Abdominal electrical stimulation, Cassia fistula emulsion, and cow’s milk exclusion may relieve childhood functional constipation, whereas probiotics and increased water intake show no benefit.
This systematic review identified randomized controlled trials of non-drug treatments for children with functional constipation that reported at least one outcome from the established core outcome set. The included studies assessed interventions targeting the gut microbiome, diet, oral supplements, pelvic floor function, electrical stimulation, dry cupping, and massage, with evidence synthesized through meta-analysis where comparable outcomes were available.
Abdominal electrical stimulation, Cassia fistula emulsion, and cow’s milk exclusion appeared effective, particularly when constipation may reflect cow’s milk allergy. Certain prebiotic and fibre mixtures, a Chinese herbal preparation, and abdominal massage also showed promise. Probiotics, combined probiotic-prebiotic products, increased water intake, dry cupping, and added biofeedback or behavioural therapy did not improve outcomes, while the overall evidence was limited by substantial risk of bias.
