Francesca Galiano
26/09/2022 - Last update 28/12/2022

Aurélie Belvaux, Michel Bouchoucha, Robert Benamouzig | Year 2017

Osteopathic management of chronic constipation in women patients. Results of a pilot study



Type of study:

Pilot study

Date of publication of the study’:



Purpose of the study

  • Objective: to determine the effects of (OMT) in the treatment of pregnant women suffering from functional constipation or evacuation disorders
  • Measured outcomes:
    • Primary: severity of constipation through Knowles Eccersley Scott Symptom (KESS) score
    • Secondary: total or segmental intestinal transit time, use of medicines, frequency of evacuation, severity of constipation with a score from 0 to 4, quality of life through Patient Assessment of Constipation Quality Of Life (PAC-QOL)


  • Number: 21 women (mean age 48.6 years)
  • Criteria of inclusion: women with functional constipation or evacuation disorders according to the Rome III criteria, whose assessment did not detect any organic cause for constipation at the time of inclusion.
  • Criteria of exclusion: women with irritable bowel syndrome (IBS), drug addiction, a history of major surgeries to the digestive system.
  • Group of study:
    • 21 women
      • 11 women with functional constipation
      • 10 with evacuation disorders
    • Duration of constipation from 10 to 20 years

Interventions and evaluations

  • Initial assessment through anorectal manometry and colonic transit time to confirm the diagnosis of functional constipation or evacuation disorders
  • Assessment of drug consumption at the beginning and at the end of the study
  • Assessment at the beginning and at the end of the study
    • of the severity of constipation through KESS and PAC-SYM score
    • of well-being and daily general functional status through SF-36
    • of quality of life through PAC-QOL
  • Assessment of total and segmental intestinal transit time at the beginning and at the end of the study
  • Assessment of abdominal pain and distention through VAS from 0 to 9, and of severity of constipation with a score from 0 to 4 before each intervention
  • Assessment of stool consistency through Bristol Stool Chart after each evacuation
  • 4 weekly OMT sessions of 1 hour
  • OMT: analysis of personal history, postural evaluation, assessment through visceral tests, osteo-articular, muscular and fascial, personalized techniques based on the somatic dysfunctions detected, although standardized (the same technique for the same dysfunction)
    • Myofascial release, muscle energy, balanced ligamentous tension and visceral techniques
  • OMT performed by one osteopath
  • The participants were asked not to change their lifestyle (diet and physical activity) during the study


  • Primary outcome: the OMT promoted a statistically significant reduction of the KESS score in the whole group and in both subgroups considered individually
  • Secondary outcomes: OMT reduced intestinal transit time in both right and left colon in a statistically significant way. In addition, intestinal transit time went back to normal in 9 women. The amount of laxative consumption dropped by a half, with 10 women stopping taking them completely.

The OMT produced a statistically significant increase in the frequency of evacuation in the entire sample, mostly in the subgroup with functional constipation. The quality of life measured through PAC-QOL increased statistically significantly in the whole sample.

Stool consistency, evaluated according to the Bristol Stool Chart, increased statistically significantly, moving towards normalization especially in the group characterized by functional constipation, even though the mean value was still indicative of constipation. Also, abdominal pain and bloating, both measured with VAS, were statistically significantly lower at the end of the study. The severity of constipation, measured with PAC-SYM, did not show any changes by the end of the study, and neither did the level of well-being measured with SF-36.


The OMT proved to be able to improve a condition of chronic constipation showing both objective results (reduction of intestinal transit time) and subjective results (KESS score, pain and bloating). The reduction of intestinal transit time occurred differently in the two subgroups: greater in the left colon in the women with functional constipation and greater, on the contrary, in the right colon in the women suffering from evacuation disorders. It is to be noted that the increase in evacuation frequency is not necessarily a good sign, in fact, it might depend on an incomplete defecation that continuously pushes patients to attempt new evacuations.

The OMT capacity to decrease the laxative consumption is a key result as they can eventually produce different collateral effects. Bigger controlled studies are needed, to better evaluate the effects of OMT and the possible differences between patients with chronic constipation and those with evacuation disorders.

The review of Osteopedia

By Marco Chiera

Strengths: good description of the OMT; description of all the evaluations realized; good discussion of the evidence of the effects of manual therapies in case of constipation; interesting results, particularly in the relation of the reduction of intestinal transit time and use of medicines.

Limits:too small a sample to generalize the results; too many outcomes were selected affecting the power of the study as each assessment instrument needs, relatively to the effectiveness of the intervention, a certain sample size (number of persons to recruit) so that possible therapeutic effects can stand out; as a consequence, the discussion does not treat appropriately some of the results either obtained or not obtained on certain outcomes; it was not analyzed if the women lifestyle changed during the study.

Are you an osteopath?

Register and enjoy the membership benefits. Create your public profile and publish your studies. It's free!

Register now

School or training institution?

Register and enjoy the membership benefits. Create your public profile and publish your studies. It's free!

Register now

Do you want to become an osteopath? Are you a student?

Register and enjoy the membership benefits. Create your public profile and publish your studies. It's free!

Register now