Original article
Psychological profiles and quality of life differ between patients with dyssynergia and those with slow transit constipation

Portions of this work were presented at the 2005 Digestive Disease Week (Chicago, IL, USA) and published as an abstract in Gastroenterology (2005; 128: 783).
https://doi.org/10.1016/j.jpsychores.2007.05.016Get rights and content

Abstract

Background

Pathophysiological characteristics differ between slow transit constipation (STC) and dyssynergic defecation, but whether psychological profiles and quality of life (QOL) are altered and whether they differ among these constipation subtypes are unknown.

Methods

We prospectively evaluated psychological profiles and QOL in 76 patients with dyssynergia, 38 patients with STC, and 44 control subjects using the Revised 90-item Symptom Checklist and 36-item Short-Form Health Survey. In addition, we examined the correlations of psychological and QOL domains with constipation symptoms and pathophysiological subtypes.

Results

Symptom scores for hostility and paranoid ideation were higher (P<.001) in patients with dyssynergic defecation than in patients with STC and control subjects. Scores for other psychological domains were higher (P<.0001) in patients with dyssynergic defecation and those with STC than in control subjects. Most QOL subscores were impaired (P<.05) in patients with dyssynergic defecation and some were impaired in patients with STC as compared with control subjects, but the two patient groups did not differ on these. The QOL subscores were strongly correlated (rc≈.9) with the psychological subscores in patients with dyssynergic defecation and those with STC, although more QOL subscores among patients with dyssynergic defecation and more psychological subscores among patients with STC primarily contributed to the canonical correlations. A set of six commonly reported constipation symptoms showed significant correlations with QOL and psychological subscores, more so among patients with STC than among patients with dyssynergic defecation.

Conclusions

Patients with dyssynergic defecation had greater psychological distress and impaired health-related QOL as compared with patients with STC and control subjects. Both patient groups were also more affected as compared with the control group. There was a strong correlation between psychological dysfunction and impaired QOL, and both also correlated with constipation symptoms.

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.

References (34)

  • G Chiarioni et al.

    Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia

    Gastroenterology

    (2006)
  • PD Higgins et al.

    Epidemiology of constipation in North America: a systematic review

    Am J Gastroenterol

    (2004)
  • JE Everhart et al.

    A longitudinal study of self-reported bowel habits in the United States

    Dig Dis Sci

    (1989)
  • WE Whitehead et al.

    Constipation in the elderly living at home: definition, prevalence, and relationship to lifestyle and health status

    J Am Geriatr Soc

    (1989)
  • S Dykes et al.

    Chronic idiopathic constipation: a psychological enquiry

    Eur J Gastroenterol Hepatol

    (2001)
  • A Wald et al.

    Psychological evaluation of patients with severe idiopathic constipation: which instruments to use?

    Am J Gastroenterol

    (1992)
  • A Glia et al.

    Quality of life in patients with different types of functional constipation

    Scand J Gastroenterol

    (1997)
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