About 19 percent of North Americans suffer from constipation, with the digestive condition being more common among women, people of color, people over 60, those who are not physically active and the poor.
The costs are significant. Hospital costs to treat the condition were estimated at $4.25 billion in 2010 alone. Constipation can also lead to depression, lower quality of life and a drop in work productivity. Treatments include use of laxatives, increased intake of dietary fiber and fluid, and exercise.
But new research from the UCLA Center for East-West Medicine published online in the Journal of General Internal Medicine shows how Eastern and Western medicine can blend to find solutions to this common medical problem. In a randomized clinical trial, 72 percent of participants said that perineal self-acupressure, a simple technique involving the application of external pressure to the perineum -- the area between the anus and genitals -- helped them have a bowel movement.
The research suggests that all primary care and general internal physicians should consider this technique as a first line intervention together with conventional treatment, said Dr. Ryan Abbott, the study's principal investigator and a visiting assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.
"Constipation is very common and can have debilitating symptoms," said Abbott, who is also a researcher and educator with the East-West center. "But patients can perform this simple intervention themselves to treat their own constipation and improve their quality of life. It can also help to limit health care costs and excessive medication use."
The researchers recruited 100 patients, nine of whom dropped out during the trial, age 18 and older whom met the established criteria for functional constipation. Among these criteria are that they have fewer than three defecations per week and that for at least 25 percent of the their bowel movements they:
- Strain during defecation
- Have lumpy or hard stools
- Experience a sensation of incomplete evacuation
- Experience a sense of obstruction or blockage
- Use manual maneuvers such as digital evacuation
After researchers gave patients just three to five minutes of instruction, patients were encouraged to perform the exercises on their own for four weeks when they felt the urge to defecate. Patients reported using the technique three to four times a week on average. The self-acupressure broke up hard stools, relaxed muscles and stimulated nerves responsible for bowel movements.
Among the other findings:
- 72 percent said the technique helped them break up, soften or pass stools
- 54 percent claimed it helped avoid hemorrhoids or lessen the severity of existing hemorrhoids.
- 82 percent said they would continue using the technique
- 72 percent said they would recommend the technique to family and friends
"This unique self-administered acupressure treatment for constipation is just one example of how an integrative approach to medicine helps patients and is cost-effective, too," said Dr. Ka-Kit Hui, Wallis Annenberg Endowed Chair in Integrative East-West Medicine at UCLA and founder and director of the UCLA Center for East-West Medicine. "Utilizing both Eastern and Western approaches helps create a new paradigm of medicine that combines the best of both worlds."
There are some limitations to this study, the authors write. For instance, like all trials of behavioral interventions, this was not a blinded trial. The sample size was also relatively small, with fewer than 100 patients completing the study. Also, the researchers were uncertain whether the technique could prevent constipation or whether similar techniques would result in comparable improvements.
But the study does provide evidence that the technique could be useful in tandem with other treatments.
"As a non-invasive, non-pharmacological treatment intervention for constipation, perineal self-acupressure likely carries a lower risk for side effects and complications than commonly used medications such as stool softeners, fiber supplements, stimulants, laxatives and lubricants," the researchers write. "In addition, perineal self-acupressure may help to control treatment costs because it only requires a brief, initial period of training. Furthermore, not all patients respond favorably to existing treatment options, and perineal self-acupressure may represent an effective alternative to conventional treatment options."
Ryan Abbott, Ian Ayres, Ed Hui, Ka-Kit Hui. Effect of Perineal Self-Acupressure on Constipation: A Randomized Controlled Trial. Journal of General Internal Medicine, 2014; DOI: 10.1007/s11606-014-3084-6