Original articlePsychological profiles and quality of life differ between patients with dyssynergia and those with slow transit constipation
Introduction
Chronic constipation affects between 12% and 19% of Americans and is regarded as one of the most common digestive complaints [1]. In addition to the physical illness, many affected patients exhibit psychological dysfunction [2], [3], [4], [5] and many have evidence of current or previous psychoaffective disorders [6]. Constipated patients with normal colonic transit have been shown to be more likely to (1) report psychological distress as compared with patients with slow transit constipation (STC) [7], [8], [9] and those with pelvic floor dysfunction [10] and (2) use antidepressants or receive psychiatric counseling [11]. In another study, the clinical outcome of surgery for chronic constipation was significantly influenced by the underlying psychology: patients with psychological dysfunction tended to have a poorer outcome as compared with those without it [12]. A recent study also described either defective or ineffective coping strategies in patients with functional constipation [13]. In contrast to these studies, one Canadian study found no correlation between psychological distress and stool frequency in patients with STC [14].
In two large population-based studies, patients with self-reported constipation had lower scores for quality of life (QOL) as compared with control subjects [15], [16]. In another study, patients with normal transit constipation had lower scores as compared with patients with STC [9], but patients with dyssynergia were not assessed. In a brief and uncontrolled survey, we observed that patients with dyssynergic defecation had some impairment of QOL [17].
Thus, whether psychological traits and QOL are altered in patients with dyssynergic defecation and whether they differ between patients with dyssynergia and those with STC have not been prospectively evaluated. We tested the following hypotheses:
- 1.
Constipated patients with dyssynergic defecation have greater psychological dysfunction and more impaired health-related QOL as compared with patients with STC and control subjects.
- 2.
There are strong correlations between psychological dysfunction and impaired QOL in constipated patients.
The aims of our study were to (1) evaluate prospectively and compare psychological profiles and QOL in patients with dyssynergic defecation, patients with STC, and control subjects and (2) correlate symptoms and pathophysiological subtypes with psychological profiles and QOL.
Section snippets
Methods
Consecutive patients referred to our tertiary care center with symptoms of chronic constipation and those who fulfilled the Rome II criteria for functional constipation [18] were eligible for participation in this study. Patients with secondary causes of constipation, including drug-induced constipation [19], and those with abdominal pain or discomfort and/or features suggestive of irritable bowel syndrome and constipation or significant comorbid illnesses, including those requiring previous
Demographics
There were 76 patients (7 males and 69 females) with dyssynergic defecation (mean age=43 years, age range=19–80 years, mean duration of symptoms=17 years), whereas there were 38 patients (2 males and 36 females) with STC (mean age=46 years, age range=20–79 years, mean duration of symptoms=19 years). Data on these patients were compared with those on 44 control subjects (9 males and 35 females, mean age=34 years, age range=18–65 years). Detailed analyses of our data showed that, except for the
Discussion
The objectives of this study were to assess, correlate, and compare psychological characteristics and health-related QOL in patients with dyssynergic defecation, patients with STC, and control subjects and to examine the influence of the underlying pathophysiology. This is the first study to have examined these features in patients with dyssynergic defecation.
Our study reveals that irrespective of the underlying pathophysiology, patients with chronic constipation had significant evidence of
Acknowledgments
This work was supported by the National Institutes of Health through Grant No. RO1 DK 57100-05 and by the National Center for Research Resources General Clinical Research Centers Program through Grant No. RR00059.
We thank Mrs. Heidi Vekemans for her superb secretarial support.
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