Abdominal Massage
Discussion
Ayas and colleagues (2006) reported on people with SCI who received at least 15 minutes of abdominal massage beginning at the cecum and extending along the length of the colon to the rectum during their regular bowel routine. Differences were found in the frequency of defecation and mean colonic transit time between phase I, when participants participated in a standard bowel program in which they received a standard diet containing 15-20 g of fiber/day and underwent daily digital stimulation, and phase II, when the participants continued to receive this standard care and had the addition of abdominal massage when attempting bowel evacuation. However, these differences were statistically insignificant, possibly due to a small and heterogeneous sample. In the study by Hu et al. (2013), manual therapy was applied to the intestine and along the colon. A statistically significant improvement was seen in the mean time of bowel movements as well as dosage of glycerine enema needed. The sample in this study was also very small but was homogenous. Janssen et al. (2014) studied the use of electromechanical massage applied to the transverse colon in a heterogeneous group of 21 individuals with SCI and self-reported neurogenic bowel dysfunction. The device was used daily for 20 minutes by six participants, every other day by nine participants and less frequently by the rest and was used at a separate time from the bowel care routine in all participants. Four participants (19%) did not complete the study due to pain or unwanted change in stool consistency precipitated by the device. Despite some positive change in some aspects of bowel function for some patients (time to result in 6, consistency in 2, amount in 3), none of the fifteen participants who completed the trial reported feeling better or more confident about their bowel function. Further suitably powered studies are required in the SCI population to determine the effectiveness of manual abdominal massage as an intervention for neurogenic bowel dysfunction. It is less clear that further studies on asynchronous electromechanical massage of limited parts of the colon are warranted.
One pilot study investigated the use of osteopathic manipulative treatment on abdominal regions of the body and its effect on NBD after SCI (Tamburella et al. 2022). Though this study was small, they found statistically significant differences in the osteo group vs. the control group in visual analogue scale scores on sense of constipation and swelling.
Conclusion
There is level 4 evidence (from one pre-post study; Ayas et al. 2006) that abdominal massage is ineffective for treating the neurogenic bowel.
There is conflicting level 4 evidence (from one pre-post study; Hu et al. 2013) that abdominal massage is effective in reducing bowel movement time as well as dosage of glycerine enemas.
There is level 4 evidence (from one pre-post study; Janssen et al. 2014) that electromechanical massage of the transverse colon is ineffective for treating the neurogenic bowel.
