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The Somatic Connection  |   October 2015
Bodywork Shown to Reduce the Symptoms of Chronic Constipation and Improve Quality of Life
Author Notes
  • University of California, San Diego School of Medicine 
Article Information
The Somatic Connection   |   October 2015
Bodywork Shown to Reduce the Symptoms of Chronic Constipation and Improve Quality of Life
The Journal of the American Osteopathic Association, October 2015, Vol. 115, 630-631. doi:10.7556/jaoa.2015.130
The Journal of the American Osteopathic Association, October 2015, Vol. 115, 630-631. doi:10.7556/jaoa.2015.130
Gürsen C, Kerem Günel M, Kaya S, Kav T, Akbayrak T. Effects of connective tissue manipulation on symptoms and quality of life in patients with chronic constipation: a randomized controlled trial [published online June 20, 2015]. J Manipulative Physiol Ther. 2015;38(5):335-343. doi:10.1016/j.jmpt.2015.06.003. 
Turkish physical therapy researchers used a bodywork modality called connective tissue manipulation (CTM) in a randomized controlled trial on patients with chronic constipation. Researchers used Rome III criteria for chronic constipation to identify 50 patients and randomly assign them to the intervention group (n=25) or to the control group (n=25). Patients in the intervention group received CTM and lifestyle advice (eg, increase fiber and water intake, increase exercise, take as necessary laxative and stool softeners), and patients in the control group received lifestyle advice. The Rome III criteria include at least 2 of 6 symptoms, such as having 3 or fewer bowel movements per week, straining during at least 25% of bowel movements, passing lumpy and hard stool in at least 25% of bowel movements, and experiencing incomplete evacuation at least 25% of the time. 
Exclusion criteria were comorbid neurologic, anatomic, or metabolic condition; pregnancy; mental problems; history of colostomy surgery; history of gastrointestinal, spinal, or pelvic surgery except cholecystectomy, appendectomy or hysterectomy; history of bowel obstruction, perforation, or bleeding; or intestinal cancer. 
The CTM protocol was based on the work of Holey1 and was applied 5 days per week for 4 weeks by the same physiotherapist. The physiotherapist applied CTM to patients in a sitting position with cross-tissue engagement across prescribed areas of the sacrum, axial skeleton, ribs, and scapulae. To my knowledge, this CTM protocol is similar to deep tissue myofascial release and patrissage. According to Holey,1 this protocol addresses important reflex areas roughly equivalent to somatovisceral interactions as formulated by Korr.2 Gürsen and colleagues reported that CTM potentially reduces sympathetic activity and increases parasympathetic activity, which improves circulation, thus “promoting the healing process.” 
The primary outcome was measured using the Constipation Severity Instrument, and secondary outcomes were measured using the Patient Assessment of Constipation Quality of Life Questionnaire and Bristol Stool Scale. At baseline, there were essentially no differences between the groups on demographics or outcome measures. 
The results revealed statistically significant improvement for the intervention group in overall Constipation Severity Instrument score (P<.001), less colonic inertia (P=.002), improved bowel movement frequency (P=.002), shorter bowel movement time (P=.004), Bristol Stool Scale softer stools (P=.005), and improvements in Patient Assessment of Constipation Quality of Life Questionnaire in all dimensions (P<.001). Limitations were no blinding and use of 1 physiotherapist. 
This article shows the benefit of manual therapy for patients with a systemic disorder and confirms my clinical experience in treating patients with irritable bowel syndrome and constipation, which has also shown benefit for bowel functions. Also, the proposed mechanism of action, based on osteopathic theory, in all likelihood also accounts for the benefit of osteopathic manipulative treatment observed in patients with postoperative ileus.2-4 
References
Holey EA. Connective tissue massage: a bridge between complementary and orthodox approaches. J Bodyw Mov Ther. 2000; 4(1): 72-80. doi:10.1054/jbmt.1999.0125. [CrossRef]
Korr IM. The Collected Papers of Irwin Korr. Colorado Springs, CO: American Academy of Osteopathy, 1979.
Crow WT, Gorodinsky L. Does osteopathic manipulative treatment (OMT) improves outcomes in patients who develop postoperative ileus: a retrospective review. Intern J Osteopath Med. 2009; 12(1): 32-37. doi:10.1016/j.ijosm.2008.03.004. [CrossRef]
Baltazar GA, Betler MP, Akella K, Khatri R, Asaro R, Chendrasekhar A. Effect of osteopathic manipulative treatment on incidence of postoperative ileus and hospital stay in general surgery. J Am Osteopath Assoc. 2013; 113(3): 204-209. [PubMed]