Chronic constipation, which has become a common public health problem worldwide, is characterized by a variety of symptoms including hard stools, excessive straining, infrequent bowel movements, bloating and abdominal pain (1). In the treatment of chronic constipation, various treatment modalities such as pharmacological and non-pharmacological approaches are used to restore normal bowel function. In recent years, non-pharmacological approaches such as lifestyle recommendations, abdominal massage, kinesio taping, physiotherapy and herbal medicine have attracted the attention of individuals with chronic constipation. Lifestyle recommendations, including diet, fluid intake, correct defecation position, weight control, and physical activity arrangement, are often used as the initial treatment in individuals with chronic constipation. Abdominal massage increases the mobility of the colon and shortens the transit time of stool through the colon, reducing the symptoms of constipation and increasing the quality of life (QoL) (2). Kinesio taping can be used to stimulate muscle activity, reduce pain, provide proprioceptive feedback, activate the skin-organ reflex, and increase lymph and blood flow (3). To our knowledge, there was no study, comparing the effects of abdominal massage and kinesio taping in the treatment of chronic constipation. The aim of this study was to compare the effects of abdominal massage and kinesio taping on constipation severity, QoL, and perception of subjective improvement in women with constipation.

This original randomized-controlled study was conducted between June 2022 and December 2022. Women with chronic constipation according to Rome IV diagnostic criteria were included. Exclusion criteria were being pregnant, having concomitant colon or gastrointestinal problem, a body mass index of >35 kg/m2, neurological, metabolic and/or malignant disease, open wound, mental problems that prevent cooperation, being allergic to taping, taken laxative treatment at least 4 weeks before participating in the study, received physiotherapy and rehabilitation program related to constipation in the last 1 year. Women were randomly divided into 3 groups: lifestyle recommendations+abdominal massage (massage group), lifestyle recommendations+kinesio taping (taping group), and lifestyle recommendations (control group). Lifestyle recommendations for women with chronic constipation complaints include a regular diet by increasing the consumption of fibrous food, not neglecting the breakfast meal, increasing fluid intake, regular walking and abdominal exercises, and correct toilet habits. The abdominal massage consisted of abdominal stroking, colon stroking, and colon kneading. Kinesio taping, applied according to Kenzo Kase's taping method, was performed using three I-shaped Kinesio tapes (Kinesio Tex® Gold) with a width of 5 cm and a thickness of 0.5 mm. Abdominal massage and kinesio taping were applied 3 days per week for 4 weeks.

Constipation severity with the Constipation Severity Instrument (CSI), bowel function with bowel diary, QoL with the Patient Assessment of Constipation QoL Questionnaire (PAC-QOL) were evaluated at pre and post-intervention. Only perception of subjective improvement with 4-item Likert-type were evaluated at post-intervention.

Sample size was calculated with the G*Power. Effect size was calculated as 0.546 for the CSI using the data of the pilot study. In the study, with alfa=0.05 type I error, beta=0.10 type II error rates for %90 power; it was determined that there should be a total of 51 samples.  The sample size was expanded by 20% to account for potential data losses, and 64 participants were determined to be adequate.

One-way ANOVA was used for normally distributed variables and Kruskal Wallis test was used for non-normally distributed variables in the comparison of groups (control group, massage group, and taping group) pre and post-intervention. Bonferroni method was preferred for pairwise comparison (post hoc) of groups with significant differences. For each group, the Dependent Sample t-test was used for normally distributed variables and the Wicoxon test was used for non-normally distributed variables in the comparison of the measurement values obtained before and after the application. For statistical analysis IBM SPSS Statistics 21.0 was used and statistical significance level was accepted as p<0.05.

A total of 66 women with chronic constipation (age: 33.55±9.86, years, BMI: 25.25± 3.72 kg/m2) were included in this study. Demographic, physical and medical characteristics of the groups were similar (p>0.05). No side effects were observed in any of the women during the applications.

Significant improvements were seen in the CSI, bowel dairy parameters (except for defecation frequency and incomplete evacuation in the control group) and the PAC-QoL scores in each group (p<0.05). In the intergroup comparisons, a greater decrease was found in the CSI-colonic inertia, the CSI-total score, and the PAC-QoL-satisfaction in the massage and taping groups compared to the control group (p<0.05). While the CSI-obstructive defecation, defecation frequency, incomplete evacuation, and the PAC-QoL-total scores improved more in the massage group than the control group (p<0.05), the CSI-pain improved more in the taping group than the control group (p<0.05) (Table 1-2). The perception of subjective improvement and normalization of stool type were mostly seen in the massage group (p<0.05).

In this study, a decrease in the severity of constipation, an improvement in bowel functions and quality of life were observed in all groups. While obstructive defecation, colonic inertia, defecation frequency, and incomplete evacuation symptoms were more improved in the massage group than in the control group; colonic inertia, and pain  were improved in the taping group compared to the control group. It was found that the QoL increased more in the massage and taping group than in the control group. Moreover, it was seen that the subjective perception of improvement and a decrease in stool hardness were from most to less in the massage, taping and control groups.

In the clinics, abdominal massage and kinesio taping should be included in the first-line conservative approaches in the treatment of chronic constipation. Long-term follow-up is also needed in further studies.

Camilleri M, Ford AC, Mawe GM, Dinning PG, Rao SS, Chey WD, et al. Chronic constipation. Nat Rev Dis Primers. 2017;3:17095.
Dogan I G, Gürsen C, Akbayrak T, Balaban YH, Vahabov C, Üzelpasaci E, et al. Abdominal Massage in Functional Chronic Constipation: A Randomized Placebo-Controlled Trial. Phys Ther. 2022;102(7).
Kase K, Wallis J, Kase T. Clinical therapeutic applications of the Kinesio taping method(Vol. 2). Tokyo: Ken I kai Co Ltd. 2003:32.

Continence 7S1 (2023) 100892
DOI: 10.1016/j.cont.2023.100892