BACKGROUND: Functional constipation (FC) is a common global high prevalence issue in children. OBJECTIVE: The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment. METHODS: This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report. RESULTS: At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (p < 0.05). The dose of oral laxative in the intervention group decreased significantly (p < 0.05), however, no significant change was observed in the control group (p > 0.05). In the intervention group comparison, statistically significant differences were found in all va-riables except the Bristol stool form scale (p < 0.05). The Bristol stool form scale after treatments was not different when the groups were compared (p = 0.32), but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group (p < 0.05). CONCLUSION: VM can be considered as a possible treatment without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.

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