movements. IBS can be associated with recurrent abdominal cramping, pain, and/or a diarrhea-constipation cycle. IBS may be stress-induced or exacerbated (Mayo Clinic, 2023). In some cases, gentle clockwise abdominal massage may be helpful in reducing symptoms; deep therapeutic massage of the lumbar, gluteal, and thigh muscles may reduce referred pain. Treatments are typically focused on the relief of pain and normalization of bowel function. Individuals suffering from constipation can use fiber supplements to soften the stools, but this may result in excessive bloating and gas, increasing abdominal discomfort. Instead, laxatives are often used to soften and increase stool frequency. Individuals experiencing diarrhea may find loperamide (see subsequent discussion) offers some relief, reducing urgency and frequency of bowel movements (Mayo Clinic, 2023). Therapeutic massage, particularly abdominal massage, is helpful for individuals who suffer from IBS if they are suffering from the bloating, gassy, and constipation symptoms that are commonly associated with this condition. If patients are actively experiencing diarrhea, then you want to avoid the stomach altogether and make sure your patient knows that the bathroom is available to them at any point throughout their session. Crohn’s disease Crohn’s disease is a form of inflammatory bowel disease. It is categorized as an autoimmune disease, meaning that the body has developed an autoimmune response, thinking that there a foreign invader in the body. Instead of attacking a virus or foreign pathogen, it starts attacking its own tissue, particularly within the GI track (Crohn’s and Colitis Foundation, 2023). Obtain doctor’s approval before beginning any body work for an individual with Crohn’s disease. If approved, relaxing abdominal massage may be beneficial. Crohn’s disease can range in severity and symptoms but can affect anywhere in the GI system. Symptoms mostly present in the forms of abdominal pain and diarrhea. Fatigue, fever, anemia, arthritis, and skin rashes can also present themselves. Location, ethnicity, age, and genetics all affect the probability to be diagnosed with Crohn’s disease (Crohn’s and Colitis Foundation, 2023). There are many tests to diagnosis Crohn’s disease, including blood tests, stool samples, biopsies and colonoscopies. When diagnosed, people who suffer from Crohn’s disease can implement diet changes, lifestyle/stress management, introduce medications, or even undergo surgery to help reduce and control the symptoms from this condition. Unfortunately, there is no current cure (Crohn’s and Colitis Foundation, 2023). Gentle manual techniques can help with stress management for individuals with Crohn’s disease, and abdominal massage can help relieve stomach pains. Colic and constipation in infants Recent studies suggest that in infants with colic, abdominal massage is beneficial in dispersing gas, easing muscle spasms, and returning the digestive system to normal. Stimulation may also relieve constipation and assist digestion. Studies have shown that additional benefits of infantile massage include weight gain, and pain relief (Mrljak et al., 2022). Additionally, the benefits of a mother or father giving infantile massage to their child are not exclusive to the infant. Parents who regularly massaged their infant showed significant reductions in stress and anxiety, leading to a greater bond with the child, and reduction in post- partum depression (Dixon, 2023). As a manual therapist performing massage on an infant requires caution. Infants are fragile and strokes must be very delicate. It is highly recommended that before working with infant massage in a professional capacity that
Soft tissue work may be contraindicated in cases of esophagitis, gastroenteritis, gastritis, and/or hernia. In each case, have a consultation and approval by the doctor before performing manual interventions. With gastritis, it is best to avoid the immediate area of the stomach, but therapeutic massage of the thoracic and lumbar spine may bring relief. Light clockwise effleurage to the abdomen, to induce relaxation, may be beneficial for cases of gastroenteritis. Heartburn Heartburn is a very common GI condition that affects many Americans. It is characterized as a burning sensation in the chest, acid regurgitation, and stomach discomfort. It is a very treatable condition with both over-the-counter and prescription medications, as well as lifestyle and diet changes. Occasional heartburn is no cause for concern and is a common occurrence for many individuals who have consumed a new or spicy or greasy food. Chronic heartburn is described as symptoms that presents more than twice a week. When this point is reached, it is advised to talk to a doctor about long-term solutions. Chronic heartburn can also be characterized by difficulty swallowing, persistent nausea, and/or vomiting. With chronic heartburn, over-the- counter medications do not often suffice, and there can be significant weight loss due to inability to eat normally. Treatment can include both over-the-counter and prescription antacid medication, diet change, and lifestyle changes like reducing stress and eliminating alcohol and smoking. In more severe cases, a surgery on the esophageal sphincter is needed (Cleveland Clinic, 2023). Manual therapy doesn’t have any significant direct short-term benefits or contraindications for treating heartburn. However, it could be argued that the benefit of stress reduction from receiving regular therapeutic massage can contribute to help improve and prevent heartburn. Healthcare Consideration: When working with someone who is actively experiencing heartburn, do not apply manual pressure the upper abdominal area. Instead, downward effleurage may soothe the stomach and abdominal muscles. Peptic ulcers Peptic ulcers are ulceration of the mucosa lining of the stomach and more commonly the duodenum affecting about 1/10th of the U.S. population. The cause may be attributed to use of NSAIDS that include aspirin, ibuprofen, and naproxen. Infection with Helicobacter pylori ( H. pylori ) accounts for about 70-90% of the cases. They are characterized by symptoms of stomach pain and discomfort. Acid-peptic diseases include gastroesophageal reflux, peptic ulcers (gastric and duodenal), and stress-related mucosal injury. Ulceration or mucosal erosion occurs when caustic substances (like acid, bile, and pepsin) in the gastrointestinal tract overpower the defenses of gastrointestinal mucosa (mucus and bicarbonate secretions, blood flow, prostaglandins, and cellular regeneration after injury) (Harvard Health Publishing, 2014). Manual therapy of the affected area in individuals with peptic ulcers is contraindicated, although manipulation of the reflex areas of the lower spine and stress-reducing therapeutic massage may be useful. Require a doctor’s consultation and approval before performing manual techniques. Irritable bowel syndrome (IBS) Irritable bowel syndrome is a chronic, recurring disorder in which the individual experiences abdominal cramping and bloating with diarrhea, constipation, or both. Abdominal pain is usually associated with increased frequency of bowel
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