Abdominal Massage: A Gut Feeling
You’ve just finished your cheat meal for the week, or perhaps you hate the idea of rewarding yourself with food like you’re a household pet, but regardless, for story-telling purposes, you’ve just finished a chipotle burrito with all the fixin’s and you’re feeling like maybe you shouldn’t have had that scoop of overpriced guacamole (yes, we know it costs extra!). You go home, stopping along the way to pick up Tums, Pepto Bismol, and Ginger Ale, because you think that despite the ridiculous amount of carbonation and sugar, that little bit of ginger flavoring is going to settle your stomach. You ingest the goods, wait for that bloating, rumbling, and cramping to go away, all the while swearing you’ll never eat that much again. Well, you and I both know that’s a lie, so this week’s MOTW is going to provide you with a manual technique known as abdominal massage, that you can perform when you finally admit that Ginger Ale isn’t gonna cut it, and that being stopped up like that is only good for hibernating bears.
As per always, a little anatomy lesson for you first. We’re going to focus on the large intestine, also known as the colon, as it’s at this region of the gastrointestinal (GI) tract that we can easily affect a significant amount of change without having exceptional palpation skills or an extensive medical background. The large intestine is about five feet in length and serves to absorb water and vitamins, causing solidifying of the feces. Yes folks, we’re going to be talking about poop, today. The large intestine gains its name from its larger diameter, as compared with the small intestine, which is four times as long but about a third of the diameter of the large intestine. The large intestine begins at the lower right side of the abdomen where it connects with the small intestine via the iliocecal valve. At this point the small intestine dumps its contents into a large pouch known as the cecum, which becomes the ascending colon. The large intestine travels up the right side of the abdomen (ascending colon), turns 90 degrees at the level of the diaphragm to traverse the abdomen (transverse colon), turns another 90 degrees at the spleen to descend the left side of the abdomen (descending colon), bends medially at the level of the left pelvic bone (sigmoid colon) and then straightens out to form the rectum which terminates at the anus.
The fecal matter moves through the large intestine via waves of musculature contractions known as peristalsis. When this peristalsis is slowed for whatever reason, more water is absorbed causing the stools to be firmer leading to constipation. While in the large intestine, feces also undergoes fermentation by bacteria, gas is produced, leading to bloating and flatulence. Abdominal massage seeks to replicate these waves of peristalsis and help the feces move through the large intestine. In folks who are really backed up, you can actually physically feel the fecal matter moving as you sequentially massage the sections of the large intestine.
To perform an abdominal massage you’re going to get into what we in the PT world call the hooklying position. In this position you’ll be on your back with your knees bent, feet flat on the supporting surface. The bent knees helps to relax the tissues of the abdomen so that you don’t need to press forcefully on your stomach in an attempt to get past those abs of steel. It should be noted that abdominal massage can be performed in any position, and I often recommend my patients perform it while sitting on the toilet. Lying on your back simply allows for improved general relaxation and increased excursion of the diaphragm.
Starting at the lower right quadrant of the abdomen just inside of the pelvic bone, using one or two hands, massage in small circles giving yourself as much pressure as you would use during a regular neck massage. Continue with these small circles and follow the path of the large intestine, moving up the right side of the abdomen, across the top of the abdomen at the level of the diaphragm (just below the ribs), and down the left side of the abdomen. When you get to the level of the left pelvic bone move centrally until you’re in line with the belly button, then head downward an inch or two. At this point you’ve traced the majority of the large intestine, sans lower portion of the rectum. From here, move your hand(s) to the lower right quadrant of the abdomen and start the journey all over again. Give yourself a good ten minutes or so of this abdominal lovin’. As previously stated, in folks suffering from constipation of any sort or those with just really full bowels you may actually be able to feel the stool move through the large intestine as you massage. Some tenderness around that lower left abdominal quadrant (sigmoid colon) is also not uncommon.
Check yo’self: This technique isn’t just for post-burrito indulgence situations. It’s a great technique I teach all of my patients with any sort of GI dysfunction and I’ve seen some fantastic results. The next time you find yourself bloated, constipated, or praying to the GI gods, try some abdominal massage. Focus on calm, even breathing and remember that you’re trying to massage your bowels, not locate your spine. Your body will thank you.
Howell, T. (2014) Visceral Functional Mobilization. Institute of Physical Art. Alexandria, VA. 22-24 August.