Evidence map›Paper›PMID 41605533›Full record

SynthesisBMJ paediatrics open2026

Efficacy and safety of non-pharmacological treatments for paediatric functional constipation: a systematic review and meta-analysis.

Daniel Arruda Navarro Albuquerque, Anna de Geus, Morris Gordon, Vasiliki Sinopoulou, Mohammad Sameerullah Khan, Aderonke Ajiboye, Shiyao Liu, Marc A Benninga, Merit Tabbers

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in BMJ paediatrics open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Daniel Arruda Navarro AlbuquerqueUniversity of Central Lancashire School of Medicine, Preston, UK.
Anna de GeusPeadiatric Gastroenterology and Nutrition, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands.ORCID http://orcid.org/0000-0002-2282-0128
Morris GordonSchool of Medicine, University of Lancashire, Preston, UK mgordon@lancashire.ac.uk.
Vasiliki SinopoulouSchool of Medicine, University of Lancashire, Preston, UK.
Mohammad Sameerullah KhanSchool of Medicine, University of Lancashire, Preston, UK.ORCID http://orcid.org/0009-0003-4353-2824
Aderonke AjiboyeSchool of Medicine, University of Lancashire, Preston, UK.
Shiyao LiuSchool of Medicine, University of Lancashire, Preston, UK.ORCID http://orcid.org/0000-0002-5245-1810
Marc A BenningaPaediatric Gastroenterology and Nutrition, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands.
Merit TabbersPaediatric Gastroenterology and Nutrition, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecent 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.

methodsPubMed, 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).

results93 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).

conclusionsImprecise 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.

Indexed as

ConstipationAdolescentChildChild, PreschoolComplementary TherapiesDefecationExercise TherapyHumansInfantRandomized Controlled Trials as TopicTranscutaneous Electric Nerve StimulationTreatment OutcomeChildGastroenterologyTherapeutics

Identifiers

PMID41605533
PMCPMC12853543

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.