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Bowel Dysfunction and Management

Abdominal Massage

Discussion

Ayas and colleagues (2006) reported on individuals 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 subjects 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 subjects 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 meantime of bowel movement as well as dosage of glycerine enema needed. The sample in this study was also very small but was homogenous. Further suitably powered studies are required in the SCI population to determine the effectiveness of abdominal massage as an intervention for neurogenic bowel dysfunction.

Conclusion

There is level 4 evidence (from one pre-post study; N=24) (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; N=20) (Hu et al. 2013) that abdominal massage is effective in reducing bowel movement time as well as dosage of glycerine enemas.

Author Year

Country

Score

Research Design

Total Sample Size

Methods Outcome
Hu et al., 2013;

China

Pre-post

N=20

Population: Thoracic SCI (13M, 7F); Mean (SD) age: 39.70 (5.25) yrs.

Treatment: Abominal massage was applied to the surface of the abdomen along the small intestine, the ascending, transverse, descending and sigmoid colon, for 60 sessions during the bowel routine (5 times/wk for 12 wks).

Outcome Measures: Bowel time, dosage of glycerine enema.

 

  1. A statistically significant improvement was found in the mean(SD) time of bowel movement (decreased from 94.0 (16.4) min to 60.5 (10.5) minutes) and dosage of glycerine enema (decreased from 68.15 (8.9) mL to 31.5 (11.8) mL) after abdominal massage treatment for 3 months.
Ayas et al., 2006; Turkey

Pre-post

N=24

Population: Age: mean 39.8yrs, range 33.1-46.6yrs; Level of injury: C4-L3, 10 participants with supraconal lesions, 14 with caudal/conal lesions; 15 with complete SCI and 9 with incomplete SCI; FIM score: mean 76.3, range 68.9-83.7; Duration of injury: mean 136.5 days, range 70.1-203

Treatment: Addition of abdominal massage beginning at the cecum and extending along the length of the colon to the rectum (phase II) to a standard bowel program (phase I)

Outcome Measures: Colonic transit times, frequency of defecation

  1. Mean (SD) frequency of defecation significantly increased from 3.79(2.15) (range 2.75-4.55) to 4.61(2.17) (range 3.67-5.54) per week.
  2. Mean (SD) total colonic transit time significantly decreased from 90.60(32.67) (range 75.87-110.47) hours to 72(34.10) (range 58.49-94.40) hours with abdominal massage.
Janssen et al., 2014; The Netherlands

Post-test

N=21

Population: N=21 (18M, 3F) with cervical SCI (N=15 completed study)

Mean (SD, range) age 56.5 (11, 38-79) years

Mean (SD) time since injury 221 (146) months

AIS-A/B/C-D: 8/2/11

13 tetraplegia, 8 paraplegia

8 complete, 13 incomplete

Treatment: Daily electromechanical abdominal massage for 20min for 10 weeks

Outcome Measures: Questionnaire on defecation, side effects, and user satisfaction.

  1. Fecal consistency: 13/15 reported no change, 2/15 reported softer consistency
  2. Fecal shape: 14/15 reported no change, 1/15 reported sausage-shaped
  3. Fecal amount: 8/15 reported no change, 3/15 reported increase, 1/15 reported decrease, 3/15 reported variable
  4. Time to defecation: 6/15 reported no change, 6/15 reported shorter, 3/15 reported variable
  5. Fecal incontinence: all reported no change
  6. Flatulence: 12/15 reported no change, 2/15 reported fewer, 1/15 reported more
  7. Overall treatment evaluation: 2/15 reported very good, 2/15 reported good, 4/15 reported adequate, 7/15 reported insufficient
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