Chronic constipation encompasses symptoms like hard or lumpy stools, excessive straining, infrequent bowel movements, bloating, abdominal pain, feeling of incomplete emptying, and use of manual maneuvers to facilitate evacuation.¹ Constipation affects between 3% and 31% of the adult population.² Constipation has important medical, social, and economic implications. Risk factors are advanced age, female gender, low socioeconomic status, decreased physical activity, dietary changes, some mood disorders (such as anxiety, depression, etc), and medications.^3,4

For chronic constipation, diverse modalities encompass pharmacological and non-pharmacological strategies within the therapeutic spectrum.^5,6 These approaches are used to increase the frequency of defecation, to reduce straining, abdominal bloating and pain, and to restore normal bowel function. Pharmacological approaches may not be suitable for every individual with constipation as they may cause side effects on fecal impaction and the enteric nervous system. Moreover, these agents are costly and have temporary effects in relieving constipation symptoms.^5,6 For this reason, in recent years, non-pharmacological strategies have gained prominence for managing chronic constipation.⁷ Lifestyle guidance encompassing dietary adjustments, optimal fluid consumption, proper defecation posture, weight management, and physical activity scheduling constitute primary interventions.^7,8 These recommendations, straightforward, cost-effective, and secure, have garnered interest as initial therapeutic modalities among chronic constipation sufferers.^8,9

Abdominal massage, one of the manual therapies, is a treatment method that reduces constipation symptoms and improves quality of life (QOL). It is inexpensive, has no side effects, and has an easy to apply method.¹⁰ It stimulates the abdominal fascial system and the autonomic nervous system, so it reduces the tension in the muscles, ligaments and fascia. Compression applied to the colon creates reflex and mechanical effects. Therefore, colon motility increases and the passage time of stool through the colon can be shortened.^11,12

Kinesio taping, originally generated by Dr Kenzo Kasea, can be used to support weak muscles, stimulate muscle activity, supply proprioceptive feedback, reduce pain, initiate the skin-organ reflex, and enhance hemodynamic circulation.¹³ The mechanisms underlying the impact of taping on chronic constipation involve enhancing blood and lymphatic circulation through the application of consistent tension to the fascial tissues. Kinesio taping applied to the abdominal or sacral areas, which are the reflex zones of the colon, can increase the mobility of the colon and shorten the colon transit time.^14,15 According to some studies, Kinesio taping was found to be effective in improving constipation-related symptoms and QOL.^16,17 However, there is insufficient data in the literature regarding Kinesio taping in the management of chronic constipation.^13,14,16-18

To our present understanding, a dearth of literature exists in assessing the comparative impacts of abdominal massage and Kinesio taping on chronic constipation management. Since it has been stated that constipation is more common in the female gender, it was decided to study with a group consisting only of women in order to conduct the study homogeneously. This study aims to compare the effects of abdominal massage and Kinesio taping on constipation severity, QOL, and perception of subjective improvement in women with constipation. The hypotheses were: The addition of abdominal massage or Kinesio taping to lifestyle recommendations would be greater impact on constipation severity, QOL, and perception of subjective improvement compared to lifestyle recommendations alone.

Study Design

The study, which was approved by the Ankara Yildirim Beyazit University Ethics Committee (Approval No. 716-03), was planned using a single-blind randomized controlled trial design. This study, which was performed according to the Helsinki Declaration rules, was registered at www.clinicaltrials.gov (NCT05330728). It was held between June 2022-December 2022. This study was reported prepared to the Consolidated Standards of Reporting Trials (CONSORT) Guidelines.

Participants

Women were recruited if they were between the ages of 18 and 65 and had a diagnosis of chronic constipation (normal and slow transit). A gastroenterologist made the diagnosis based on anamnesis, Rome IV criteria,¹ physical/neurologic examination, anorectal tests, and a bowel diary. Exclusion criteria were being pregnant, having concomitant colon or gastrointestinal problems (gastrointestinal bleeding, acute inflammation, etc), having a body mass index of > 35 kg/m², having difficulty defecating, having anorectal dyssynergia, having secondary constipation, having open wounds, having neurological, metabolic and/or malignant disease, mental problems that prevent cooperation, presence of infection and/or hernia, having received a physiotherapy and rehabilitation program for constipation in the last 1 year (such as massage and Kinesio taping), abdominal surgery or surgery in the last 1 year, to have had abdominal radiotherapy, to be allergic to taping, and to take laxative treatment up to 4 weeks before the treatment. Women were first evaluated and then treated in the department of physiotherapy and rehabilitation. All participants approved the informed consent form.

Randomization

An independent investigator who was not involved in the study performed randomization via a computer-based block randomization procedure. Women were assigned to one of 3 groups: massage group, taping group, and control group.

Interventions

Women with chronic constipation in the massage group received lifestyle recommendations + abdominal massage, women in the taping group received lifestyle recommendations + Kinesio taping and women in the control group received lifestyle recommendations alone. None of the patients used medications such as laxatives during the study.

Lifestyle recommendations

Lifestyle guidance encompasses incorporating fiber-rich foods, consistent breakfast consumption, heightened fluid intake, doing abdominal exercises, regular walking, and acquiring proper toilet habits.³ After assessments, women were explained about these recommendations once. It was checked whether it complied with the recommendations by calling regularly once a week.

Abdominal massage

Abdominal massage with the Swedish technique was applied to women with chronic constipation.⁵ After placing pillows under the heads and knees of the women lying in the supine position, massage with baby oil was used. Abdominal stroking (Fig. 1), colon stroking (Fig. 2), and colon kneading (Fig. 3) were the stages of abdominal massage. Abdominal and colon stroking was performed first, followed by colon kneading. Moderate pressure applied, kneading from sigmoid to ascending colon, following colon line, employing colon kneading technique (clockwise and circular movements). After the colon kneading was finished, colon and abdominal stroking were repeated, respectively. Three weekly sessions of abdominal massage were administered over a span of 4 weeks.

Figure 1. Abdominal stroking. (A) Fingertips were placed on the symphysis pubis. (B) It was advanced along the rectus abdominis muscles with a deep upward stroking. (C) At the level of the lower costal, the hands are spread out to the sides. (D) It was advanced to the middle and descended along the course of the transverse abdominal muscles. (E) At the return of the second stroking, the starting point was descended obliquely for the oblique abdominal muscles.

Figure 2. Colon stroking. (A) stroking started on cecum. (B) Moved upwards on the ascending colon. (C) It was advanced on the transverse column and the hand below the midline changed direction. (D) The bladder was passed with superficial stroking.

Figure 3. Colon kneading. (A) A friction movement was initiated in the distal part of the descending colon. (B-F) It was advanced to the starting point by applying friction 5 cm upwards each time.

Kinesio taping

For Kinesio taping, 3 I-shaped Kinesio Tape Tex Gold tapes (5 cm wide, 0.5 mm thick) were employed. The anchor of the first tape was started at the bottom of the descending colon. The tape was applied upward on the left side of the abdomen along to just below the ribs. The anchor of the second tape was started at left side of the abdomen of the transverse colon. The tape was applied toward the right side of the abdomen just below the ribs to the right side. The anchor of third tape was started at the top of the ascending colon. The tape was applied downward on the right side of the abdomen just below the ribs. All tapes were also applied with 15-25% tension (Fig. 4). Kinesio taping sessions were conducted 3 days per week over a 4-week period.

Figure 4. Kinesio taping application.

Outcomes

At the beginning of the study, demographic, physical, medical, and lifestyle characteristics were recorded. The amount of daily fiber consumption was calculated. Daily tea and coffee consumption amount was questioned as self-report, considering the number of cups as 1 cup of 200 mL. The womens’ physical activity was measured using the Turkish version of the International Physical Activity Questionnaire-7 for baseline standardization.¹⁹ As outcome measures (patient-reported outcome measures), constipation severity, bowel diary, and QOL were performed at baseline (pre-treatment) and after 4 weeks (post-treatment). Perception of subjective improvement was also questioned after 4 weeks.

Primary outcome

Constipation severity was assessed using the Turkish adaptation of the Constipation Severity Instrument (CSI).²⁰ The CSI, which consists of 16 questions, is composed of 3 sub-headings: obstructive defecation, colonic inertia, and pain. The overall score spans from 0 to 73. An increase in the score indicates an increase in the severity of constipation.

Secondary outcomes

Bowel function was assessed with a 7 days bowel diary. Women were asked not to change their daily defecation habits or the amount of liquid and food intake. The defecation frequency, defecation duration, and incomplete evacuation were recorded with this dairy.²¹ Also, stool type was obtained from the Bristol Stool Scale.²² In this 7-point scale; items 1 and 2 denote hard stools, while items 3 and 4 represent normal (looser) stools.²²

QOL was assessed with the Turkish adaptation of the Patient Assessment of Constipation QOL (PAC-QOL) questionnaire.²³ The PAC-QOL, which includes the subscales of “physical discomfort,” “psychosocial discomfort,” “worries/concerns,” and “satisfaction,” consists of 28 questions. The highest score is 140, and the lowest score is 28. Higher scores indicate that constipation affects the QOL more negatively.

Perception of subjective improvement was assessed through a 4-item Likert-type scale.²⁴ Accordingly, women preferred one of the expressions “worse, same, better, or improved” in the pre-treatment and post-treatment comparison.

Patients’ compliance with lifestyle recommendations was assessed with the Visual Analogue Scale.²⁵ On this scale, the “0” point was defined as “Never (0%) I did not comply” and the “10” point was defined as “I fully (100%) complied”. The women marked the spot that best suited them on the 10 cm horizontal line. Using a ruler, the distance from this point to the origin (0 point) was measured and recorded in centimeters.²⁵

Sample Size

The data of the pilot study were used for the sample size calculated with the G*Power (G*Power version 3.1.9, Franz Faul, Universität Kiel, Germany) package program.²⁶ The effect size was determined as 0.546 according to CSI. It was determined that 52 people were included in the study with a = 0.05 type I error and b = 0.10 type II error rates for 90% power. By calculating possible data losses, the sample size was increased by 20% and it was found appropriate to include 64 people in the study.

Statistical Methods

The Shapiro-Wilk test was used to evaluate whether the variables in the study were in accordance with the normal distribution. Descriptive statistics for all variables were used. Data were shown as mean ± standard deviation if they were normally distributed, and as median (interquartile range) if they were not normally distributed. Categorical variables related to perception of subjective improvement were assessed with chi-square test. Non-normally variable related to compliance with lifestyle recommendations were assessed with Kruskal-Wallis test. Categorical variables were expressed as frequency (n) and percentage (%).

A two-way Analysis of Variance (two-way ANOVA) test was conducted to compare variations in measurements among groups. When the group × time interaction effect was found to be significant, differences between groups were calculated as post- versus pre-changes and compared using one-way ANOVA. Reporting was based on the results of the Games-Howell post hoc test when homogeneity of variance was ensured, and Tukey-HSD when it was not achieved.

IBM SPSS Statistics 26.0. (Released 2012, IBM SPSS Statistics for Windows, version 26.0; IBM Corp, Armonk, NY, USA) program was used for statistical analysis and calculations. Significance level: P < 0.05 was established.

Eighty-six women with constipation were included. Since 20 women were not included in the study for various reasons, the study was completed with a total of 66 women. (Fig. 5). No adverse effects were noted among any of the women throughout the interventions. The demographic, physiological, and medical characteristics of the groups demonstrated homogeneity (except of tea consumption) (P > 0.05) (Table 1).

Figure 5. Flowchart of the participants.

Table 1 . Comparison of Demographic, Physical, and Medical Characteristics of Groups

	Massage group (n = 22)	Taping group (n = 22)	Control group (n = 22)	P-value
Age (yr)	32.41 ± 9.65	32.82 ± 10.02	35.41 ± 10.09	0.557
BMI (kg/m2)	23.83 (4.78)	24.95 (7.90)	23.88 (5.33)	0.734
Marital Status
Married	10 (30.3%)	12 (36.4%)	11 (33.3%)	0.834
Single	12 (36.4%)	10 (30.03%)	11 (33.3%)
Education (yr)	13.50 (8.00)	12.00 (8.00)	14.00 (8.00)	0.805
Chronic disease
Yes	2 (22.2%)	4 (44.4%)	3 (33.3%)	0.675
No	20 (35.1%)	18 (31.6%)	19 (33.3%)
Constipation duration (mo)	36.00 (30.00)	24.00 (36.00)	30.00 (19.50)	0.683
Number of main meals
≤ 2	11 (36.7%)	10 (33.3%)	9 (30.0%)	0.832
≤ 3	11 (30.6%)	12 (33.3%)	13 (36.1%)
Breakfast presence
Yes	11 (28.2%)	15 (38.5%)	13 (33.3%)	0.471
No	11 (40.7%)	7 (25.9%)	9 (33.3%)
Daily water consumption (glass)	2.50 (3.50%)	4.00 (3.38%)	2.00 (3.50%)	0.448
Low daily fiber consumption, ie, < 30 g/day, yes	9 (41)	10 (46)	8 (37)	0.829
Tea consumption (cup) L/day	5.36 (2.57)	3.54 (2.36)	4.00 (1.92)	0.030a
Tea consumption
Yes	22 (34.9%)	19 (30.2%)	22 (34.9%)	0.032
No	0 (0.0%)	3 (100.0%)	0 (0.0%)
Coffee consumption (cup) L/day	2.04(1.55)	1.59(1.25)	1.63(1.46)	0.515
Coffee consumption
Yes	18 (34.6%)	17 (32.7%)	17 (32.7%)	0.718
No	3 (23.0%)	5 (38.5%)	5 (38.5%)
Smoking status
Yes	9 (50.0)	4 (22.2)	5 (27.8)	0.159
No	12 (25.5)	18 (38.3)	17 (36.2)
Alcohol status
Yes	6 (40.0%)	4 (26.7%)	5 (33.3%)	0.728
No	16 (35.5%)	17 (37.8%)	12 (26.7%)
Physical activity score (MET × min/wk)	1506.00 (2422.00)	3305.50 (5005.75)	897.00 (1127.50)	0.407

^aP < 0.05.

MET, metabolic equivalent of task.

Data are presented as mean ± SD, median (interquartile range), or n (%).

Changes over time in groups were compared in terms of CSI scores, and statistically significant group × time interaction effects were observed for all variables except the incomplete evacuation, and large effect sizes (Partial η² > 0.14) were found (Table 2). In Table 2, all parameters except CSI-obstructive defecation, incomplete evacuation, were found to be similar in the massage and taping groups, and a statistically significant improvement was detected in these 2 groups compared to the control group. The improvement in CSI-obstructive defecation was seen most in the massage group and least in the control group.

Table 2 . Comparisons of Difference in Constipation Severity Instrument Scores (Interaction of Group × Time)

	Control group (n = 22)	Massage group (n = 22)	Taping group (n = 22)	P group(Partial η2)	P time(Partial η2)	P interaction(Partial η2)
CSI- Obstructive defecation
Pre-intervention	21.18 ± 3.55	22.50 ± 4.52	21.73 ± 4.19	0.277	< 0.001	< 0.001
Post- intervention	17.68 ± 4.06	12.82 ± 3.57	15.00 ± 4.02	(0.04)	(0.814)	(0.388)
Difference	–3.5 ± 2.09a	–9.68 ± 3.83b	–6.73 ± 3.53c
CSI-Colonic inertia
Pre-intervention	15.68 ± 3.59	17.36 ± 3.7	16.91 ± 4.59	0.502	< 0.001	< 0.001
Post- intervention	13.46 ± 4.22	10.41 ± 3.19	9.77 ± 3.38	(0.022)	(0.752)	(0.346)
Difference	–2.23 ± 1.57a	–6.95 ± 2.85b	–7.14 ± 4.48b
CSI-Pain
Pre-intervention	6.09 ± 4.29	8.73 ± 3.21	6 ± 3.09	0.05	< 0.001	< 0.001
Post- intervention	4.59 ± 3.29	3.55 ± 2.61	2 ± 1.93	(0.09)	(0.656)	(0.262)
Difference	–1.5 ± 1.95a	–5.18 ± 3.2b	–4 ± 2.62b
CSI-Total score
Pre-intervention	42.96 ± 8.74	48.82 ± 9.26	44.68 ± 9.43	0.315	< 0.001	< 0.001
Post- intervention	35.86 ± 9.53	27.23 ± 8.06	26.77 ± 7.89	(0.036)	(0.823)	(0.422)
Difference	–7.09 ± 4.26a	–21.59 ± 7.17b	–17.91 ± 9.68b
Defecation frequency (times/wk)
Pre-intervention	2.64 ± 1.23	2.14 ± 0.77	2.27 ± 0.99	0.445	< 0.001	< 0.001
Post- intervention	3 ± 1.02	4.18 ± 1.01	4.23 ± 2.33	(0.025)	(0.589)	(0.289)
Difference	0.36 ± 0.67a	2.05 ± 0.9b	1.95 ± 1.84b
Defacation duration (min)
Pre-intervention	19.18 ± 7.71	24.41 ± 7.51	18.77 ± 8.04	0.209	< 0.001	0.001
Post- intervention	15.14 ± 8.44	14 ± 5.9	12.39 ± 5.46	(0.049)	(0.627)	(0.194)
Difference	–4.05 ± 3.61a	–10.41 ± 5.73b	–6.39 ± 6.66b
Incomplete evacuation
Pre-intervention	0.82 ± 1.14	2 ± 1.07	1.36 ± 0.9	< 0.001	< 0.001	0.210
Post- intervention	0.41 ± 0.59	1 ± 0.69	0.64 ± 1	(0.201)	(0.307)	(0.048)
Difference	–0.41 ± 1.01	–1 ± 1.35	–0.73 ± 0.88

^a,b,cLettering indicates differences between groups. Different letters mean difference, same letters mean no difference. Analyses were made with two-way analysis of variance to compare variations in measurements among groups (P < 0.05).

CSI, constipation severity instrument.

Changes over time in the groups in terms of PAC-QOL scores were compared, and the group × time interaction effect was found to be statistically significant in all variables except the worries/concerns variable, and large effect size (Partial η² > 0.14) were found (Table 3). In table 3, all parameters except worries/concerns were found to be similar in the massage and taping groups, and a statistically significant improvement was detected in these 2 groups compared to the control group.

Table 3 . Comparisons of difference in Patient Assessment Constipation–Quality of Life Scores (Interaction of Group and Time)

	Control group (n = 22)	Massage group (n = 22)	Taping group (n = 22)	P group(Partial η2)	P time(Partial η2)	P interaction(Partial η2)
PAC-QOL-Physical discomfort
Pre-treatment	14.05 ± 2.9	16.73 ± 1.7	14.77 ± 2.39	0.321	< 0.001	< 0.001
Post-treatment	12.59 ± 3.14	10.32 ± 2.61	10.18 ± 3.3	(0.035)	(0.738)	(0.406)
Difference	–1.45 ± 2.32a	–6.41 ± 2.24b	–4.59 ± 2.97b
PAC-QOL- Psychosocial discomfort
Pre-treatment	21.36 ± 5.56	24.82 ± 5.54	22.73 ± 5.21	0.738	< 0.001	< 0.001
Post-treatment	18.86 ± 5.4	15.46 ± 3.84	15.59 ± 5.3	(0.01)	(0.705)	(0.327)
Difference	–2.5 ± 2.43a	–9.36 ± 4.7b	–7.14 ± 4.99b
PAC-QOL-Worries/concerns
Pre-treatment	34.5 ± 3.8	36.32 ± 4.56	33.18 ± 4.8	0.409	< 0.001	0.118
Post-treatment	30.86 ± 5.74	28.41 ± 6.63	28.55 ± 8.74	(0.028)	(0.38)	(0.066)
Difference	–3.64 ± 3.47	–7.91 ± 9.23	–4.64 ± 7.19
PAC-QOL-Satisfaction
Pre-treatment	16.46 ± 3.11	17.05 ± 2.95	16.46 ± 4.07	0.056	< 0.001	< 0.001
Post-treatment	14.59 ± 3.11	10.41 ± 2.65	11 ± 3.57	(0.087)	(0.663)	(0.272)
Difference	–1.86 ± 3.01a	–6.64 ± 3.62b	–5.45 ± 3.53b
PAC-QOL -Total score
Pre-treatment	86.36 ± 12.22	93.96 ± 11.21	86.41 ± 11.62	0.252	< 0.001	< 0.001
Post-treatment	76.91 ± 14.72	65.14 ± 11.19	65.55 ± 16.37	(0.043)	(0.706)	(0.281)
Difference	–9.45 ± 8.91a	–28.82 ± 16.48b	–20.86 ± 12.51b

PAC-QOL, patient assessment constipation–quality of life.

^a,bLettering indicates differences between groups. Different letters mean diference, same letters mean no difference. Analyses were made with two-way analysis of variance to compare variations in measurements among groups (P < 0.05).

The type of stool was the same across all 3 groups before treatment (P = 0.744). After treatment, the group with the highest return to normal stool type was the massage group (59.1% type 3 and 36.4% type 4), followed by the taping group (50.0% type 3 and 36.6% type 4), while the control group had the hardest stools (54.5% type 3 and 9.1% type 4) (P = 0.039). The perception of subjective improvement was greatest in the massage group, followed by the taping group, and least in the control group (P < 0.05, Table 4). Moreover, the patients’ compliance with lifestyle recommendations of the groups was similar (P > 0.05, Table 4).

Table 4 . Comparison of Perception of Subjective Improvement and Compliance With Lifestyle Recommedations of the Groups

	Massage group (n = 22)	Taping group (n = 22)	Control group (n = 22)	BG-P value
Perception of subjective improvement Worse + Same	1 (4.5)	4 (18.2)	8 (36.4)	0.031a
Better + Cured	21 (95.5)	18 (81.8)	14 (63.6)
Compliance with lifestyle recommendations (cm)	4.95 (5.00)	5.50 (3.58)	6.20 (1.40)	0.175b

^achi-square test.

^bKruskal Wallis test.

BG, between-group.

Significant at P < 0.05.

This study documented a reduction in constipation severity and improvement in bowel function and QOL in all groups. In constipation severity and QOL, large effect sizes were found in all parameters except incomplete evacuation and worries/concerns. Except for obstructive defecation, all parameters were similar in the massage and taping group and improved more than the control group. Furthermore, perception of subjective improvement and decreased stool hardness were ranked from highest to lowest in the massage, taping, and control groups.

Abdominal massage is generally recommended in the management of chronic constipation, however there are limited studies comparing the effects of massage compared to other methods.^10,24,27,28 Birimoglu Okuyan and Bilgili,²⁷ applied abdominal massage to one group and did not give any treatment to the other group. Abdominal massage has been found to be effective in the management of constipation and improving QOL. In the study of Doğan et al,¹⁰ it was found that constipation severity, bowel function and QOL improved more in the abdominal massage + advice group compared to the placebo therapeutic ultrasound + advice group. Nouhi et al²⁸ observed the positive effects of abdominal massage on stool type. Orhan et al²⁴ also applied abdominal massage to the first group, connective tissue massage to the second group, and standard bowel care to the third group with chronic constipation. There were similarly significant improvements in bowel symptoms and QOL in both groups treated with abdominal massage and connective tissue massage. In our study, large effect sizes were found in the massage group for constipation severity (excluding incomplete evacuation), bowel function and quality of life (except for worries/concerns). Additionally, obstructive defecation improved more in the massage group than in the taping and control groups. Stool type was normalized mostly in the massage group. The group with the best perception of subjective improvement was the massage group. The reason for these findings may be due to the reflex and mechanical effects of the massage and increased colon motility. According to these results, it should be encouraged to recommend abdominal massage as primary care for people with chronic constipation.

Kinesio taping is one of the common methods in physiotherapy and rehabilitation due to reduction of pain, regulating muscle function, and increasing circulation.¹³ Recently, it has been stated that Kinesio taping is used to improve internal organ functions.^16,29,30 However, there are a limited number of studies investigating the use of Kinesio taping in colorecto-anal problems.^12-14,16-18 Pyszora et al¹⁷ reported that as a result of Kinesio taping applied to a 62-year-old person with chronic constipation, there was an increase in defecation frequency and a decrease in the symptoms of abdominal distension with difficulty in defecation. Lee¹⁸ stated that Kinesio taping applied for 3 weeks in university students with constipation has a positive effective on bowel functions. Orhan et al¹⁶ investigated the effects of Kinesio taping and connective tissue massage on constipation and QOL in children with cerebral palsy. Consequently, it was found that both applications had similar effects in alleviating the constipation-related symptoms and improving QOL. In our study, it was determined that the constipation severity, bowel functions and QOL increased in the taping group. In addition, in the taping group, constipation severity (except of obstructive defecation), QOL improved more than the control group, similar to the massage group. The greatest reduction in obstructive defecation maintenance was found in the massage group, followed by the taping group. The improvement was least in the control group. These improvements may be due to the effect of Kinesio taping applied to the colon reflex region, which regulates myofascial tone and increases blood flow.²⁵ Adding Kinesio taping, which is an easy, non-invasive and safe method, to the treatment programs of individuals with constipation can enrich the programs and make them more effective in improving constipation symptoms and QOL.

Lifestyle recommendations are one of the first treatment options in individuals with chronic constipation. Although individuals are advised to increase their fluid intake to alleviate the symptoms of constipation, there is no high-quality evidence on this issue.¹⁵ Fujiwara and Nakata,³¹ in their study that included university students, stated that skipping breakfast increases the prevalence of constipation and negatively affects the QOL. In their meta-analysis, Yang et al³² reviewed randomized controlled trials involving adults and children and found that a fiber-rich diet increased the frequency of bowel movements in individuals with constipation compared to the placebo group. On the other hand, it was stated that increase in physical activity level was beneficial in terms of improvement of constipation in elderly individuals with physical inactivity and constipation symptoms.³³ Because of these reasons, the effects of lifestyle recommendations for constipation should be investigated.⁹ In this study, the effect size was found to be large in the constipation severity, bowel functions (except of incomplete evacuation), and QOL (except of worries/concerns) in the group that received lifestyle recommendations alone. However, improvements in all parameters (except for incomplete evacuation and worries/concerns) were greater in the abdominal massage and Kinesio taping groups than in the control group. According to these results, lifestyle recommendations are a treatment method that should not be neglected in the clinic.

The study had some limitations. First, practitioners were not blinded in this study. Second was that the colonic transit time method, recommended as an objective tool, was not used to determine colonic function. However, this impractical method is expensive and requires radiographic evaluation. Therefore, in this study, the Rome IV classification system was used in the diagnosis of chronic constipation. Third was that the long-term follow-up of the applications could not be presented. Fourth was that our study included women with both normal and slow transit time constipation. We did not eliminate them. Final limitation was that the average age of women was quite young. This may affect the generalizability of the study’s results. It may be important to pay attention to these issues in future studies.

In this study, all groups exhibited reduced constipation severity, improved bowel functions, and enhanced QOL. Abdominal massage had more positive effects on the severity of constipation and bowel functions than taping and lifestyle recommendations. In both massage and taping applications, the QOL increased more than the lifestyle recommendations. These approaches can be used as a conservative treatment method. Therefore, healthcare professionals should be aware that abdominal massage or Kinesio taping can be integrated into the management of constipation according to the symptoms of the patients. Future studies should investigate long-term effects and optimal treatment protocol.

We thank all the participants who participated in the study. This study was submitted as a abstract to the International Continence Society (ICS)-2023 and was accepted as an oral presentation. This congress will be held on 27-29 September 2023 in Toronto-Canada.

None.

None.

Yasemin Karaaslan and Seyda Toprak Celenay: concept development (provided idea for the research), design (planned the methods to generate the results), and critical review (revised manuscript for intellectual content, this does not relate to spelling and grammar checking); and Yasemin Karaaslan, Aysenur Karakus, Deniz Ogutmen Koc, Amine Bayrakli, and Seyda Toprak Celenay: supervision (provided oversight, responsible for organization and implementation, and writing of the manuscript), data collection/processing (responsible for experiments, patient management, organization, or reporting data), analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results), literature search (performed the literature search), and writing (responsible for writing a substantive part of the manuscript).