 2 days of the week and 15 minutes per day.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: massage; abdominal massage; chronic constipation; primary constipation; functional constipation; defecation