Comparative effectiveness of multiple different non-pharmacologic interventions for post-stroke constipation: a Bayesian network meta-analysis

Your competent? doctor already has EXACT PROTOCOLS to prevent constipation, right. Oh no, you don't have a functioning stroke doctor, do you?

The incidence of constipation for stroke was 48%.  June 2017

 And your doctor was completely incompetent in not addressing this problem? Only 8+ years of total incompetence!

Do you prefer your doctor and hospital and board of directors' incompetence NOT KNOWING? OR NOT DOING?

 Comparative effectiveness of multiple different non-pharmacologic interventions for post-stroke constipation: a Bayesian network meta-analysis

Sisi Feng, Xinhui Wu, Xuemei Dai, Zhihao Liu, Yi Luo and Fei Wang*

Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China

Edited by

Yiming Meng, China Medical University, China

Reviewed by

Xin Cui, China Academy of Chinese Medical Sciences, China

Tao Jiming, Shanghai University of Traditional Chinese Medicine, China

Jieying Zhang, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, China

Remi Okwechime, University of Rochester Medical Center, United States

Duong Thi Huong Nguyen, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam

*Correspondence

Fei Wang, wangfei896@163.com

Received 11 March 2025

Accepted 16 September 2025

Published 10 October 2025

Citation

Feng S, Wu X, Dai X, Liu Z, Luo Y and Wang F (2025) Comparative effectiveness of multiple different non-pharmacologic interventions for post-stroke constipation: a Bayesian network meta-analysis. Front. Neurol. 16:1591620. doi: 10.3389/fneur.2025.1591620

Background: 

Post-stroke constipation (PSC) is a common complication among stroke patients, with a positive correlation to stroke severity. Straining during defecation in constipated patients can increase intracranial pressure, posing a high risk for secondary strokes, negatively impacting prognosis, disease progression, and contributing to the development of depression and anxiety. Non-pharmacological interventions (NPIs), including traditional Chinese medicine (TCM) and rehabilitation approaches, have been explored due to challenges in advancing Western medical treatments. However, the optimal treatment remains unclear, necessitating guidance for clinical practice. This research employs Bayesian network meta-analysis (NMA) to identify the most effective NPIs for improving clinical outcomes and alleviating constipation in post-stroke patients.

Methods: 

We conducted a NMA of randomized controlled trials to evaluate the relative efficacy of eight NPIs for PSC: acupuncture therapy (AT), acupoint catgut embedding (ACE), auricular therapy (ART), moxibustion (MT), abdominal massage (AM), point application (PA), physiotherapy (PT), and cognitive behavioral therapy (CBT). The primary outcome was the clinical effective rate (CER), and the secondary outcome was the Constipation Scoring System (CCS). To establish a comparative hierarchy of interventions, surface under the cumulative ranking curve (SUCRA) values were calculated, representing the probability of relative efficacy across treatments.

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Marijuana use linked with decreased constipation)

Results: 

A comprehensive literature review identified 53 clinical studies with 5,813 participants to evaluate the relative efficacy of eight NPIs. ACE ranked highest for both CER and CCS (SUCRA = 94.7, 97.8%), followed by PT (88.4, 81.7%). In contrast, ART and AM ranked lower, indicating relatively less efficacy compared with other interventions.

Conclusion: 

Acupoint catgut-embedding (ACE) may represent a potentially superior non-pharmacological intervention for improving clinical outcomes and reducing constipation severity in post-stroke patients. Physiotherapy (PT) also demonstrated favorable efficacy, ranking second in both clinical outcomes. However, further high-quality, multicenter clinical trials are needed to validate and refine these findings.

Keywords

post-stroke constipation; non-pharmacologic interventions; Bayesian network meta-analysis; alternative therapies; rehabilitation

Introduction

Post-stroke constipation (PSC) emerges subsequent to an acute cerebrovascular incident, featuring challenges in defecation and dry stools reminiscent of chestnuts. A pervasive complication post-stroke, it manifests universally across stroke types and stages, with an incidence ranging from 30 to 60% (1, 2). Stroke disrupts middle brain nerve conduction, hampering the defecation reflex. Dehydrating agents in initial treatment contribute to dry stools, while prolonged immobility and compromised limb movement decelerate peristalsis. Inadequate dietary fiber intake exacerbates constipation in stroke patients. Conversely, constipated individuals often employ breath-holding, heightening intracranial pressure a high-risk factor for stroke occurrence and potential craniocerebral injury (3). Moreover, prolonged fecal retention facilitates toxin entry into the bloodstream, diminishing nervous system function and impeding neurological recovery in stroke patients (4). This detrimental interplay significantly obstructs stroke rehabilitation, negatively affecting patients’ quality of life and intensifying depression and anxiety. Addressing constipation becomes integral to stroke treatment, emphasizing prevention and symptom alleviation.

In Western medicine, pharmacological interventions (PI) dominate constipation resolution (5, 6). However, these interventions carry numerous adverse effects and are prone to drug resistance. This not only increases patient discomfort but may also protract the disease course. A multinational study by Wald et al. (7), involving over 13,879 questionnaires, revealed persistent constipation in 20–40% of patients despite extensive laxative use. Recognizing the limitations of Western medicine, non-pharmacological interventions (NPIs), such as traditional Chinese medicine (TCM) and rehabilitation interventions, offer more promising avenues. This study comprehensively summarizes the advantages of NPIs for PSC, including acupuncture therapy (AT), acupoint catgut-embedding (ACE), auricular therapy (ART), moxibustion (MT), abdominal massage (AM), point-application (PA), physiotherapy (PT), and cognitive behavioral training (CBT). While advantages vary among these interventions, the absence of guidelines ranking their efficacy for PSC treatment introduces clinical confusion. To address this gap, we propose employing Bayesian network meta-analysis (NMA) to comprehensively analyze eight randomized controlled trials (RCTs) evaluating clinically used NPIs for PSC. Our aim is to identify an optimal protocol for guiding clinical practice, grounded in robust evidence and statistical inference.

Materials and methods

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extended statement guidelines (8). The study is registered under the International Prospective Register of Systematic Reviews (PROSPERO)1 with the registration number CRD42022377376. Given that all analyses were built upon previously published research, ethical approval and patient consent were deemed unnecessary for this investigation.