Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 29:15:1565801.
doi: 10.3389/fcimb.2025.1565801. eCollection 2025.

Clinical efficacy of non-pharmacological treatment of functional constipation: a systematic review and network meta-analysis

Shufa Tan  1 , Chengtao Peng #  2 , Xin Lin #  3 , Chuanyue Peng  1 , Yunyi Yang  4 , Shuang Liu  1 , Ling Huang  5 , Yuhong Bian  1 , Yuwei Li  3 , Chen Xu  3
Affiliations

Clinical efficacy of non-pharmacological treatment of functional constipation: a systematic review and network meta-analysis

Shufa Tan et al. Front Cell Infect Microbiol. .

Abstract

Introduction: The purpose of this study is to compare the relative effectiveness and safety of non-pharmacological interventions for the treatment of functional constipation (FC).

Methods: We searched Pubmed, Embase, Cochrane, and Web of Science databases for randomized controlled trials published from 2010 to November 2024. The quality of the included studies was evaluated using the Cochrane bias risk tool and Review Manager 5.4, and the evidence was graded using GRADEPro. A network meta-analysis (NMA) was conducted using R Studio, and the surface under the cumulative ranking curve (SUCRA) was used to rank the included drugs for each outcome measure to compare the clinical efficacy of different treatment methods for chronic functional constipation.

Results: A total of 29 RCT studies were included, with a total of 4389 patients with functional constipation who were randomly assigned to receive placebo or one of the nine different non-pharmacological treatment methods. The assessment of bias risk showed that the bias risk of most included studies was low. The results showed that the first-ranked treatment method for clinical efficacy was acupuncture; the first-ranked treatment method for changes in spontaneous bowel movement (SBM) and complete spontaneous bowel movement (CSBM) was fecal microbiota transplantation (FMT); the first-ranked treatment method for changes in the Bristol Stool Form Scale (BSFS) score was FMT; the first-ranked treatment method for changes in the Patient Assessment of Constipation Quality of Life (PAC-QOL) score after treatment was the Vibration capsule; the first-ranked treatment method for changes in the Patient Assessment of Constipation Symptoms (PAC-SYM) score after treatment was percutaneous electrical stimulation; and the treatment method with the lowest incidence of adverse reactions was probiotics.

Conclusion: Based on the SUCRA values and NMA results, we found that FMT showed better effects and higher safety on BSFS scores, SBM, and CSBM. In addition, acupuncture showed a good clinical efficacy. We hypothesize that the combination of FMT and acupuncture may be an effective and safe treatment option for functional constipation, but further high-quality clinical studies are needed to confirm this.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024625747.

Keywords: chemical drugs; clinical efficacy; fecal microbiota transplantation; functional constipation; gut microbiota; network meta-analysis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Literature screening process.
Figure 2
Figure 2
Risk of bias for inclusion in randomized controlled trials.
Figure 3
Figure 3
Forest plot of clinical efficacy data for trial and control group participation. RR, Risk Ratio.
Figure 4
Figure 4
(a) network evidence; (b) rankogram figure.
Figure 5
Figure 5
Forest plot of placebo P compared with different interventions. (a) Overall response rate; (b) BSFS change; (c) SBM change; (d) CSBM Change; (e) PAC-QOL Change; (f) PAC-SYM Change; (g) Adverse event.
Figure 6
Figure 6
Heat map of network meta-analysis of different interventions for clinical cure rates in patients with constipation. **indicates statistical significance.
Figure 7
Figure 7
Heat map of network meta-analysis of each outcome index. (a) Overall response rate; (b) BSFS change; (c) SBM change; (d) CSBM Change; (e) PAC-QOL Change; (f) PAC-SYM Change; (g) Adverse event.
Figure 8
Figure 8
(a) network evidence diagram; (b) node analysis diagram; (c) rankogram figure.
Figure 9
Figure 9
Heat map of network meta-analysis of different interventions for BSFS scores in patients with constipation. **indicates statistical significance.
Figure 10
Figure 10
(a) network evidence diagram; (b) node analysis diagram; (c) rankogram figure.
Figure 11
Figure 11
Heat map of network meta-analysis of different interventions for SBM in patients with constipation. **indicates statistical significance.
Figure 12
Figure 12
(a) network evidence; (b) rankogram figure.
Figure 13
Figure 13
Heat map of network meta-analysis of different interventions for CSBM in patients with constipation. **indicates statistical significance.
Figure 14
Figure 14
(a) network evidence diagram; (b) node analysis diagram; (c) rankogram figure.
Figure 15
Figure 15
Heat map of network meta-analysis of different interventions for PAC-QOL in patients with constipation. **indicates statistical significance.
Figure 16
Figure 16
(a) network evidence; (b) rankogram figure.
Figure 17
Figure 17
Heat map of network meta-analysis of different interventions for PAC-SYM in patients with constipation. **indicates statistical significance.
Figure 18
Figure 18
(a) network evidence; (b) rankogram figure.
Figure 19
Figure 19
Heat map of network meta-analysis of different interventions for adverse event in patients with constipation. **indicates statistical significance.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Agirman G., Yu K. B., Hsiao E. Y. (2021). Signaling inflammation across the gut-brain axis. Science. 374, 1087–1092. doi: 10.1126/science.abi6087 - DOI - PubMed
    1. Airaksinen K., Yeung N., Lyra A., Lahtinen S. J., Huttunen T., Shanahan F., et al. (2019). The effect of a probiotic blend on gastrointestinal symptoms in constipated patients: a double blind, randomised, placebo controlled 2-week trial. Benef Microbes. 10, 617–627. doi: 10.3920/BM2018.0163 - DOI - PubMed
    1. Alavi K., Thorsen A. J., Fang S. H., Burgess P. L., Trevisani G., Lightner A. L., et al. (2024). The American society of colon and rectal surgeons clinical practice guidelines for the evaluation and management of chronic constipation. Dis. Colon Rectum. 67, 1244–1257. doi: 10.1097/DCR.0000000000003430 - DOI - PubMed
    1. Aminizadeh M., Tirgari B., Rashtabadi O. R., Jahani Y., Tajadini H. (2023). Effectiveness of auricular acupressure on constipation and related quality of life among the older people in the residential care home: a randomized clinical trial. BMC Geriatr. 23, 171. doi: 10.1186/s12877-023-03881-7 - DOI - PMC - PubMed
    1. Aziz I., Whitehead W. E., Palsson O. S., Törnblom H., Simrén M. (2020). An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev. Gastroenterol. Hepatol. 14, 39–46. doi: 10.1080/17474124.2020.1708718 - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources