Among children with chronic functional constipation, the combination of abdominal muscle training, breathing exercises, abdominal massage and standard treatment resulted in more frequent bowel movements, a recent study reports.

The study, “The use of abdominal muscle training, breathing exercises and abdominal massage to treat pediatric chronic functional constipation,” involved 72 children, ages 4 to 18, with chronic functional constipation (CFC).

These participants were randomly assigned to either the physiotherapy group or the medication control group. Subjects in the medication control group received conventional treatment for CFC, including laxatives, guidance toward a high-fiber diet, toilet training and disimpaction, when necessary.

Subjects assigned to the physiotherapy group not only received the same standard treatments for CFC, but also underwent two 40-minute physiotherapy sessions per week for a total of six weeks. These sessions included isometric training of the abdominal muscles, breathing exercises and abdominal massage.

“The aim [of the abdominal massage] was to perform propulsive abdominal massage to promote colonic and rectal motility to train intestinal function and defecation,” state the study’s authors. “The physiotherapist performed slow circular clockwise movements, along the line of the colon, applying constant moderate pressure to the abdomen with a regular tennis ball on each point for one minute, beginning with the ascending colon and moving toward the sigmoid colon.”

The primary outcome measures in this study were the frequency of defecation and fecal incontinence. Secondary outcome measures were defecation effort and pain, stool consistency and retentive behavior. Parents or guardians of the children documented these factors in a journal, which was submitted to the researchers once a week.

Results of the study showed that, after six weeks of treatment, defecation frequency was higher among the subjects in the physiotherapy group than those in the medication control group. However, there were no differences between the two groups in the frequency of fecal incontinence or the secondary outcome measures.

“Physiotherapy for the isometric training of abdominal muscles, breathing exercises and abdominal massage increased the defecation frequency after six weeks of treatment,” state the study’s authors, “but fecal incontinence remained unchanged, probably because patients had come from tertiary service and had more severe CFS of longer duration.”

The researchers conclude isometric training of the abdominal muscles, breathing exercises and abdominal massage may be used as a complementary therapy for constipated pediatric patients.


Authors: Carlos André Gomes Silva and Maria Eugênia Farias Almeida Motta.

Sources: Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal de Pernambuco. Originally published in February 2013 in Colorectal Disease.