Constipation May Be Improved by Self-Applied Acupressure

Diana Phillips

November 24, 2014

Applying external pressure to the perineum in conjunction with standard constipation treatment can improve bowel function and quality of life for people suffering from the common digestive condition, a study has shown.

In a randomized trial of 91 patients, the self-acupressure technique improved constipation symptoms at 4 weeks in 72% of the patients randomly assigned to the treatment, Ryan Abbott, MD, MTOM, from the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues report in an article published online November 18 in the Journal of General Internal Medicine.

The findings suggest that education in perineal self-acupressure should be a component of first-line constipation treatment, the authors write. The noninvasive, nonpharmacologic intervention carries a lower risk for adverse effects and complications than common medications, and it may help control the significant healthcare costs associated with the condition, they write, noting that "U.S. hospital costs alone associated with constipation were estimated at over $4.25 billion in 2012."

On the basis of earlier research suggesting the technique might facilitate defecation by breaking up hard stools, relaxing the anal sphincter muscles, and stimulating the nerves involved in bowel movements, the investigators sought to evaluate it in a controlled setting. From July 2013 to April 2014, they recruited participants from the local community who met Rome III criteria for functional constipation.

Of 100 patients enrolled in the trial, 91 completed the study, including 45 who had been randomly assigned to standard care and 46 patients randomly assigned to the self-acupressure group. Standard care involved conventional treatment options, including increased dietary fiber intake, stool softeners, and increased exercise. Participants in both groups received educational materials about constipation and conventional treatment options, whereas those in the self-acupressure group also received sex-specific educational material and training in the technique, which consisted of 3 to 5 minutes of instruction on how to apply perineal pressure. The latter group was not restricted from using conventional treatment options.

All the study participants completed survey instruments on enrollment and at 1 month. Relative to standard care alone, self-acupressure in conjunction with standard care produced significant improvements in Patient Assessment of Constipation Quality of Life scores, as well as patient-assessed bowel function, based on modified Bowel Function Index scores, and functional health and well-being, based on Short Form Health Survey version 2 (SF-36v2) Health Survey scores, the authors write.

Specifically, the mean overall Patient Assessment of Constipation Quality of Life scores, the primary study outcome, improved by 0.76 units in the perineal-pressure treatment group compared with 0.17 units in the control group 4 weeks after randomization, for a treatment-effect difference of 0.59 (95 % confidence interval, 0.37 - 0.81; P < .01), which "exceeds the 0.5 standard deviation...standard that has been used to define a clinically meaningful difference with respect to interventions for constipation," the authors report.

With respect to treatment-effect subgroups, the treatment and control groups improved, respectively, by 0.84 and 0.23 units in mean Physical Discomfort Score, 0.63 and 0.15 units in mean Psychosocial Discomfort Score, 0.82 and 0.14 units in mean Worries and Concerns Score, and 0.77 and 0.21 units in mean Satisfaction Score.

Similar improvements were observed across the secondary outcomes, the authors report. In the treatment and control groups, respectively, the mean modified Bowel Function Index improved by 18.1 and 4.2 units. The mean SF-12v2 Physical Component Score improved by 2.69 units in the treatment group and declined by 0.36 units in the control group, whereas the mean SF-12v2 Mental Component Score improved by 3.12 and 0.30 units, respectively.

Participants in the treatment group assessed the intervention positively. "Seventy two percent reported that the technique helped them to 'avoid or better manage the effects of constipation,' " the authors write. In addition, 82% of the patients in the treatment group said they would continue to use the technique, and 72% said they would recommend it to family and friends.

"This study suggests that clinicians should consider incorporating education in perineal self-acupressure as a first-line treatment for constipation, along with conventional interventions such as increased exercise and dietary fiber intake," the authors conclude. In addition to the treatment's low-risk profile and the potential to control treatment costs, "perineal self-acupressure may represent an effective alternative to conventional treatment options," particularly for individuals who do not respond favorably to existing treatment options.

The study was support by the Annenberg Foundation, the Gerald Oppenheimer Family Foundation, the Panda Foundation, and Yale University. The authors have disclosed no relevant financial relationships.

J Gen Intern Med. Published online November 18 2014. Abstract

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