Physiotherapy aids defecation in constipated children

By Lucy Piper, Senior medwireNews Reporter

Physiotherapy may be an effective complementary therapy to laxatives for treating constipation in children, research indicates.

The findings showed that the combined use of isometric training of abdominal muscles, breathing exercises, and abdominal massage increased defecation frequency in children with chronic constipation aged 4-18 years, although it had no effect on fecal incontinence.

"The use of a combination of exercises that stimulate and relax the abdominal muscles that indirectly act on the pelvic floor, in coordination with diaphragmatic breathing, may trigger contraction of the intestinal and rectal muscles and bring relief to patients with CFC [chronic functional constipation]," the team led by Maria Eugênia Motta (Universidade Federal de Pernambuco, Recife, Brazil) explains.

They add that physiotherapy for training intestinal function is likely to have mechanical effects by stimulating colonic movements and increasing fecal propulsion and abdominal muscle tone, as well as neurological effects through stimulation of the parasympathetic nervous system, which increases motility and stimulation of the sympathetic nervous system, reducing anxiety and increasing endogenous serotonin to relieve discomfort.

Indeed, such therapy administered in combination with regular laxative therapy resulted in a significantly higher frequency of bowel movements in 36 children, at 5.1 days/week versus 3.9 days/weeks for 36 similarly aged children taking laxatives only. Physiotherapy was administered during 12 sessions, which were held twice a week with each lasting 40 minutes.

The frequency of fecal incontinence was similar between the two groups, however, at 3.6 days/week and 3.0 days/week, respectively. The researchers say in Colorectal Disease that this is "probably because patients had come from tertiary services and had more severe CFC of longer duration."

They point out, however, that if bowel frequency increases, other bowel habit parameters "tend to improve gradually as well."

Motta and team also note that physiotherapy increased treatment adherence. Of the 72 children enrolled in the study, two in the physiotherapy group and eight in the laxatives group were not fully compliant during the 6 weeks of treatment.

They conclude that "physiotherapy may be used as a complementary therapy for constipated pediatric patients," and believe that it may further benefit children by making them less prone to the condition as adults.

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