Constipation, which includes rectal evacuation disorders, slow transit constipation, and IBS to name a few is one of the most common gastrointestinal disorders worldwide (1,2). The complexity of constipation and its impact on a person’s health and quality of life is often misunderstood and common treatment strategies such as diet, exercise, hydration, and stress management can be an oversimplification of what is necessary to effectively manage the disorder (1). From a rehabilitation lens, it is pivotal to prioritize the function of the nervous system when developing a treatment strategy for constipation, considering the nervous system is the central control mechanism of all functions and processes in the human body.

Dry needling, specifically, dry needling with electrical stimulation, is one of the most impactful tools we have in rehabilitation to improve the health and function of the nervous system. Dry needling has evolved from a procedure that utilizes a monofilament needle to deliver mechanical input into “trigger points” in muscle tissue to include the use of a monofilament needle for the delivery of electrical stimulation, which is often described as percutaneous electrical stimulation or neuromodulation. The use of electrical stimulation with dry needling can have a profound effect on improving the healing capacity of tissues and the overall functional recovery of the human body primarily due to the impact it has on the nervous system. Therefore, we must have a sound understanding of the neuroanatomy and physiology of any region of the body and the associated dysfunction to effectively develop and implement a treatment plan.

The gastrointestinal system is considered the most complicated system in our body in terms of the number of structures involved in function and regulation and the enormity of neurons that innervate the gastrointestinal tract, and it is yet to be fully understood (3). The enteric nervous system, which is commonly considered the third branch of the autonomic nervous system, is at the center of regulatory control of the gastrointestinal (GI) tract and precisely coordinates the function of GI neurons, glial cells, macrophages, interstitial cells, and enteroendocrine cells which drives gut motility and secretions (3). It is interesting to note that the sophistication of the enteric nervous system allows the GI tract to be able to function independently of any neural inputs from the central nervous system (3,4). However, normal physiologic functioning of the GI tract is influenced by bidirectional neuronal connections between the enteric and central nervous systems which is known as the “brain-gut-axis” (3).