A healthy gut flora and a healthy gastrointestinal system are critical in everyday living and it certainly affects the life of an individual. A condition known as constipation is one of the health issue that everybody face at least once or more in their life time. Primary or functional constipation is prevalent worldwide and it has a substantial negative impact on the quality of life of an individual. Although people usually think constipation is something trivial or too prevalent to consider it as a medical condition. However, when an individual is not able to have a bowel movement and pass out faeces everyday it’ll lead to a multiple health issues from minor condition like feeling bloated to moderate issue like fever to severe condition such as fecal impaction with vomiting. The purpose of this literature review is to study the effectiveness of acupuncture on primary constipation. Acupuncture has gaining popularity as an alternative and complementary treatment method from western drugs and over the counter products. Therefore, we will search through the database to find the most common and effective acupuncture points used for functional or primary constipation with evidence based studies.
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A comprehensive search of Pubmed and EBSCO will be conducted to identify studies for primary constipation. The search strategy is using three key words (1) “acupuncture” AND “functional constipation”; (2) “acupuncture” AND “primary constipation”. Limitation selected were human species only, English for language, and most recent 5 years research studies.
Keywords: Acupuncture, Constipation
Constipation is a very common symptom that almost everyone has experienced in their lifetime. Chronic constipation will greatly affect the quality of life of an individual. Constipation is divided into functional or primary constipation and secondary constipation. Functional constipation (FC) is a common functional gastrointestinal disorders, defined as hard or lumpy stools, infrequent bowel movements, a feeling of incomplete evacuation after a bowel movement, straining during defecation that does not meet the IBS criteria, bloating, and abdominal discomfort.1,2 Secondary constipation, such as crohn’s disease, ulcerative colitis, and colon cancer, involves anatomical and physiological issues that may need surgery and drugs for treatment. This literature review will focus on functional constipation only.
According to epidemiological data, the prevalence of functional constipation in the population is 12%-19% in USA, 19.2% in Europe, 19.7% in Oceania, and 14% in Asia.3,4 In United States, consultations for constipation account for 2.5 million visits per year.5 The mean annual cost per patient with constipation is estimated to be $7,522.6 In 2010, over $850 million dollars were charged in relation to hospitalization due to constipation as primary diagnosis. 7 It is a considerable financial burden on top of negative quality of life from symptoms of constipation. Treatments for constipation usually include stool-softeners, osmotic & stimulant laxatives, dietary fiber supplements, and sometimes enemas for refractory constipation. Common drugs include lactulose, polyethylene glycol, inaclotide, lubiprostone, bisacodyl, prucalopride, and tegaserod.5 As current symptomatic treatments produce unsatisfactory responses or intolerable side effects by patients, many of them turn and seek help from alternative medicine. Many scientific studies have used acupuncture as an effective method to treat acute and chronic constipation with less side effects.
Acupuncture is an ancient healing art dated back to more than 3,000 years ago. The start of acupuncture in the US dates back to the 1970’s and the Nixon era in particular. It is documented that in 1972 a journalist for the New York Times, James Reston, accompanied President Nixon’s Secretary of State, Henry A. Kissinger, to China. During the trip in China, James Reston had an emergency appendectomy in a Chinese hospital. Doctors used acupuncture to relieve his pain. Amused and impressed with the effectiveness of acupuncture treatments, James Reston wrote about his hospitalization and acupuncture in the New York Times. That article exposed countless Americans for the first time to acupuncture. From there, the popularity of acupuncture grew in linear direction. For this reason, more and more scientic experiments were performed and scientific studies were published. Different types of scientific methods and studies were defined and established by the western world. Therefore, in order to promote acupuncture to be “scientific” and head towards the main stream, we must have research articles that have large enough sample size, randomized, controlled, non biased, good methodology, and with consistent results. Most importantly, the studies are published in English. We don’t need to prove TCM in Asia because it’s proven over 3000 years with countless of human lifes.
II. MATERIALS AND METHODS
Literature searches were conducted in three electronic medical databases: PubMed, Hindawi, and EBSCO. The search strategy was to use 3 key words (1) “acupuncture” AND “functional constipation”; (2) “acupuncture” AND “primary constipation” returned a total number of 383 articles. This review will only focus on studies conducted in humans and English-language articles.
For PubMed which consists of medline, pubmed central, and bookshelf, a total of 81 articles appeared with method (1) and 41 articles with method (2). Limitation on ‘Article types’ is set as randomized controlled trial only, ‘Text availability’ set as free full text, and ‘Publication dates’ set as within 5 years, 2015 -2019. Also, only human species and articles in English were selected. In the end, there were 4 articles available by method (1) and 6 articles available by method (2). However, in method (2), 3 out of 6 articles are duplicate and other 3 articles are secondary constipation. A total of 4 articles found in the end.
For EBSCO, alternative healthwatch and medline with full text were used for search. Search criteria will remain consistant with PubMed. Limiters available for EBSCO are full text, publication dates within 5 years, language set in English, and only human species is considered. The only issue for EBSCO is selecting article type is not available. Therefore, it has to be done manually by reading the subject heading and abstract from each research article. Method (1) generated 10 articles and method (2) generated 6 articles. However, in method (2), all 6 articles are included in the 10 articles found by method (1). A total of 6 articles found in the end.
- Effectiveness of acupuncture treatment for primary or functional constipation
- Randomized Controlled Trials (RCTs)
- Must have full text and free for public
- Years of publications: 2015-2019
- English language
- Human subject
- Secondary constipation
- Chinese Herbs
- Clinical trial on single gender
- Secondary analysis on randomized control trials
PubMed: n = 122
a.“acupuncture” and “functional constipation” n = 81
b. “acupuncture” and “primary constipation” n = 41
EBSCO: n = 129
a.“acupuncture” and “functional constipation” n = 84
b. “acupuncture” and “primary constipation” n = 45
Citations from database:
n = 251
Excluded articles: n = 225
- Randomized Controlled Trials
- Free full texts
- Within 5 years
Included articles: n = 26
Not Related articles: n = 7
Duplicates: n = 9
Exclusion Criteria: n = 5
Articles included in review:
n = 5
Figure 1. Flow Diagram of Research Procedures
The search process and studies included are shown in Figure 1. Initially, a total number of 251 articles were collected from PubMed and EBSCO database. After selecting five limitation criteria the number of research papers condensed to 26 articles. Nine articles were duplicates and seven articles were not related to constipation directly, ie. Bowel diseases, after manual comparison by reading. Finally, in order to keep the core of this literature review simple and straight foreward, I further limit the intervention to no moxa and herbal formulas. One of the article consist female gender only which I believed was biased. Secondary constipation due to crohn’s disease or ulcerative colitis for example were excluded. Research articles contained secondary analysis on randomized controlled trials did not show any acupuncture points for the treatment so it did not fit the objective of this literature review. Thus, it was not considered. In the end, five excellent articles met the requirements.
Alphabetical order in the end!
- Wald, A. (2016). Constipation: Advances in diagnosis and treatment. JAMA, 315(2), 185-191. Retrieved from https://jamanetwork.com
- Pare, P., Ferrazzi, S., Thompson, W.G., Irvine, E.J., & Rance, L. (2001). An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol, 96, 3130-3137.
- Xu, X., Zheng, C., Zhang, M., Wang, W., & Huang, G. (2014). A randomized controlled trial of acupuncture to treat functional constipation: Design and protocol. BMC Complementary & Alternative Medicine, 14, 423. Retrieved from http://www.biomedcentral.com
- Zeng, Y., Zhang, X., Zhou, J., Wang, X., Jiao, R., & Liu, Z. (2018). Efficacy of electroacupuncture compared with transcutaneous electric nerve stimulation for functional constipation. Medicine, 97(19), e0692.
- Zhu, L., Ma, Y., & Deng, X. (2018). Comparison of acupuncture and other drugs for chronic constipation: A network meta-analysis. PLoS ONE, 13(4): e0196128.
- Nyrop, K. A., Palsson, O. S., Levy, R. L., Korff, M. V., Feld, A. D., Turner, M. J., & Whitehead, W. E. (2007). Costs of health care for irritable bowel syndrome, chronic constipation, functional diarrhoea and functional abdominal pain. Alimentary Pharmacology & Therapeutics, 26(2), 237-248.
- S. Sethi, S. Mikami, J. Leclair et al., “Inpatient burden of constipation in the United States: an analysis of national trends in the United States from 1997 to 2010”, The American Journal of Gastroenterology, vol. 109, no. 2, pp. 250-256, 2014.
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