Safety and Efficacy of Manual and Automated Abdominal Colonic Massage for Chronic Constipation: A Systematic Review...

Abdominal colonic massage shows benefits against chronic constipation (CC). While both manual and automated versions of this therapy show potential, there is currently no comprehensive synthesis comparing their effectiveness and safety.

Studies on manual and device-assisted abdominal massage for CC were identified from major bibliographic databases (1990-2025). Risk of bias was assessed. Outcomes included bowel movements per week (BM/w), quality of life (QoL), and adverse events. Meta-analyses were stratified by patient profile and intervention type. Where available, control data were extracted and compiled in a third group compared with manual and automated intervention through POST-PRE analysis of variance statistical synthesis.

Of 1,352 records screened, 54 studies met inclusion criteria, 35 were included in the meta-analysis (1965 patients). No study was judged at high risk of bias. Meta-analysis showed significant improved BM/w and QoL after both manual ( pBM/w&QoL < 0.00001) and device-assisted ( pBM/w = 0.0006; pQoL < 0.00001). Stratified analyses showed consistent effect estimates in functional constipation/chronic idiopathic constipation across intervention types, whereas neurogenic bowel dysfunction meta-analysis was not feasible because of limited studies. No significant difference was observed between manual or device-assisted outcomes in any subgroup. Sensitivity analyses confirmed the robustness of results. Statistical synthesis confirmed both manual and automated interventions outperformed controls (BM/w: x5.9-x7.6; P = .0006; QoL: x2.4-x4.1; P < 0.005) with no significant difference between them. Adverse events were rare (6.3%), mild, and self-limiting.

Abdominal massage is a safe and effective treatment for CC from both neurogenic bowel dysfunction and functional constipation/chronic idiopathic constipation origin. The automated version is equal or more effective than the manual, making it a strong candidate for inclusion in regular clinical practice.