Purpose: This study evaluated psychologic profiles, quality of life scores and parameters of anorectal physiologic function in patients with chronic, refractory constipation.
Methods: Thirty-one patients with constipation who were referred to the pelvic floor laboratory underwent anorectal manometry, including a balloon expulsion test, and completed the brief symptom inventory 53 (BSI-53) and the SF-36. Constipation was defined as 2 or fewer bowel movements per week and/or defecatory difficulty for at least 6 months. For comparison, 40 healthy volunteers completed the BSI-53 and the SF-36. Psychologic profiles and quality of life scores were also compared between constipated patients with evidence of pelvic floor dysfunction (defined as the inablility to pass a 60 ml. balloon spontaneously within 3 minutes) and constipated patients without pelvic floor dysfunction (PFD). For continuous variables, means were compared using the two-sample T-test. Categorical variables were analyzed using chi-square or Fisher's exact tests.
Results: The constipation group consisted of 31 patients (mean age, 44.5 ± 10.9 years; 87% female). There were 40 healthy controls (mean age, 42.0 ± 12.4 years; 85% female). The global severity index (GSI, a measure of overall psychologic distress) was higher in the constipation group vs. controls (62.3 ± 9.4 vs. 52.2 ± 8.6, p <0.001). For all scales of the SF-36, mean quality of life scores were significantly lower in patients with constipation compared to controls (p <0.01 for all comparisons). Within the constipation group, 4 patients were identified as having PFD (2 females; mean age, 42.8 ± 14.3 years). In the subgroup analysis comparing patients with evidence of PFD to patients with constipation alone (n = 27), there was no difference in the GSI. Significant differences were found between groups in the SF-36 subscales of role limitations (physical health and emotional problems) and social functioning (p <0.05).
Conclusions: Patients with constipation who were referred to the pelvic floor laboratory demonstrated lower overall quality of life (as measured by the SF-36) and significantly higher scores for psychologic distress (as measured by the GSI) when compared to controls. Further studies are needed to clarify whether psychologic distress contributes to symptoms of refractory constipation or results from chronic illness.