| |
Somatization
disorders may also be associated with constipation. It is part of the common experience
of clinicians that some people spend a lifetime worrying about their bowels without
apparent cause. This brings certain questions to mind:
- Are constipated patients
commonly psychologically abnormal?
- Should psychological tests
be included in the assessment battery for investigations of constipation?
The answer
probably depends on two factors:
- The length of the history
of constipation.
- The presence of accompanying
illness factors which are associated with the onset of constipation.
Patients who
have chronic complaints of constipation, but in whom no defect
of intestinal function can be found, have been reported to contrast
with those who have similar complaints but whose intestinal transit
time is found to be extended. Compared with the slow transit patients,
normal transit patients appear more likely to have an abnormal
psychological profile in terms of:
Figure
7.1 Comparison of Proportions of Patients With Psychiatric
History According to Confirmation of Diagnosis of
Constipation (Ashraf
et al., 1996)
|
|
|
Clearly
the effective therapies might differ between the two populations
of constipated patients, one centering on correction of bowel
motility and the other on educational and behavioral techniques.
Therefore, in a constipation study that was testing the efficacy
of a mode of treatment, it might be important to know how many
of each sort of patient was present in the group under investigation.
Such a study would need both subjective and objective measures
of constipation among its outcomes.
Note
that we are considering here otherwise healthy people who have
a chronic history of complaints of constipation. Among this group,
patients with normal transit may be quite common (10 out of 25
in the study by Wald
et al. Both groups had had symptoms for a mean of 10-15
years). Their symptoms may or may not be explained by abnormalities
of defecation.
The
situation among medically ill patients is different, in that few
have previously had persistent problems with constipation. Those
who have persistent problems can readily be identified by a screening
question. Unpublished observations by the author show significant
differences between palliative care patients’ reported rates of
constipation before and after the onset of their illness.
Table
7.2
|
|---|
Frequency
of constipation
| Before
illness
| Since
illness
|
|---|
| Always | 4
| 23
|
| More
than half the time | 7
| 27
|
| Less
than half the time | 4
| 20
|
| Rarely | 34
| 15
|
| Never | 44
| 8
|
| N
= 93 (45 male, 48 female) |
|
|