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.
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.
Total Sample Size
|Hu et al., 2013;
|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.
|Ayas et al., 2006; Turkey
|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
|Janssen et al., 2014; The Netherlands
|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
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.