Effect of Abdominal Massage on Constipation: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

BACKGROUND: Constipation is a common gastrointestinal disease that seriously affects quality of life. Although abdominal massage (AM) has shown some therapeutic effects in some clinical practices, high-quality evidence on AM treating constipation is still scarce. OBJECTIVE: This systematic review and meta-analysis aimed to thoroughly investigate the efficacy and safety of AM treatment for constipation. METHODS: According to the PRISMA guidelines, we searched the PubMed, Web of Science, Cochrane Library, Embase, and Scopus databases for English-language studies published up to July 2025. We searched for randomized controlled trials (RCTs) investigating AM for constipation and screened them according to predefined inclusion and exclusion criteria. The risk of bias was assessed using the Cochrane Collaboration tool (RevMan 5.30). Heterogeneity among trials was measured using the I2 statistic. Effect sizes were expressed as standardized mean difference (SMD) and 95% confidence intervals (CI). Additionally, sensitivity analyses, subgroup analyses, and meta-regression analyses were conducted to further explore sources of heterogeneity. RESULTS: A total of 25 RCTs published from 2009 to 2024 involving 1,508 subjects were included after screening, of which 19 were included in the meta-analysis. The overall risk of bias in the included studies was low. Our findings demonstrated that AM significantly improved constipation severity in patients with constipation (SMD = -1.64, 95% CI = [-2.26, -1.01], p < 0.00001); quality of life (SMD = -1.71, 95% CI = [-2.31, -1.11], p < 0.00001); number of bowel movements per week (SMD = 1.17, 95% CI = [0.70, 1.65], p < 0.00001); stool consistency (SMD = 1.2, 95% CI = [0.05, 2.36], p = 0.04); and pain intensity associated with constipation (SMD = -1.26, 95% CI = [-1.74, -0.77], p < 0.00001). Subgroup analyses further indicated that even short-term AM interventions may positively impact on patients with constipation. Additionally, regarding safety, most included trials did not report adverse events. CONCLUSION: AM is safe and effective in the treatment of constipation. Although the results of sensitivity analysis and subgroup analysis provide important guidance for clinical selection of AM treatment options, these results need to be interpreted with caution given the diversity of constipation etiologies.