From the Guidelines
Osteopathic treatment for constipation should be used in conjunction with conventional medical approaches, prioritizing lifestyle modifications and pharmacological management as recommended by the American Gastroenterological Association and American College of Gastroenterology clinical practice guideline 1.
Key Recommendations
- The primary approach involves osteopathic manipulative treatment (OMT) targeting the abdomen, pelvis, and spine to enhance gastrointestinal motility and function.
- Specific techniques include gentle abdominal massage following the direction of the colon, visceral manipulation to release restrictions around the intestines, and spinal manipulation focusing on the thoracic and lumbar regions that innervate the digestive system.
- Lifestyle modifications are crucial, including:
- Increased water intake (at least 8 glasses daily)
- A high-fiber diet (25-30g daily), with psyllium being the most effective fiber supplement 1
- Regular physical activity (30 minutes daily)
- Establishing a consistent bathroom routine
Pharmacological Management
- Polyethylene glycol (PEG) is recommended as a first-line treatment for chronic idiopathic constipation (CIC) due to its efficacy and safety profile 1.
- Osmotic laxatives, such as PEG, are preferred over stimulant laxatives for long-term management.
- Stimulant laxatives, like bisacodyl or sodium picosulphate, may be used short-term or as rescue therapy.
Osteopathic Treatment
- Osteopathic manipulative treatment should be performed by a trained osteopathic physician.
- Typically requires 3-6 sessions over several weeks for optimal results.
- Can complement conventional medical approaches, particularly for functional constipation without underlying pathology.
Important Considerations
- Adequate hydration is essential when using fiber supplements or osmotic laxatives.
- Side effects, such as bloating, flatulence, and abdominal distension, may occur with pharmacological management.
- Regular monitoring and adjustments to treatment plans may be necessary to optimize outcomes.
From the Research
Osteopathic Treatment of Constipation
- The effectiveness of osteopathic manipulative treatment (OMT) for constipation has been studied in several research papers 2, 3.
- A pilot study published in 2017 found that OMT had potential benefits for treating functional constipation in women, with improvements in stool frequency, Bristol Stool Form scale, and decreased abdominal pain and bloating 2.
- Another study published in 2014 found that osteopathic manipulative therapy (OMTh) may be beneficial in the treatment of patients with irritable bowel syndrome (IBS), with more pronounced short-term improvements compared to sham therapy or standard care only 3.
Comparison with Other Treatments
- Traditional medical therapies for chronic constipation, such as polyethylene glycol, tegaserod, lactulose, and psyllium, have been found to be effective in managing constipation symptoms 4, 5.
- A systematic review published in 2005 found good evidence to support the use of polyethylene glycol and tegaserod, and moderate evidence to support the use of psyllium and lactulose 5.
- A review published in 2004 discussed various agents used for the medical management of chronic constipation, including bulk and fiber products, lubricating agents, stimulants, and osmotic laxatives 4.
Diagnosis and Management
- Constipation can be classified as primary or secondary, and primary constipation can be further divided into slow transit constipation or outlet obstruction 6.
- The diagnostic workup for constipation involves focused lab tests and structural evaluation, followed by a therapeutic trial of fiber and laxatives, and finally, specialized tests 6.
- Treatment for constipation can consist of dietary changes, medications, physical therapy, and possibly surgery in refractory cases 6.