Natural Ways to Help Constipation, Part 1 - Abdominal Massage

Constipation is a common digestive issue that affects many people worldwide so it is no wonder that people look for natural ways to help constipation. Abdominal massage can be one way that may help.

Here in Australia, constipation is reported to affect anywhere between 3 and 30 percent of the adult population depending on the study reporting. Constipation is defined by infrequent bowel movements or difficulty passing stools. While occasional constipation happens sometimes and usually resolves on its own, chronic or severe cases of constipation may require medical attention and investigation to find out if there are any potential underlying issues.

The following things may be a sign that you are constipated:

• Having fewer than 3 bowel movements each week

• Fewer bowel movements than what is considered normal for you

• Difficultly passing stool or straining to have a bowel movement

• Not passing much stool

• Not feeling fully emptied after passing stool

• Dry, hard, lumpy stools or stools like pellets

If you have been experiencing these signs for more than a week and nothing is changing despite what you try you should see your GP. This is especially the case if things are worsening, you have abdominal pain or there is blood in your stool or from your rectum.

There are many things you are able to do to help improve constipation and over the next few blogs I will discuss some natural ways that may help constipation and improve your bowel movements.

In this blog piece I will discuss the benefits of trying abdominal massage as a natural way to help constipation.

How it helps

Abdominal massage may also be known as tummy massage, belly massage, stomach massage, visceral massage and che nei tsang, which is Thai abdominal massage. There is also visceral osteopathy, also referred to as visceral manipulation, which is a form of body therapy focusing on treating the viscera (internal organs) and their associated tissues. This type of treatment can also be used to help those of you experiencing constipation.

One of the main benefits of having abdominal massage for constipation is that it helps in stimulating bowel movements. This stimulation can help to promote peristalsis, which is the wave-like movement of the intestines that propels stool and other intestinal contents forward. By enhancing peristalsis, abdominal massage can facilitate the movement of stool through the digestive tract, making it easier to pass and helping to regulate bowel movements and alleviate constipation.

When constipation is present, the accumulation of gas and bloating may also be accompanying symptoms, causing further discomfort. In addition to improving bowel movements abdominal massage may also help in reducing additional symptoms of gas and bloating.

Additionally, abdominal massage helps by relaxing and reducing tension that may be held in the abdomen. When the muscles are tense or tight, they can put pressure on the digestive organs and may restrict the normal flow of stool and also blood flow to the abdominal area. Restriction in tissues of the internal organs such as the ligaments and fascia that support them, may also contribute to sluggish and slow digestion. By releasing tension of the tissues in the abdomen, abdominal massage may help to improve the overall function of the digestive system and relieve constipation.

Another benefit of abdominal massage may be in aiding in the elimination of waste and toxins from the body. The gentle manipulation of the abdominal area helps to improve blood circulation and lymphatic drainage, which are essential for the removal of waste products from the digestive system. The lymphatic system is responsible for removing waste products and toxins from the body. Abdominal massage may help to stimulate lymphatic drainage in the abdominal area, aiding in the removal of waste materials and reducing inflammation. By enhancing these processes, abdominal massage may support the body's natural detoxification mechanisms and promote regular bowel movements.

Apart from the physical benefits, abdominal massage may also have a positive impact on your mental and emotional well-being. People often feel they hold their stress in their abdomen and having a massage treatment of the abdomen may help to induce a state of deep relaxation and help to calm the mind, reducing stress and anxiety. Stress is known to be a contributor and aggravator of digestive issues, including constipation, so relaxation induced by abdominal massage may help to alleviate these symptoms, just as a massage of the neck and shoulder can help to relive tension there. This mechanism of relaxation works by the stimulation of the vagus nerve. The vagus nerve is a cranial nerve that plays an important role in the parasympathetic nervous system (PSNS). The PSNS is responsible for promoting your rest and digest state, which is vital for the promotion of optimal digestion. Abdominal massage stimulates the vagus nerve, triggering the release of acetylcholine, a neurotransmitter that helps encourage digestion and bowel movements. By activating the vagus nerve, abdominal massage may help in regulating digestion and help to improve constipation.

What the research says

There has been research suggesting that abdominal massage may help to alleviate constipation. While these studies provide promising evidence, it's important to note that more research is needed to fully understand the benefits of abdominal massage for constipation in different populations. Future studies could explore the most optimal techniques and best duration of abdominal massage, as well as the long-term effects of regular massage on constipation symptoms. Additionally, it would be valuable to investigate the potential mechanisms by which abdominal massage is beneficial, particularly its impact on gut motility, intestinal microflora and the release of neurotransmitters involved in bowel function.

So far there have been some promising studies on the effect of abdominal massage in the older population, a group that has a high prevalence of constipation.

One of these studies was a randomised clinical trial which studied the effect of abdominal massage in elderly patients with constipation who were hospitalised with fractures (1). This study demonstrated that receiving abdominal massage for 15 minutes a day for 3 consecutive days saw a significant improvement in bowel movements compared to the control group. Another study in a similar population suggested that abdominal massage improved both age related constipation and quality of life in the intervention group compared to the control group. This study consisted of massaging the large colon 5 days a week for 10 minutes for a period of 4 weeks (2).

Opioids are known to induce constipation in a large portion of people who take them which can be frustrating for patients who need them. A study looking at the effects of abdominal massage on patients with opioid induced constipation found that abdominal massage improved constipation including the feeling of incomplete bowel emptying, the severity of straining, and the severity of anal pain (3). It also reported improvement in symptoms of bloating, stool consistency as well as an increase in the number of defecations. Quality of life was also improved. Subjects in the intervention group of the study were trained to self-administer abdominal massage 15 minutes twice a day, 30 minutes before breakfast and 30 minutes before dinner, over 4 weeks.

Two meta-analysis studies, one looking at effect of abdominal massage to manage constipation and the other looking at abdominal massage treatment for functional constipation concluded that while further research was needed the use of abdominal massage in clinical settings should be considered (4, 5). The studies evaluated in these papers suggested abdominal massage improved constipation and other related symptoms such as defecation frequency, defecation time, stool consistency, difficulty passing stool, pain, bloating, feeling of partial evacuation, and also quality of life.

In addition to helping manage constipation, another benefit which may be related to aiding in the improvement of constipation is the improvement of gut microbiome. Research over the last couple of decades has been revealing that the gut microbiome, the community of microorganisms living in our digestive system, plays a crucial role in maintaining overall health, including proper digestion. Abdominal massage may support a healthy gut microbiome by increasing blood flow to the abdominal area, which provides essential nutrients and oxygen to the gut bacteria. This in turn may promote the growth of beneficial bacteria and help to maintain a balanced microbiome. A study looking at the effects of abdominal massage on individuals with type 2 diabetes also looked at the effect on intestinal microbiota. It reported that abdominal massage improved levels of enterobacter, bifidobacteria and lactobacilli as well as glucose metabolism (6). However, this is just one study and a lot more studies are needed to look into these promising results.

In conclusion, while the available research suggests that abdominal massage may be a beneficial treatment for constipation, further investigation is required to establish its efficacy and determine the most effective approaches. Larger and longer-term studies would be beneficial to get a better understanding of how effective treatment is over long term and the mechanism of how abdominal massage and other physical therapy modalities like visceral osteopathy may help to improve digestion.

Nonetheless, abdominal massage remains a non-invasive, low-cost intervention that may offer relief to individuals suffering from constipation, particularly in conjunction with other lifestyle modifications and medical therapies.

Other considerations

Overall, abdominal massage may be a good treatment to consider as a natural way to help constipation and improve digestive health in addition to diet and lifestyle considerations. It offers numerous benefits for relieving constipation from stimulating peristalsis and increasing blood flow to relaxing the abdominal muscles and tissues of the viscera as well has helping to reduce stress. Abdominal massage can help improve digestion, and may be helpful in alleviating symptoms of constipation, and promoting overall digestive health.

If you are experiencing chronic constipation or other digestive issues and you feel physical therapy of the abdomen may be beneficial for you, it may be helpful to consult a professional massage therapist who has experience in abdominal massage or a healthcare provider like an osteopath who practices visceral osteopathy. That way you can be provided personalised guidance and techniques that are tailored to your specific needs as well as education on what you can do at home to help.

In addition to abdominal massage, it's important to maintain a healthy lifestyle and to have a healthy diet plan which is relevant to your individual needs to support regular bowel movements. Considering lifestyle factors can greatly contribute to the effectiveness of abdominal massage in relieving constipation and vice versa. A holistic approach that considers diet, exercise and stress management along with medical support where indicated is beneficial to any health issue.

When it comes to seeking professional help for constipation, there are a few key factors to consider. First and foremost, if you have a pre-existing medical condition such as inflammatory bowel disease or a gastrointestinal disorder, it is crucial to consult with a healthcare professional before attempting abdominal massage or any other form of treatment. Treatment should never be performed when you have an acute flare up of some conditions such as Crohn’s, Ulcerative Colitis or Diverticulitis. Some conditions may have specific contraindications or require particular care, and it's important to have a healthcare provider guide you in managing your constipation safely and effectively. They will be able to assess your individual situation, take into account your medical history, and provide personalised recommendations. If you are unsure if abdominal massage is suitable for you always consult your GP or health provider first.

Additionally, if your constipation is severe or persistent and does not improve with self-care measures, it is advisable to seek medical attention. This is particularly important if you experience accompanying symptoms such as abdominal pain, bloating, or changes in bowel habits. Your GP or healthcare provider can help identify the underlying cause of your constipation and determine the most appropriate treatment options for you. They may perform a physical examination, order diagnostic tests, or refer you to a specialist if necessary. A diagnosis or ruling out potential causes can be an important step to having the most appropriate management plan administered for your situation. In some cases, if constipation is caused by an underlying medical condition, for example hypothyroidism, treating the underlying condition may be necessary to alleviate constipation symptoms.

It's worth noting that seeking professional help does not necessarily mean that you will be prescribed medication or undergo invasive procedures. In many cases, healthcare providers will first recommend conservative measures such as dietary changes, increased fluid intake, and lifestyle modifications. However, if these initial interventions are not effective, your healthcare provider may discuss other treatment options with you.

Overall, abdominal massage offers many potential benefits for individuals experiencing constipation. However, it is important to note that that each individual's situation is unique and everyone's body is different; what works for one person may not necessarily work for another. It is important to have open and honest communication with your healthcare provider to ensure that you receive the most appropriate and effective treatment for your constipation.

References

1. Nouhi E, Mansour-Ghanaei R, Hojati SA, Chaboki BG. The effect of abdominal massage on the severity of constipation in elderly patients hospitalized with fractures: A randomized clinical trial. Int J Orthop Trauma Nurs. 2022 Nov;47:100936. doi: 10.1016/j.ijotn.2022.100936. Epub 2022 Feb 24. PMID: 36274468.

2. Sevil Olgun and Ismet Eser. The Effect of Abdominal Massage on Chronic Constipation and Constipation Quality of Life in Elderly: A Randomized Controlled Trial. Int. J. Caring Sci. 2022 Jan-Apr Volume 15, Issue 1 pg 316.

3. Yıldırım D, Can G, Köknel Talu G. The efficacy of abdominal massage in managing opioid-induced constipation. Eur J Oncol Nurs. 2019 Aug;41:110-119. doi: 10.1016/j.ejon.2019.05.013. Epub 2019 Jun 1. PMID: 31358243.

4. KAYIKÇI EE, KOCATEPE V, AKYÜZ F, CAN G. The Effects of Abdominal Massage on the Management of Constipation: A Systematic Review of Randomised Controlled Trials. Bezmialem Science 2020;8:311-317.

5. Gu X, Zhang L, Yuan H, Zhang M. Analysis of the efficacy of abdominal massage on functional constipation: A meta-analysis. Heliyon. 2023 Jul 7;9(7):e18098. doi: 10.1016/j.heliyon.2023.e18098. PMID: 37496907; PMCID: PMC10366436.

6. Xie Y, Huan MT, Sang JJ, Luo SS, Kong XT, Xie ZY, Zheng SH, Wei QB, Wu YC. Clinical Effect of Abdominal Massage Therapy on Blood Glucose and Intestinal Microbiota in Patients with Type 2 Diabetes. Oxid Med Cell Longev. 2022 Aug 3;2022:2286598. doi: 10.1155/2022/2286598. PMID: 35965680; PMCID: PMC9365616.