Around half of all people with MS experience bowel problems at some time. A common problem is constipation, defined as passing hard stools (poo or faeces) less than three times a week. There is a wide range treatment options including lifestyle changes to diet and exercise which can make a real difference. The aim of this study was to evaluate the effect of abdominal massage as a treatment for constipation.
191 participants who felt their constipation was “bothersome” were recruited at MS centres in the UK and assigned to one of two groups. One group was given advice on improving bowel care plus training in abdominal massage and encouraged to carry out massage for 10 minutes each day for six weeks. The other group was given advice only.
The study found that abdominal massage did improve bowel symptoms, but the effect was small and not statistically significant. The researchers concluded that, while the results do not justify routine use of abdominal massage for everyone reporting constipation, they do indicate that this approach would be worth considering as an additional option to help people manage constipation.
Many people with MS experience bowel problems. A common problem is constipation, defined as passing hard stools (poo or faeces) less than three times a week. This can be accompanied by bloating of your abdomen and discomfort, tiredness and fatigue and loss of appetite. Constipation can cause other symptoms of MS, such as spasticity, to get worse or be more troublesome. It is well known that constipation can affect your self-esteem, energy levels, mood, relationships, sexual activities and your ability to work.
There are many approaches to managing constipation and straightforward lifestyle changes to diet and exercise can make a real difference. There are also a variety of treatment options including laxatives, suppositories and enemas. Massage therapy stimulates gut motility and has shown promise as a treatment for constipation in a small study of people with MS; the aim of this study was to test the effectiveness of abdominal massage in a larger group of people with MS.
How this study was carried out
191 participants who felt their constipation was “bothersome” were recruited at 12 MS centres around the UK. Participants were assigned to one of two groups:
- advice to optimise bowel care
- advice to optimise bowel care plus abdominal massage
Those in the abdominal massage group and/or their carer were taught how to do the abdominal massage and given a DVD and instruction book. A daily massage of 10 minutes duration was recommended. All participants had a weekly phone call from a health professional to check on progress and any changes or difficulties in their bowel management.
Participants completed questionnaires at the start of the study, at the end of 6 weeks of intervention and again at 24 weeks and kept a bowel diary for the duration of the study. To further assess the treatment, 20 participants had telephone interviews at the beginning and end of the trial.
At the end of the study, the abdominal massage group recorded a slight, but not statistically significant, improvement in the Neurogenic Bowel Dysfunction Score, a questionnaire which measures overall bowel symptoms. However, at the end of the study, participants in the abdominal massage group did record some important findings. They:
- passed stools more frequently
- felt that they emptied their bowel more completely
- generally took fewer laxatives
- felt better.
Interviews also identified that participants liked the fact that:
- drugs were not involved
- they could do the massage themselves
- there was a lack of adverse side effects.
The study found that abdominal massage lead to an improvement in bowel symptoms, but it was small and not statistically significant. The researchers conclude that while the results do not justify routine use of abdominal massage for everyone reporting constipation, they do indicate that this approach would be worth considering as an additional option to help people manage constipation.
McClurg D, et al.
Abdominal massage plus advice, compared with advice only, for neurogenic bowel dysfunction in MS: a RCT.
Health Technology Assessment 2018 Oct;22(58):1-134
More about abdominal massage and managing constipation
Constipation is a common problem for people with MS. It’s not fully understood how and why constipation happens in MS but one of the causes may be that waste travels through the colon more slowly. As one of the functions of the colon is to reabsorb water, the longer it takes for waste to travel through the colon (known as transit time), the harder and smaller your stools become.
The good news is that there are lots of different ways to reduce constipation, though it may take some experimenting to find what works for you. Some self-management tips for improving constipation include:
- eating regularly
- getting enough fibre
- drinking enough fluids
- exercising regularly
- posture when sitting on the toilet
- giving it time
- reviewing medicines
- and of course, abdominal massage.
There is also a wide range of treatment options such as laxatives, stimulants and enemas. Health professionals, including your MS specialist nurse, GP and continence services can work with you to find the ones that are right for you.
Find out more about bowel problems and constipation on the MS Trust website. You can also download or order a free copy of our recently updated book Managing your bowels.