Efficacy of physiotherapeutic interventions in the management of functional constipation in pediatric and adolescent populations: a systematic review and meta-analysis.

Abstract

To evaluate the efficacy of physiotherapeutic interventions in the management of functional constipation (FC) in pediatric and adolescent populations, and to analyze the methodological quality of the available evidence. A systematic review of randomized controlled trials (RCTs) published in PubMed, Cochrane Library, Embase, and Web of Science was conducted (February-March 2025). Studies including participants aged 18 years diagnosed with FC, treated with pelvic floor physiotherapy versus conventional medical treatment, were included. Methodological quality was assessed using the PEDro scale (Physiotherapy Evidence Database). Seven clinical trials were included in the meta-analysis with sample sizes ranging from 45 to 400 participants (total n = 775). The interventions covered pelvic floor exercises, biofeedback, telerehabilitation, visceral mobilization, and electrostimulation. The majority showed improvements in painful defecation, fecal consistency, and quality of life, with less consistent results in defecatory frequency (MD = 1.00; 95% CI: 0.35 to 1.65). However, the marked heterogeneity in protocols (type, intensity, duration), variability in assessment instruments, and frequent co-intervention with polyethylene glycol (PEG) hinder comparison between studies and limit external validity. Follow-ups shorter than 12 months and the absence of blinding of participants and therapists constitute additional risks of bias.<h4>Conclusions</h4>Pelvic floor physiotherapy appears to be a promising adjuvant intervention in the treatment of pediatric FC, with positive effects on symptoms and quality of life. Nevertheless, multicenter trials with standardized protocols, large samples, and prolonged follow-up are required to confirm its efficacy and long-term sustainability.<h4>What is known</h4>•Despite the clinical use of physiotherapy, there was no quantitative synthesis integrating its efficacy against standard medical treatment, nor had its specific effect size on defecatory pain and quality of life been established in the pediatric population.<h4>What is new</h4>•This meta-analysis confi rms that pelvic fl oor physiotherapy is an eff ective adjuvant with a large effect size, demonstrating consistent improvements in reducing painful defecation and enhancing the biopsychosocial dimensions of quality of life.