The Effects of Connective Tissue Manipulation and Abdominal Massage in Patients With Chronic Constipation
Condition: Constipation
MeSH terms: Constipation
Study type: Interventional

Summary: 
      The aim of this study is to investigate the effect of connective tissue manipulation and
      abdominal massage on severity of constipation and health related quality of life in patients
      with chronic constipation. According to literature, there are studies that investigate the
      effects of abdominal massage on bowel movements. But there is no randomized controlled trial,
      explore the short and long-term effects of different massage technics on chronic
      constipation. Hypothesis of this study is that connective tissue manipulation and abdominal
      massage improves symptoms of constipation and health related quality of life in patients
      suffering with constipation.
    

Detailed description: 
      Chronic constipation is not a disease but a symptom of a condition involving insufficient
      defecation and whose definition varies from person to person. Health professionals define
      constipation as 3 times or less per week defecation and the patients define it as the
      sensation of incomplete bowel evacuation, hard stool, straining, and difficulty in
      defecation. Chronic constipation is a common condition experienced by the general public, and
      it reduces the health related quality of life (HRQOL) by negatively affecting the physical,
      mental, and social well being of individuals. In a recent meta-analysis, the global
      prevalence rate of chronic constipation was reported to be 14%; it was also reported that its
      incidence rate is correlated with increasing age and low-income level, and it is more common
      among females.

      Because the underlying pathophysiology of chronic constipation has not been clearly
      identified, its treatment has been difficult for both healthcare professionals and patients.
      Following the elimination of pathological and secondary causes, the treatment of chronic
      constipation is initiated by non-pharmacological treatment methods, such as lifestyle
      modifications (increased dietary fiber and water intake as well as increased physical
      activity), defecation training, and physiotherapy approaches. If lifestyle modification and
      conservative treatment methods do not help the patient, pharmacological treatment methods,
      such as osmotic laxatives, stimulant laxatives, stool softeners, lubricants, chloride channel
      activators, and serotonin agents, may be used. At the final stage, if the pharmacological
      treatment is not successful in patients with slow-transit constipation, surgical treatment
      options, such as segmental, subtotal, or total colectomy, are considered. Conservative
      treatment methods used in patients with chronic constipation may include abdominal massage,
      connective tissue manipulation (CTM), chiropractic treatment, electrical stimulation,
      anorectal biofeedback and exercise.

      CTM, one of the conservative treatment methods for chronic constipation, generates local
      mechanical effects on mast cells in the connective tissue by short and long tractions and
      thus creates vasodilation by reducing the sympathetic activity. Subsequently, parasympathetic
      effect increases and the improvement in the circulation promotes healing process. But there
      is very little research that examine its effectiveness on constipation and bowel function. In
      the case report of Holey et al., it was reported that CTM was better than abdominal massage
      in improving symptoms of constipation. Also, another study revealed that combination of
      pelvic exercises and CTM played a role in healing bowel functions in women immediately after
      the post cesarean delivery.

      Abdominal massage is another treatment approach using the management of chronic constipation.
      The benefits of physiotherapy in treatment of constipation include mechanical and
      neurological effects. Mechanical effects include accelerating colonic motility, improving
      colonic transit time, coordinating the muscles and increasing abdominal muscle tone. The
      neurological effect is to enhance the activity of the parasympathetic nervous system.
    

Intervention name(s): lifestyle advice; connective tissue manipulation; abdominal massage
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.; CTM wil be applied five days per week, a total of 20 sessions for 4 weeks. Each session lasted around 15-20 minutes. While patients are in a sitting position, starting from the lumbosacral region, lower thoracic, scapular, inter-scapular and cervical regions will be included in the treatment, respectively.; Abdominal massage will be applied five days a week for four weeks. Each session will last around 15-20 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Constipation; connective tissue manipulation; abdominal massage; bowel movements; quality of life