Physiotherapy for Children with Functional Constipation: A Pragmatic Randomized Controlled Trial in Primary Care

Area of Science:

• Pediatric Gastroenterology
• Physical Therapy
• Primary Care Medicine

Background:

• Functional constipation is a common condition in children.
• Conventional treatment includes toilet training, dietary advice, and laxatives.
• Dyssynergic defecation may contribute to constipation in some children.

Purpose of the Study:

• To evaluate the effectiveness of physiotherapy combined with conventional treatment versus conventional treatment alone for pediatric functional constipation.
• To assess treatment success, defined by symptom resolution and absence of laxative use, over an 8-month period.

Main Methods:

• A pragmatic randomized controlled trial involving 234 children (aged 4-17 years) diagnosed with functional constipation.
• Participants were assigned to receive either conventional treatment plus physiotherapy or conventional treatment alone.
• Outcomes measured included treatment success (Rome III criteria without laxatives), absence of constipation regardless of laxative use, and perceived treatment effect.

Main Results:

• Adding physiotherapy did not significantly improve the primary outcome of treatment success compared to conventional treatment alone (adjusted relative risk [aRR] 0.80).
• At 4 months, physiotherapy showed lower success rates, but by 8 months, success rates were similar (42% vs. 41%).
• Parent-reported global symptom improvement was significantly higher in the physiotherapy group (aRR 1.40).

Conclusions:

• Physiotherapy is not recommended as a universal treatment for all children with functional constipation in primary care settings.
• While some parents perceived greater symptom improvement with physiotherapy, it did not translate to statistically significant improvements in constipation resolution.
• Further research may explore specific subgroups of children who might benefit from physiotherapy.