Nicole Cutler L.Ac.
Institute for Integrative Healthcare
When a healthy diet and exercise do not successfully relieve constipation for your clients, learn which massage techniques you can use to help relax their abdomen, reduce their discomfort and encourage regular defecation.
Constipation is one of the most common medical complaints in the United States, with many causes and manifestations. During an intake interview, clients will often report to their massage therapist that they are constipated. Sometimes, a client’s abdomen will be distended and tender, and further questioning by the therapist will reveal a history of constipation. At other times, a list of the client’s medications may help a therapist understand why there is frequent constipation. Massage therapists who are quick to identify this problem can perform a more therapeutic treatment by including constipation relieving techniques.
Constipation means different things to different people. Medically speaking, constipation is usually defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week.
The most frequent reasons people report being constipated include:
- Passing stool infrequently
- Passing hard stool
- Difficulty in passing stool – straining or pain
- A sense of incomplete emptying after a bowel movement
Acute vs. Chronic
It is important to distinguish acute from chronic constipation. Acute constipation requires urgent assessment because a serious medical illness may be the underlying cause, such as a tumor of the colon. Constipation also requires an immediate physician assessment if it is accompanied by worrisome symptoms including:
- rectal bleeding
- abdominal pain and cramps
- nausea and vomiting
- involuntary weight loss
In contrast, chronic constipation typically does not require immediate attention, particularly if simple measures bring relief.
Although constipation is rarely serious, it can lead to:
- bowel obstruction
- chronic constipation
- spastic colitis (irritable bowel syndrome, a condition characterized by alternating periods of diarrhea and constipation)
- laxative dependency
Theoretically, constipation can be caused by the slow passage of digesting food through any part of the intestine. However, more than 95 percent of the time the slowing occurs in the colon. Some of the more common causes of slow passage in the colon are:
- Certain Medications – see below for more specifics
- Urge Suppression – Bowel movements are under voluntary control. This means that the normal urge people feel when they need to have a bowel movement can be suppressed. Although occasionally it is appropriate to suppress an urge to defecate (e.g., when a bathroom is not available), doing this too frequently can lead to a disappearance of urges and result in constipation.
- Lack of Fiber – Fiber is important in maintaining soft, bulky stool. Diets that are low in fiber can cause constipation. The best natural sources of fiber are fruits, vegetables and whole grains.
- Laxative Overuse – An association has been shown between the chronic use of stimulant laxatives (e.g., senna, castor oil, and certain herbs) and damage to the nerves and muscles of the colon, which likely causes constipation.
- Hormone Imbalance –Hormones can affect bowel movements. For example, too little thyroid hormone and too much parathyroid hormone can cause constipation. High estrogen and progesterone levels, such as during menstruation or pregnancy, may also cause constipation.
- Diseases Affecting the Colon – There are many diseases that can affect the function of the muscles and/or nerves of the colon. These include diabetes, scleroderma, intestinal pseudo-obstruction, Hirschsprung’s disease and Chagas disease. Cancer or narrowing of the colon can block the colon, causing a decrease in stool flow.
- Central Nervous System Disorders – Several diseases of the brain and spinal cord may cause constipation, including Parkinson’s disease, multiple sclerosis and spinal cord injuries.
- Colonic Inertia – Colonic inertia is a condition in which the nerves and/or muscles of the colon do not work normally. As a result, the contents of the colon are not propelled through the colon normally.
- Pelvic Floor Dysfunction – Pelvic floor dysfunction refers to a condition in which the muscles of the lower pelvis that surround the rectum and are critical for defecation do not work normally.
Being able to recognize some of the medicines causing constipation can lead to a swift assessment for administering a bowel-helpful massage. Additionally, your client may not be aware that the drug they are taking may be contributing to their constipation. In this case, a client’s awareness of the connection can prompt him or her to discuss other options with his or her physician. Some of the most common offending medications include:
- Narcotic pain medications such as codeine (e.g., Tylenol #3), oxycodone (e.g., Percocet) and hydromorphone (Dilaudid)
- Antidepressants such as amitriptylene (Elavil) and imipramine (Tofranil)
- Anticonvulsants such as phenytoin (Dilantin) and carbamazepine (Tegretol)
- Iron supplements
- Calcium channel blocking drugs such as diltizaem (Cardizem) and nifedipine (Procardia)
- Aluminum-containing antacids such as Amphojel and Basaljel
Additional medication classes that may slow colonic function include anticholinergics, antihypertensives, bile acid sequestrants, calcium supplements and antipsychotics.
When proper eating and exercise fail to relieve constipation, various massage techniques can help relax the abdomen, reduce discomfort and encourage regular defecation.
- Acupressure – Applying gradual pressure on the acupressure point Conception Vessel 6 (three finger-widths below the navel) and Large Intestine 11 (at the outer edge of the elbow crease) can encourage bowel activity. Additionally, working on the stomach meridian from the foot up to the knee can relax and open up the colon.
- Essential Oil Massage – In her book Scentual Touch: A Personal Guide to Aromatherapy, Judith Jackson suggests adding six drops each of rosemary and thyme essential oils to one ounce of a carrier oil to massage the abdominal area up the right side, across the top and down the left in a circular motion.
- Reflexology – Working points relating to the lower back and tailbone on both feet and the solar plexus points on both hands can have a restorative effect on regular bowel movements.
The likelihood of seeing clients who experience occasional or regular constipation is very high. Because some people may not be direct in declaring their bowel habits, being familiar with its causes, including common medication culprits, can give the massage therapist a solid foundation for assessing constipation. Once you’ve uncovered some underlying defecation issues, you can choose from a variety of techniques to encourage bowel activity, including the three listed above. Being able to help your clients achieve a more balanced state of gastrointestinal health is a tremendous and valued therapeutic skill.