Objective:

To examine whether adding repetitive transcranial magnetic stimulation (rTMS) to electroacupuncture (EA) at Baliao points leads to greater clinical improvement in patients with functional constipation (FC) compared to EA alone in a retrospective cohort study.

Approach:

• Study Design: Retrospective cohort study analyzing FC patients treated at a single hospital from February 2022 to March 2025.
• Participants: Patients were allocated to an observation group (rTMS combined with EA, n = 67) or a control group (EA alone, n = 75).
• Outcomes: Primary outcome was weekly complete spontaneous bowel movements (CSBMs); secondary outcomes included PAC-SYM, PAC-QOL, BSFS, and colonic transit time (CTT).
• Statistical Analysis: Longitudinal outcomes analyzed with linear mixed-effects models; confounding addressed by various statistical methods.

Key Findings:

• CSBMs increased more in the observation group (week-8 median 4.00 vs. 3.00; p < 0.001).
• Improvements in PAC-SYM, PAC-QOL, BSFS, and CTT were also greater in the observation group (all p < 0.001).
• A large response (≥3 CSBMs/week increase) was more frequent with combined treatment (67.2% vs. 17.3%; relative risk 3.87, 95% CI 2.30 to 6.53).
• Adverse events were mild and comparable between groups (22.39% vs. 18.67%, p = 0.583).

Interpretation:

The addition of rTMS to EA at Baliao points was associated with greater improvements in bowel frequency, symptom severity, quality of life, and colonic transit.

Limitations:

• The study was non-randomized and lacked a sham control and blinding.
• Findings should be interpreted as exploratory and hypothesis-generating.

Conclusion:

The findings suggest that combining rTMS with EA may enhance treatment outcomes for functional constipation, warranting further investigation in randomized trials.