Abstract
Background: Functional constipation (FC) in children is characterized by infrequent bowel movements and straining or painful defecation, often accompanied by abdominal pain and fecal incontinence. Typically, in cases without organic pathology, it is diagnosed as this disease. When diagnosed according to Rome IV criteria, the global prevalence of this condition is 14.4%. Additionally, one study reported that in the UK, one in seven adults and one in three children suffer from constipation. In just one year (2018-2019), the National Health Service incurred £168 million in costs related to constipation, with over 175,000 hospital days consumed and numbers continuing to rise. Massage therapy is viewed as a promising treatment modality, though systematic evaluation evidence for its use in combination therapies remains insufficient. Research Objective: This study aims to systematically evaluate the efficacy and safety of tuina massage as an adjunct to conventional treatment for pediatric functional constipation through meta-analysis. Materials and Methods: Eight databases were searched to collect relevant randomized controlled trials (RCTs) from their inception to 23 January 2026. Primary outcomes included clinical total effective rate and BSFS score. Secondary outcomes comprised adverse reaction incidence, recurrence rate, defecation difficulty, and improvement in bowel movement frequency. Quality assessment was performed using the Cochrane Risk of Bias tool (RoB 2). Meta-analysis was conducted using RevMan 5.4 and Stata 13 software. Results: A total of 16 RCTs involving 1387 pediatric patients were included. Meta-analysis revealed that compared with conventional therapy alone, the combination of Tuina and conventional therapy significantly improved the overall clinical response rate (RR = 1.18, 95% CI 1.10 to 1.25, p < 0.00001; Tau(2) = 0.01), improved the Bristol Stool Form Scale (BSFS) score (MD = 0.55, 95% CI 0.32 to 0.78, p < 0.00001; Tau(2) = 0.05), and reduced the defecation difficulty score (MD = -1.36, 95% CI -1.75 to -0.98, p < 0.00001; Tau(2) = 0.18). However, substantial heterogeneity was observed across these outcomes (I(2) = 75%, 71%, and 96%, respectively). The 95% prediction intervals crossed the null value for all three primary outcomes (treatment success rate: 0.95-1.47; BSFS score: -0.25 to 1.35; defecation difficulty score: -2.85 to 0.13), indicating that the true effect may vary substantially across future study settings. Regarding recurrence, Tuina-assisted therapy resulted in a lower recurrence rate compared to conventional therapy alone (RR = 0.27, 95% CI 0.16 to 0.47, p < 0.00001). While improvements in weekly bowel movement frequency were reported, they could not be confirmed due to insufficient sample size. It remains unclear whether Tuina can mitigate adverse effects associated with control group treatments. Conclusions: Current evidence suggests that tuina as an adjunct to conventional treatment may offer improvements in treatment success, stool consistency, defecation difficulty, and recurrence rates in children with functional constipation. However, given the substantial heterogeneity (I(2) up to 96%), wide prediction intervals that crossed the null value for all three primary outcomes, methodological limitations of the included studies (e.g., lack of blinding, unclear randomization), and short follow-up periods (most ≤2 months), these findings should be interpreted as exploratory rather than definitive. Evidence on weekly stool frequency and adverse reactions remains inconclusive. High-quality, long-term trials with standardized outcome measures and rigorous blinding are needed to validate these preliminary findings.