Does Bowel Massage Really Work?

Abdominal massage, an age-old remedy for slow bowel, became a tool we reached for less in recent decades. Was it due to the advent of passive interventions such as pharmaceutical laxatives? I don’t know, but I do know constipation can weigh you down physically, emotionally and even financially. Can you believe Americans spend about 725 million dollars on laxatives each year?! (Higgins, 2004). But, drugs don’t always get to the root cause of the problem and may have undesirable side effects; for example, long-term laxative use can cause dependency over time, worsening constipation, and even lead to bowel impaction. Performing abdominal massage to yourself has been shown to relieve constipation and abdominal pain in comparison to laxative use alone and without any adverse side effects (Lamas et al, 2009). Bowel massage is a conservative self-remedy that is making a come back and proving in the research to be a valid tool for improving bowel health.

Who is bowel massage effective for?

The research has shown that bowel massage is helpful for people with neurological disorders such as spinal cord injury and multiple sclerosis, after surgery, in cancer patients taking opiates, in elderly and palliative care patients. More research is needed on the effectiveness of bowel massage on populations of people with thyroid conditions and hormonal imbalances, however…unless impacted, why not give it a try? In Ayas’ 2006 study, bowel massage decreased colon transit time in people with spinal cord injury and increased bowel movements per week. A 2010 study involving multiple sclerosis patients showed that teaching bowel massage in addition to education regarding toileting posture, adequate fluid intake, and the importance of diet and exercise, was superior to the latter interventions alone. In addition to relieving constipation in MS patients, these interventions softened stool and decreased toileting time (McClurg et al, 2010). Bowel massage can even stimulate peristalsis (movement of stool within the large intestine) in patients with post-surgical ileus (Sinclair, 2010).

How do you perform a bowel massage?

There are variations in bowel massage technique and occasionally the anatomical track of the large intestine. I have put together a video of how I coach my patients in bowel massage.

Typically I tell my clients to perform this technique around the time of their usual BM (for example, after waking or prior to eating lunch). Although I do not recommend the use of essential oils to my patients (contraindications can be vague and occasional adverse side effects are possible), I thought it was interesting that a study by Kim in 2005 showed abdominal massage using essential oils with rosemary, lemon, and peppermint increased the frequency of bowel movements with massage and improved the length of time the massage was effective after cessation (Kim also notes that constipation is generally decreased for 7-10 days after stopping bowel massage). There is variability in the length of time that a bowel massage must be performed on consecutive days; some studies showing results in as few as 1 week and others 8.

How does it work?

Bowel massage is likely effective via stimulation and relaxation (Sinclair, 2010).

Stimulation

Massage is stimulating to the smooth muscle within the intestinal tract and promotes peristalsis or waves of contraction that propel stool towards the anus (like I said it’s like moving game pieces on a playing board towards the finish line). Compressing and releasing pressure along the intestine active stretch receptors that reinforce defecation reflexes and rectal contraction (Brookes et al., 2004). Bowel massage can also help ease abdominal pain reducing trigger points within the intestinal muscles! Inflating balloons within the espophagus, small intestine and colon have been shown to reproduce abdominal pain. Abdominal massage can relieve abdominal discomfort and likely due to stimulation and relaxation of the connective tissue in these areas.

Relaxation

The vagus nerve innervates the digestive system. Self-massage induces a parasympathetic state which promotes digestive reflexes and peristalsis (or movement of bowel within the large intestine) (Liu et al., 2005). Stimulating the parasympathetic nervous system will decrease abdominal muscle tension, increasing motility of smooth muscle in the large intestine, increase digestive secretions, and relax sphincters in the digestive tract.

Below I have linked some patient handouts for techniques to relieve constipation naturally.

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- Article written by Susannah Haarmann, PT, WCS, CLT

Susannah is a board-certified Women's Clinical Specialist by the American Physical Therapy Association. She is a private practice owner in Asheville, North Carolina and teaches internationally in pelvic health and breast oncology rehabilitation. Susannah is an advocate of conservative treatment for pelvic health conditions and writes books and courses on pelvic health and breast cancer rehabilitation.

References:

Ayaş, Ş., Leblebici, B., Sözay, S., Bayramoğlu, M., Niron, E.A., The Effect of Abdominal Massage on Bowel Function in Patients with Spinal Cord Injury. American Journal of Physical Medicine & Rehabilitation. 2006; 85(12): 951-955.

Ernst E, Abdominal Massage Therapy for Chronic Constipation: A Systematic Review of Controlled Clinical Trials. 1999;6:149-151

Higgins, P.D., 2004. Epidemiology of constipation in North America: a systematic review. Am Journal of Gastroenterology 99 (4), 750e759.

Kim, M.A., et al., Feb 2005. Effect of aromatherapy massage for the relief of constipation in the elderly. Taehan Kanho Hakhoe Chi 35 (1), 56e64.

Lamas, K., Lindholm, L., Stenlung, H., Engstrom, B., Jacobsson, C., Effects of abdominal massage in management of constipation—A randomized controlled trial. Intl J of Nursing Studies. 2009; 46 (6): 759-767.

McClurg, D., Hagen, S., Hawkins, S., Lowe-Strong, A., Abdominal massage for the alleviation of constipation symptoms in people with multiple sclerosis: a randomized controlled feasibility study. Multiple Sclerosis Journal. 2010; Vol 17, Issue 2, pp. 223 - 233.  

Sincalir, M., The use of abdominal massage to treat chronic constipation. J of Bodywork and Movement Therapies. 2010; 1-10.