10.4 Abdominal massage
The use of abdominal massage has been reported
by 22-30% of individuals with neurogenic bowel
dysfunction (Coggrave et al 2008, Han 1998).
Physiological studies have demonstrated that
massage produces a measurable response in the
rectum and anus (Coggrave et al 2007a). Regular
use of abdominal massage has been found to
reduce constipation in individuals with Multiple
Sclerosis (McClurg et al 2011). Massage is applied
to the abdomen following the usual lie of the colon
in a clockwise direction. Using the back or heel of
the hand or a tennis ball or similar, pressure is
applied and released firmly but gently in a
continuous progression around the abdomen.
Lighter stroking movements may also be used,
which may trigger somato-visceral reflexes.
Massage may be used before and after digital
rectal stimulation, insertion of stimulants or digital
removal of faeces to aid evacuation (Coggrave
2005). A recent review of the evidence found that
‘abdominal massage can relieve constipation of
various physiological causes by stimulating
peristalsis, decreasing colonic transit time and
increasing the frequency of bowel movements.
It reduces feelings of discomfort and pain, and
induces a feeling of relaxation. It has also been
found to improve patients’ quality of life (Lamas et
al 2011). However, evidence is still lacking in regard
to mechanism of action, required duration for
effectiveness, and which aetiologies respond to it.