Peer-reviewed article
Efficacy and safety of non-pharmacological treatments for paediatric functional constipation: a systematic review and meta-analysis.
Arruda Navarro Albuquerque D, de Geus A, Gordon M, Sinopoulou V, Khan MS et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review of 93 randomised controlled trials examined non-pharmacological treatments for constipation in children aged 0-18 years, involving nearly 7,800 children. Some treatments showed benefits: electrical stimulation combined with pelvic floor exercises improved treatment success and bowel frequency compared to exercises alone, and nerve stimulation had similar effects. However, most therapies provided very low certainty evidence, meaning conclusions cannot be drawn. The review highlights problems with study quality and reporting in this area, calling for better-designed trials.
Key points
- Abdominal transcutaneous electrical stimulation plus pelvic floor muscle exercises improved treatment success (RR 1.75) and defecation frequency (MD 1.85) compared with exercises alone, with moderate certainty
- Percutaneous tibial nerve stimulation plus pelvic floor exercises led to more treatment success (RR 1.73) and greater defecation frequency (MD 1.82)
- Behavioural therapy plus polyethylene glycol did not improve treatment success and probably reduced defecation frequency
- A substantial portion of therapies provided very low certainty evidence, limiting conclusions
- Poor reporting, imprecise data and substantial heterogeneity across studies weakened evidence quality assessments
Limitations
The review cannot determine effectiveness for most non-pharmacological treatments due to very low certainty evidence across many studies. No specific country data is provided, and the review does not address which treatments may be most suitable for different child ages or clinical contexts.
Abstract
Background Recent studies have expanded the evidence on novel and existing non-pharmacological treatments for paediatric functional constipation (FC). This study aimed to systematically review the efficacy and safety of non-pharmacological therapies for FC in children. Methods PubMed, MEDLINE, Embase, PsycINFO, Cochrane Library and trial registries were searched from inception to March 2025. Randomised controlled trials (RCTs), including children (0-18 years) with FC treated with non-pharmacological interventions compared with placebo, no treatment or other interventions, were included. Primary outcomes were treatment success, defecation frequency and withdrawals due to adverse events. Dual data extraction and appraisal was conducted. Certainty was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results 93 RCTs comprising 7787 children (50.4% female) were included investigating dietary, psycho-educational, physiotherapeutic interventions, various complementary and complementary medicine interventions, and electrical stimulation. A substantial part of the therapies provided evidence that was of very low certainty, meaning no conclusions could be drawn. Abdominal transcutaneous electrical stimulation plus pelvic floor muscle exercises (PFME) may improve treatment success and defecation frequency compared with PFME alone (risk ratio (RR): 1.75 (95%CI 1.25 to 2.44) and mean differences (MD): 1.85 (95%CI 1.28 to 2.43), moderate certainty). Percutaneous tibial nerve stimulation plus PFME leads to more treatment success (RR: 1.73 (95%CI 1.08 to 2.77), low certainty) and greater defecation frequency (MD: 1.82 (95%CI 0.82 to 2.82), moderate certainty). Behavioural therapy plus polyethylene glycol may not improve treatment success (RR: 0.83 (95%CI 0.62 to 1.12), low certainty) and probably reduces defecation frequency (MD: -1.80 (95%CI -2.88 to -0.72), moderate certainty). Conclusions Imprecise data, poor reporting and substantial heterogeneity led to downgrading in GRADE assessments. Some non-pharmacological treatment options for children with FC show beneficial effects, and these may be considered in the management of children. Future trials should aim to improve methodological rigour. Prospero registration number CRD42023416891.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Non-pharmacological treatments including dietary, psycho-educational, physiotherapeutic, complementary medicine interventions, and electrical stimulation
- Population
- 7,787 children (50.4% female) with functional constipation
Key finding
Abdominal transcutaneous electrical stimulation plus pelvic floor muscle exercises improved treatment success (RR 1.75, 95% CI 1.25-2.44) compared with exercises alone
D et al. · Europe PMC · 28 Jan 2026