The Effect of Abdominal Massage on Gastrointestinal Functions: a Systematic Review

Highlights

• Massage therapy is one of the oldest forms of treatment.

• Abdominal massage therapy recommended for treating some symptoms of diseases.

• Abdominal massage therapy can be effective in improving the intestinal function disorders.

Abstract

Introduction

abdominal massage with regular and rhythmic movements has been used to treat some symptoms of diseases.

Objectives

to review data collected from randomized controlled trials regarding the effect of abdominal massage (AM) on gastrointestinal functions (GFs).

Methods

we conducted a systematic review of articles accessible through PubMed, Scopus, Science Direct, Google Scholar, and Web of Science. All eligible English RCT- published articles related to the effect of AM on GFs were included in the study from the time of their acceptance until June 2019.

Results

ten studies with 464 patients met the inclusion criteria. Three studies reported that AM alleviated constipation symptoms in patients with multiple sclerosis, cancer, and elderly adults. In three studies, AM increased bowel movements in people with constipation and patients undergoing skeletal traction. The results of three studies conducted on intensive care patients showed that AM improved GFs, and decreased abdominal circumference and distension. Two studies showed the effectiveness of AM in reducing the gastric residual volume. However, one study indicated no significant difference between the intervention and control groups. The results of two studies showed that AM did not affect laxative intake, nausea or vomiting, frequency of defecation, and food intake. Furthermore, AM did not decrease ventilator-associated pneumonia in patients undergoing mechanical ventilation. The studies reported no adverse effects of AM.

Conclusions

there was promising evidence for the effect of AM on GFs. However, further studies are needed to measure the unknown dimensions of AM in patients.

Introduction

Massage therapy is one of the oldest forms of treatment ¹ that has been used for centuries in many civilizations and cultures. ² Massage is the regular and rhythmic movements of an individual's hand on body tissues, including nerves and muscles, to achieve certain goals. ³

Massage therapy can increase blood circulation and lymphatic fluid ⁴, lower the stresses on the muscles, help remove the wastes, and make people relaxed with secretion of endorphins. ³ Among different types of massage, AM can stimulate the parasympathetic activity and thus the gastrointestinal response. ^5,6 It increases peristaltic movement and changes the pressure of the abdomen via mechanical and reflexive methods, and subsequently accelerates the passage of food through the gastrointestinal tract. ⁷ AM techniques have been used to reduce muscle tension, improve local circulation, relieve malnutrition, stimulate gastric acid secretion, increase appetite and intestinal movements[8], 9., [10], 11., reduce the gastric residual volume, abdominal distention and fecal incontinence, and intra-abdominal pressure. ^7,12,13The literature review showed the effectiveness of AM in reducing the symptoms of constipation in patients ¹⁴, reducing the residual volume and distention in patients with nasogastric tube and patients under mechanical ventilation in medical-surgical intensive care units ^7,15, reducing distention, incontinence, the frequency of defecation in patients with spinal cord injury ¹⁶, decreasing consumption of laxatives and improving diet in disabled children with chronic constipation ¹⁷, increasing the number of bowel movements, stool weight and consistency, and increasing the ability of the elderly people in rest homes to completely empty the bowels. ^18,19 Okuyan and Bilgili showed that AM could reduce the constipation and increase quality of life of the older adults. ²⁰ The use of AM with fluid therapy has been effective in improving the clinical effects and shortening the duration of diarrhea in children. ²¹ Furthermore, AM can prevent the formation of new stones by washing the bile duct via stimulation of gall bladder ²² and gallstones recurrence after endoscopic sphincterotomy (EST). Despite the evidence that AMs are effective in improving GFs ^7,15., 16., [17],^19,21,23,24, several studies do not support this result. ^16,25., [26], 27., 28., 29. AM has been introduced as a silent killer in the southern region of Nigeria because of perinatal mortality and its complications. ²⁶ For example, one case suffered from embolization immediately after AMs. AMs can release plaques or cause thrombosis. ²⁷ One study found that AM had no effect on pain, fatigue, nausea, drowsiness, anorexia, dyspnea, mobility restriction, or body weight in patients with malignant ascites. ²⁵ Furthermore, it did not affect the difficult defecation, abdominal pain, and times of defecation in patients with spinal cord injury. ¹⁶ Use of electromechanical massage devices did not affect the intestinal function in spinal cord injured patients with chronic intestinal problems. ²⁸ There is no consensus that AM can be effective in improving the intestinal function disorders in patients with spinal cord injury. ²⁹ Only the review articles conducted in 2011 have shown the promising treatment of constipation with AM. ^12,30 In addition, another review study only mentioned the effects of AM on the function of the neurogenic bowel in patients with spinal cord injury. ²⁹ The literature review shows various studies that have examined the effect of AM on GFs in different age groups with a variety of underlying diseases. However, it is still unclear whether AM can be a useful intervention to improve the gastrointestinal function of different individuals or not. According to the available evidence, only three systematic reviews have been conducted in this regard, one of which has only examined evidence related to the effect of AM on constipation, and another one has restricted the literature review to a specific community. ^12,29,30 However, relevant studies have not reached a consensus that whether AM can improve GFs in patients or not. Although AM is commonly used, no information is available about the efficacy and safety of the gastrointestinal function in different populations. Therefore, concerning different effects of massage on gastrointestinal function and disorders, its inexpensiveness and non-invasiveness, patients' acceptance and the willingness of the medical staff in the implementation of massage, it is necessary to examine its effectiveness based on existing evidence. Therefore, this study aimed to review systematically existing studies conducted on the effect of AM on the gastrointestinal function. This study has answered the following questions:

What massage techniques were used? How long was the follow-up period after AM? Which GFs were improved? Was AM safe in patients?