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Constipation: An Osteopathic insight on treatment and management?



What is constipation?

Constipation, being a condition of the Gastrointestinal Tract (GIT), is contemporarily defined as a decrease in the number of defecations per week in conjunction with further signs of defecation distress and disturbance (Włodarczyk et al., 2021). Commonly, the aetiology of the condition is divided into two groups. Primary constipation, referring to intrinsic problems of the colon such as Rectal Evacuation Disorders (RED), and secondary constipation, referring to consequences of disease, diet, drugs or metabolic syndromes. With this in mind, the direct cause of constipation can also be considered unknown or multifactorial in nature (Pannermans et al., 2020).

Despite this, it is positive to observe the great steps in better understanding conditions of the GIT in the 21st century.


Constipation- the Clinical Criteria:

The Rome Criteria, of which the most current version was released in 2016 (Schmulson & Drossman, 2017), takes a wider focus upon multicultural, biopsychosocial and pharmacological factors when defining and explaining conditions of the GIT. (Pannermans et al., 2020). With the updated Rome IV Criteria, it is interesting to note that constipation is now considered a functional bowel disorder on a continuum with diarrhea and IBS. Furthermore, recent research has also drawn attention onto the emerging impact of the gut microbiota upon conditions such as constipation (Włodarczyk et al., 2021).



For the latest Rome IV diagnostic criteria

Normal Transit Constipation and RED are the two most present subtypes of constipation (Pannermans et al., 2020). Of the latter, it was found that constipation arose when the proper, sequential, bowel movements – straining of abdominal muscles, followed with the consequential increase in abdominal pressure and relaxation of the pelvic floor and anal sphincters - did not function optimally. This dyssynergia, or mal coordination of muscle contractions, was observed to be a frequently persistent issue in adults whom displayed this presentation in childhood (Pannermans et al., 2020).



Symptoms of constipation:

A patient with constipation regularly presents with sub-optimal rates of defecation frequency, hard stools, complaints of straining when defecating, sensations of incomplete evacuations, pain and abdominal discomfort.


Note: It is important to address that these physical signs can be accompanied by psychological signs of distress, especially in the paediatric population, (Włodarczyk et al., 2021) and often present along with risk factors such as poor diet and a sedentary lifestyle (Sobrado et al., 2018).



Osteopathic management of constipation:

Osteopaths focus on the treatment of the neuromuscular system to improve functional body mechanics. This includes improving joint motion, muscle tonicity, tissue motility, and regulation of nervous impulses (Manchini et al,. 2023). Osteopathy applies a method of treatment based on the principles of the unity of the body by adopting structural, cranial and visceral approaches - including techniques such as hands on treatment (ie. massage), as well as exercise prescription and lifestyle advice (Pasin Neto & Borges, 2020).

 

OMT is an intervention that can be adopted alongside other first-line management protocols. Osteopaths are advocates for educating patients about the best way to move their body – such as encouraging movement and exercises to highlighting the importance of a healthy musculoskeletal system to help function and feel well. Considering constipation, an osteopath is well educated regarding the muscles and tissues of the abdomen and pelvic floor, and can therefore offer advice and assistance. This assistance could be techniques to position the body so to optimally defecate (ie. laxing puborectalis) (Landmann & Wexner, 2008), or perhaps perform gentle visceral manipulation techniques to aid in managing symptoms (Pasin Neto & Borges, 2020). Furthermore, as a first line healthcare professional, an osteopath can reinforce where appropriate, the benefits of a healthy diet and an active lifestyle (Daniali et al., 2020).

 


To further demonstrate the impact of OMT, there has been a small but promising 2020 study in a population of stroke patients suffering with diagnosed constipation. Constipation was inferred to be due to the poor regulation of the nervous system, in conjunction with hindered movements for the visceral organs (due to loss of body movements and rigidity) that followed the instance of the stroke. It was found that there was good evidence to suggest that visceral mobilisation OMT assisted intestinal motility and the reduction in nervous system excitability. To further elaborate, OMT was seen to assist outcomes of improved bowel movement and thus a reduction in symptoms of constipation (Pasin Neto & Borges, 2020).

 

To sum up - a registered osteopath can be a collaborative aid in the assistance and management of many common health conditions – including constipation. It is this collaboration where the true value of osteopathy is found.


Where can I get help!

The team at Complete Care Osteopathy in Lilydale are well equipped to help with your health needs. We encourage you to open the dialogue as to how osteopathic treatment may assist your condition.


(03) 7036 6525



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