The goal of this clinical trial is to learn if a combined exercise and abdominal massage program improves bowel function and daily well-being in children with functional constipation. Researchers will compare this program with standard care by measuring bowel symptoms, rectal size, pelvic floor strength, trunk endurance, and quality of life.
Children aged 5-18 years
Diagnosed with functional constipation according to Rome IV criteria
Voluntary participation with written informed consent obtained from parents or legal guardians
Refusal to participate
Presence of congenital conditions (e.g., Down syndrome, Hirschsprung disease)
Endocrine or metabolic disorders (e.g., hypothyroidism, diabetes mellitus, diabetes insipidus)
Neurological or psychiatric disorders (e.g., spina bifida, cerebral palsy, autism spectrum disorders)
Parallel
Stretching, Strengthening, and Stabilization Exercises
Other interventionChildren will complete exercises to improve flexibility, muscle strength, and trunk stability.
Abdominal Massage (I Love You Technique)
Other interventionGentle abdominal massage will be applied following the colon pathway to support bowel movement.
Standard Care and Education
BehavioralChildren and their parents will receive education about bowel function and lifestyle guidance on diet, fluid intake, toileting habits, and physical activity.
Pelvic Floor Muscle Training
Other interventionChildren will practice fast and slow pelvic floor contractions to improve muscle strength and endurance.
Breathing Exercises
Other interventionChildren will perform simple diaphragmatic breathing exercises daily to support abdominal and pelvic muscle coordination.
Rectal Diameter (measured by ultrasound)
Rectal diameter will be measured using abdominal ultrasonography to assess rectal distension related to functional constipation. Measurements will be performed before the intervention and at the end of the eight-week program. Changes in rectal diameter will be used to evaluate the effectiveness of the combined exercise and abdominal massage program.
Constipation Symptoms (Rome IV Diagnostic Criteria)
Constipation symptoms will be assessed using the Rome IV diagnostic criteria for functional constipation, including bowel movement frequency, fecal incontinence, painful or difficult defecation, stool withholding behavior, and presence of large stools.
Bowel Function (Bowel Diary + Bristol Stool Scale)
Bowel function will be evaluated using a 7-day bowel diary including stool frequency and stool consistency (Bristol Stool Scale, Types 1-7). The diary will be completed for one week at baseline and for one week after the 8-week program.
Pelvic Floor Function
Pelvic floor muscle function will be evaluated using the Oxford Scale adapted for children. Muscle contraction strength will be graded during a clinical assessment.
Quality of Life (Visual Analog Scale)
Children's and parents' quality of life will be measured using a Visual Analog Scale ranging from zero to ten, with higher scores indicating greater impact of constipation on daily life.
Perceived Improvement (9-Point Patient Global Impression of Change Scale)
Perceived improvement will be evaluated using the 9-point Patient Global Impression of Change Scale. Parents will rate their child's overall change in constipation symptoms compared to the start of the study, with higher scores indicating greater improvement.
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Zeynep Idil Sevimli
Lead sponsor
Fizyofit Pilates Stüdyosu
Sponsor institution
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