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 Researchers focused on 53 school-age kids with what’s known as
functional constipation, a common childhood problem that can be
caused by psychological or neurological issues. This type of
constipation isn’t due to physical or hormonal issues that make
bowel movements difficult.
All of the kids received standard care for constipation, which
included toilet training, education and laxatives. A subset of 27
children chosen at random also got physical therapy.
After six months, 92 percent of the participants in the physical
therapy group no longer had functional constipation, compared with
63 percent of the kids who didn’t get physical therapy, researchers
report in Gastroenterology.
“While most people associate ‘muscles’ with ‘strength’, they do more
than assist in lifting heavy objects,” said lead study author
Marieke van Engelenburg – van Lonkhuyzen, a researcher at Maastricht
University in the Netherlands.
Children with functional constipation may have weak pelvic floor
muscles from poor posture or sitting in an awkward, unstable
position on an adult-size toilet seat, she said by email.
The pelvic floor muscles work closely with the diaphragm, lower back
muscles and abdominal muscles to support the spine and stabilize the
digestive system. When the pelvic muscles don’t work optimally, kids
can struggle to control bowel movements.
“Effective, voluntary and involuntary, contraction and relaxation
must be present when passing urine or feces on the toilet, to avoid
dysfunctional voiding or constipation,” she added.
To assess the potential for exercise to ease constipation by
improving posture and pelvic muscle strength, researchers offered
physical therapy to half of the kids aged 5 to 16 years who
participated in the study.
At the start of the experiment, 42 percent of the kids had bowel
movements less than three times a week and more than half of had
stools that were unusually hard, large or painful. All but one of
them had been prescribed laxatives.
Standard care for all of the kids included counseling with children
and their parents to address any myths or fears about going to the
bathroom, advice on the need for fluids and a fiber-rich diet, and
instructions on the best timing and habits for attempting to use the
toilet.
In addition, kids assigned to physical therapy practiced proper
posture on the toilet and did exercises to teach awareness of
sensations that indicate a need to defecate and effective muscle
contracting and relaxing for easier bowel movements.
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One limitation of the study is that many parents didn’t consent to
have researchers do rectal exams to test the strength of children’s
pelvic floor muscles before and after treatment, the authors note.
As a result, researchers didn’t have enough data to determine how
exercises may have influenced muscle function.
Some children may be able to resolve constipation with standard
therapy, as happened with a subset of kids in the study, noted
Jennifer Verrill Schurman, a researcher at University of Missouri -
Kansas City School of Medicine who wasn’t involved in the study.
“However, if constipation has persisted for a period of time, if the
child has shown behavioral signs of withholding stool or routinely
postponing defecation, or if a child seems unable to have a bowel
movement even when they are sitting on the toilet and appear to be
trying, these are indications that moving forward with at least an
evaluation for pelvic floor physical therapy as part of initial
treatment may be warranted,” Verrill Schurman said by email.
“Most of the kids in the current trial had issues with functional
constipation for longer than 6 months, and many evidenced at least
some of these behavioral associations, which may help to explain why
physiotherapy enhanced standard treatment to the degree observed,”
she added.
SOURCE: http://bit.ly/2d8C4Yw Gastroenterology, online September 17,
2016.
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