Chronic Constipation

Effectiveness of abdominal massage on chronic constipation in adults: A systematic review and meta-analysis.

Huang SY, Chiao CY, Chien LY · International journal of nursing studies · 2025 · n=1431

Chronic constipation is a common distressing symptom. Abdominal massage is a safe, noninvasive, and comfortable intervention. However, it is rarely used in formal clinical practice as its' effectiveness for chronic constipation remains unclear. This systematic review aimed to investigate the effectiveness of abdominal massage on defecation frequency, stool consistency, colonic transit time, constipation symptoms, quality of life, laxative use, and adverse events in adults. Additionally, we aimed to compare the effectiveness of abdominal massage in chronic constipation with different etiologies and types of abdominal massage techniques. Data from eight English and Chinese electronic databases until May 15, 2024, including randomized controlled trials (RCT) and quasi-experimental studies, were used. The risk of bias was assessed using the Cochrane risk-of-bias tool. Results were synthesized using a random-effect model. This study was registered on the 7th of January 2023 to the Interna

Network meta-analysis of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults.

Deng X, Liang C, Zhou L, Shang X, Hui X, Hou L · European journal of nutrition · 2024 · n=903

To compare the outcomes associated with the use of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults. We searched eight electronic databases from database inception to July 11, 2023, to identify randomized controlled trials (RCTs) that report efficacy and safety for the treatment of chronic constipation. The risk of bias in the included RCTs was evaluated according to the Cochrane tool, and the certainty of the evidence was assessed using the Confidence in Network Meta-Analysis framework. The analysis was conducted using R version 4.3.0. Out of the 37 RCTs, a total of 21 different types of interventions were reported, involving 3,903 patients. This NMA demonstrated that both prebiotics and synbiotics resulted in an increase in frequency of stool movements per week. Compared to placebo, lactulose (Mean difference [MD] = 3.39, 95% Confdence interval [CI] [1.13, 5.65], moderate certainty), mix2 (consisting of Lactulose and Bacillus

Comparative profiles of lubiprostone, linaclotide, and elobixibat for chronic constipation: a systematic literature review with meta-analysis and number needed to treat/harm.

Rao SS, Manabe N, Karasawa Y, Hasebe Y, Nozawa K, Nakajima A · BMC gastroenterology · 2024

To comprehensively evaluate the efficacy, safety, patient symptoms, and quality-of-life (QoL) of lubiprostone, linaclotide, and elobixibat as treatment for chronic constipation (CC). Systematic literature review (SLR) and meta-analysis (MA). Literature searches were conducted on PubMed and Embase using the Ovid platform. SLR including randomized controlled trials (RCTs) and observational studies was conducted to identify the overall efficacy and safety of lubiprostone, linaclotide, and elobixibat. Thereafter, MA was performed using only RCTs. The number needed to treat (NNT) and number needed to harm (NNH) analyses were additionally conducted. The primary outcome was efficacy regarding change in spontaneous bowel movements. Secondary outcomes included safety, constipation-related symptoms, and QoL. Twenty-four studies met the inclusion criteria for the SLR: 17 RCTs, 4 observational studies, and 3 single-arm trials. Feasibility assessment for the MA resulted in 14 studies available

Efficacy and Safety of Over-the-Counter Therapies for Chronic Constipation: An Updated Systematic Review.

Rao SSC, Brenner DM · The American journal of gastroenterology · 2021

Constipation is commonly treated with over-the-counter (OTC) products whose efficacy and safety remain unclear. We performed a systematic review of OTC therapies for chronic constipation and provide evidence-based recommendations. We searched PubMed and Embase for randomized controlled trials of ≥4-week duration that evaluated OTC preparations between 2004 and 2020. Studies were scored using the US Preventive Services Task Force criteria (0-5 scale) including randomization, blinding, and withdrawals. The strengths of evidence were adjudicated within each therapeutic category, and recommendations were graded (A, B, C, D, and I) based on the level of evidence (level I, good; II, fair; or III, poor). Of 1,297 studies identified, 41 met the inclusion criteria. There was good evidence (grade A recommendation) for the use of the osmotic laxative polyethylene glycol (PEG) and the stimulant senna; moderate evidence (grade B) for psyllium, SupraFiber, magnesium salts, stimulants (bisac

Chronic constipation: A review of literature.

Forootan M, Bagheri N, Darvishi M · Medicine · 2018

Chronic constipation is described as a common complication determined by difficult and/or rare passage of stool or both. The difference in definition of constipation has led to a wide range of reported prevalence (i.e., between 1% and 80%). Various factors are involved in the pathogenesis of the disease, including type of diet, genetic predisposition, colonic motility, absorption, social economic status, daily behaviors, and biological and pharmaceutical factors. Diagnostic and therapeutic options play a key role in the treatment of chronic constipation. There are still debates about the timing of these diagnostic and therapeutic algorithms. A systematic and comprehensive search will be performed using MEDLINE, PubMed, EMBASE, AMED, the Cochrane Library and Google Scholar. Better understanding of the pathophysiology of chronic constipation and efficacy of pharmacological agent can help physicians for treating and managing symptoms.In this study, some of the old and new therapies in th

Constipation in children: fibre and probiotics.

Tabbers MM, Benninga MA · BMJ clinical evidence · 2015

Prevalence of childhood constipation has been estimated at 1% to 30% in the general population worldwide; most children have no obvious aetiological factors. One third of children with chronic constipation continue to have problems beyond puberty. Half of the children with chronic faecal impaction and faecal incontinence have experienced an episode of painful defecation, and many children with chronic constipation exhibit withholding behaviour. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of fibre for children with chronic constipation? What are the effects of probiotics for children with chronic constipation? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administrati

AGA Clinical Practice Update on Evaluation and Management of Refractory Constipation: Expert Review.

Staller K, Neshatian L, Lembo A, Bharucha AE · Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026

Although most patients with chronic constipation respond to medical therapy, a subset experiences refractory constipation (RC), which poses unique diagnostic and therapeutic challenges. Because RC is relatively rare, clinicians should systematically (1) exclude correctable secondary causes such as medications, neurologic disorders, and defecatory disorders (DDs); (2) confirm the presence of slow colonic transit; and (3) ensure that patients have undergone adequate trials of over-the-counter and Food and Drug Administration-approved medications and nonpharmacologic therapies, including combinations thereof. Surgical treatments, such as colectomy, may be considered in patients who fail available treatments. However, surgical treatment of chronic constipation is associated with increased risk of complications and a not insignificant number of unsatisfactory outcomes. Prior to advising surgery, it is essential to confirm slow colonic transit, exclude concurrent DDs, and evaluate for severe

Mexican consensus on the diagnosis and treatment of constipation in the pediatric population.

Figueroa-Salazar R, Ruíz-Castillo MA, Toro-Monjaraz EM, Casas-Guzik L, Peña-Vélez R, Bacarreza-Nogales DV · Revista de gastroenterologia de Mexico (English) · 2025

Chronic constipation is a common condition seen in pediatrics. In recent years, new diagnostic and treatment measures have been applied, motivating the Asociación Mexicana de Gastroenterología to bring together a panel of national and international experts, for the aim of unifying concepts, providing recommendations on the use of complementary studies, and proposing the most appropriate treatment. A systematic search of the literature in English and Spanish was carried out for each statement formulated, utilizing Medline/PubMed, Cochrane Database, EMBASE (Ovid), and LILACS. The Delphi method was used for developing the consensus. Ten questions and 43 statements were discussed, establishing a recommendation grade and evaluating the quality of evidence. Different concepts, diagnostic methods, and pharmacologic and surgical therapeutic measures were discussed, and following three voting rounds, the recommendations based on current clinical evidence were established.

British Dietetic Association Guidelines for the Dietary Management of Chronic Constipation in Adults.

Dimidi E, van der Schoot A, Barrett K, Farmer AD, Lomer MC, Scott SM · Neurogastroenterology and motility · 2025

Current clinical guidelines for chronic constipation offer limited dietary recommendations. The aim of this project was to develop the first comprehensive evidence-based dietary guidelines for the management of chronic constipation in adults. Four systematic reviews and meta-analyses were performed to identify eligible randomized controlled trials (RCTs). The findings generated from the meta-analyses were then used to develop guideline statements using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and a Delphi consensus survey among a multidisciplinary expert Guideline Steering Committee. Recommendation statements were produced for treatment response, stool output, gut symptoms, adverse events, and quality of life, and only based on the findings where ≥ 2 RCTs contributed to the meta-analysis. The strength of recommendation was assessed using the GRADE approach. Consensus voting among the Guideline Steering Committee was performe

Efficacy of a postbiotic and its components in promoting colonic transit and alleviating chronic constipation in humans and mice.

Ma T, Li Y, Yang N, Wang H, Shi X, Liu Y · Cell reports. Medicine · 2025 · n=110

This study evaluates the efficacy of the postbiotic Probio-Eco in alleviating constipation in humans and mice. A randomized, double-blind, placebo-controlled crossover trial involving 110 adults with chronic constipation (Rome IV criteria) demonstrates that a 3-week Probio-Eco intervention significantly improves constipation symptoms, stool straining, and worry scores. Gut microbiota and metabolomic analyses reveal modulations in specific gut microbiota, succinate, tryptophan derivatives, deoxycholate, propionate, butyrate, and cortisol, correlating with symptom relief. A loperamide-induced mouse model confirms that Probio-Eco and its bioactive components (succinate, 3-indoleacrylic acid, and 5-hydroxytryptophan) alleviate constipation by stimulating mucin-2 secretion, regulating intestinal transport hormones, and promoting anti-inflammatory responses. Multi-omics integration identifies key pathways, including succinate-short-chain fatty acid, tryptophan-5-hydroxytryptophan-serotonin,

Effects of Transcutaneous Auricular Vagal Nerve Stimulation on Chronic Constipation: A Multicenter, Randomized Controlled Study.

Liu T, Wang Z, Li Y, Kang X, Wang X, Ren G · United European gastroenterology journal · 2025 · n=106

The objective of this study was to investigate the efficacy of transcutaneous auricular vagal nerve stimulation (taVNS) in adult patients with chronic constipation. Consecutive patients who met the Rome IV criteria for chronic constipation were enrolled and randomly assigned to either the taVNS group or the sham-taVNS group. Treatment consisted of 30 min of therapy twice a day for 4 weeks. The primary outcome was the response rate at week 1-4, defined as the proportion of patients with a weekly complete spontaneous bowel movement (CSBM) of ≥ 3 and weekly excessive use of rescue medication ≤ 3 times. Secondary outcomes included spontaneous bowel movements, anxiety and depression scores, abdominal symptoms, and adverse events. The study was terminated due to lack of efficacy revealed by the interim analysis. A total of 106 patients were randomized, with 52 participants in the taVNS group and 54 participants in the sham-taVNS group. After 4 weeks o

Supervised exercise and pelvic floor muscle training eases current pelvic and genital pain but not worst pelvic and genital pain in women with endometriosis: a randomised trial.

Gabrielsen R, Tellum T, Bø K, Engh ME, Frawley H, Nedregård Tveito S · Journal of physiotherapy · 2025 · n=41

How much does adding supervised group and independent individual exercise including pelvic floor muscle training (PFMT) to multidisciplinary pain management affect pelvic and genital pain in women with endometriosis? How much does it affect dyspareunia, dysuria, quality of life (with emphasis on psychological distress, including symptoms of depression and anxiety), symptoms of chronic constipation and pelvic floor muscle (PFM) function? A two-armed, parallel-group, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes. Women aged 18 to 45 years with laparoscopically confirmed endometriosis experiencing pelvic/genital pain. All participants attended a pain management course. The exercise group (n = 41) then performed weekly supervised general exercise training including PFMT for 4 months, and home training two to three times/week. The control group (n = 40) received no further intervention. Primary outcomes were th

Vesicoureteral Reflux.

Leslie SW, Aeddula NR · 2026

Management of Chronic Constipation: A Comprehensive Review.

Hojo M, Shibuya T, Nagahara A · Internal medicine (Tokyo, Japan) · 2025

Traditionally, the treatment of chronic constipation has focused on lifestyle modification, dietary guidance and therapy, and osmotic and stimulant laxatives. Recently, several drugs with new mechanisms of action have been introduced as treatments for chronic constipation. In Japan, polyethylene glycol and lactulose can now be administered under insurance coverage. The number of treatment options for constipation has increased dramatically. First, lifestyle modifications and dietary therapies must be implemented. If constipation does not improve sufficiently, specialized functional tests are performed to diagnose physiological subgroups. If functional tests are not available, patients are classified as having the "decreased frequency of defecation" type or the "difficult defecation" type based on the patient's symptoms, with treatment applied according to each type. Medical therapy includes osmotic laxatives, secretagogues, bile acid transporter inhibitors, probiotics, prokinetics, and

Dietary management of chronic constipation: a review of evidence-based strategies and clinical guidelines.

Dimidi E · The Proceedings of the Nutrition Society · 2025

This review comprehensively examines the current evidence on the dietary management of chronic constipation, and the dietary recommendations presented in clinical guidelines for chronic constipation. Several randomised controlled trials (RCT) have investigated the effect of dietary supplements, foods and drinks in chronic constipation. Systematic reviews and meta-analyses of these RCTs have demonstrated that psyllium supplements, specific probiotic supplements, magnesium oxide supplements, kiwifruits, prunes, rye bread and high mineral water content may be effective in the management of constipation. However, despite the plethora of evidence, current clinical guidelines only offer a limited number of dietary recommendations. The most commonly recommended dietary strategy in clinical guidelines is dietary fibre, followed by senna supplements and psyllium supplements. The least commonly recommended dietary strategies are magnesium oxide, Chinese herbal supplements, prunes and high minera

Constipation

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Part of the National Institutes of Health, NIDDK offers detailed, easy-to-understand information about constipation for the general public. It covers causes, symptoms, diagnosis, and treatment options for both acute and chronic constipation.

Effects of Abdominal Massage With TENS on Para Sacral Versus Sacral Area on Symptom Severity and Quality of Life in Severe Chronic Constipation Among Young Females

n=26 · NCT06303011 · COMPLETED · COMPLETED

Constipation is Infrequent or difficult evacuation of FECES. These symptoms are associated with a variety of causes, including low DIETARY FIBER intake, emotional or nervous disturbances, systemic and structural disorders, drug-induced aggravation, and infections. Patients complaining of constipation may mean different things by the term The frequency of their bowel actions may be less than 'normal', their stools maybe difficult to pass, or they may have a sense of malaise or abdominal discomfort which they attribute to a 'sluggish bowel', though the stool frequency and consistency are apparently normal. Objective of this study is to compare effects of Abdominal massage. withTENSonparasacralversussacralareaonsymptomseverityandqualityoflifein severechronicconstipationamongyoungfemales.

The Safety and Efficacy of Fecal Microbiota Transplantation Combined With Nutritional Intervention in the Treatment of Functional Constipation：a Pilot Study

n=5 · NCT07387952 · RECRUITING · RECRUITING

Chronic constipation is a common gastrointestinal disease with a global prevalence of about 15%, significantly affecting daily life and quality of life. Traditional treatments primarily rely on laxatives, which may lead to adverse effects with prolonged use, while surgical interventions have limited patient acceptance. Recent studies indicate that gut microbiota therapies-including probiotics, prebiotics, synbiotics, postbiotics, and fecal microbiota transplantation (FMT)-can effectively manage chronic constipation. This study aims to investigate the safety and efficacy of FMT combined with a prebiotic nutritional intervention (using a co-localization strategy) in the treatment of functional constipation. Additionally, the investigators will explore changes in fecal microbiota and metabolomic profiles following the treatment.

Efficacy of Combined Interferential Therapy and Electronic Cupping Therapy for Chronic Constipation Management

n=110 · NCT06611852 · ACTIVE_NOT_RECRUITING · ACTIVE_NOT_RECRUITING

Constipation is a common gastrointestinal issue affecting individuals worldwide. Interferential therapy, a form of electrotherapy, has been suggested to have potential benefits in improving gastrointestinal motility and relieving constipation symptoms. Introducing of a new method like electronic cupping therapy with interferential therapy may optimize the therapeutic outcomes by potentially increasing bowel movements and improving overall gastrointestinal function.

TRIP Database- search: chronic constipation

TRIP Database

TRIP is a clinical search engine designed to allow users to quickly and easily find high-quality research evidence to support their practice. A search for 'chronic constipation' yields relevant guidelines, systematic reviews, and primary research.

Cochrane colorectal cancer screening group publications (search 'constipation')

Cochrane

The Cochrane Library provides systematic reviews and meta-analyses on various medical topics, including interventions for constipation. It is a leading source for evidence-based healthcare information.