Pelvic floor physical therapy for functional constipation in children: a systematic review and meta-analysis

Functional constipation is a prevalent pediatric condition and affects the physical and psychological well-being of children. Pelvic floor physical therapy is an emerging approach to manage pelvic floor dysfunction and constipation. This review aimed to evaluate current evidence regarding the effects of pelvic floor physical therapy in children with functional constipation. Three bibliographic databases, PubMed, Embase, and Scopus, were searched from inception to April 1, 2025. Randomized controlled trials comparing the effects of pelvic floor physical therapy to conventional treatment were eligible for inclusion. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Meta-analyses were performed to determine the effects of different pelvic floor physical therapy treatment approaches. Thirteen randomized controlled trials were included, with 997 children with functional constipation. All included studies were scored four to eight on the PEDro scale, indicating fair to good quality. No adverse events related to pelvic floor physical therapy were reported. Biofeedback demonstrated no significant differences compared to control (RR: 0.91, 95% CI 0.50-1.68, p = 0.01). Other treatment approaches of pelvic floor physical therapy demonstrated some positive outcomes, including therapeutic exercise, manual therapy, electrical stimulation, and multimodal treatment. Compared to conventional treatment, these treatments demonstrated significantly increased defecation frequency (MD: 1.89, 95% CI 1.30-2.47, p < 0.001), reduced painful defecation (RR: 0.69, 95% CI 0.54-0.89, p = 0.004), enhanced quality of life (SMD: 1.14, 95% CI 0.26-2.01, p = 0.01), and reduced fecal incontinence (RR: 0.59, 95% CI 0.46-0.74, p < 0.001). Pelvic floor physical therapy is feasible and effective in mitigating symptoms and improving the quality of life for children with functional constipation. Medical providers may consider pelvic floor physical therapy as an adjunctive intervention for children with functional constipation to advance the quality of care.