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Chronic Constipation Linked
to Anxiety and Depression

By Amy Norton

NEW YORK (Reuters Health) - Psychological well-being is known to be intertwined with gastrointestinal health, and new research suggests that women with chronic constipation are more likely to be anxious or depressed than women who don't have bowel problems.

In a study of 34 women with chronic constipation, UK investigators linked emotional distress with changes in the nerve pathway that helps control gut function. They say the findings suggest a specific path through which psychological factors directly influence the digestive system.

Dr. Anton Emmanuel and colleagues at St. Mark's Hospital in Middlesex report the results in the August issue of the journal Gut.

The researchers compared the patients--who had suffered bouts of constipation for an average of 21 years--with a group of women with no history of gastrointestinal illness. All took standard tests that measure psychological symptoms such as anxiety and depression, self-image, social functioning and ability to form intimate relationships. They also underwent ultrasound to gauge their rectal blood flow, a measurement of activity in nerves that run from the brain to the gut.

Women with chronic constipation were more likely than healthy women to report anxiety, depression and feeling less ``feminine.'' They also found it harder to form close relationships.

Moreover, the investigators found that the poorer a patient's psychological well-being was, the lower her rectal blood flow. As for healthy women, there was no link between blood flow and psychological factors--which, the researchers point out, was partly due to the fact that there was little variance in these measures among healthy women.

``We have shown a direct demonstrable link between certain aspects of central brain activity--anxiety, depression, feeling 'unfeminine'--and gut dysfunction,'' Emmanuel told Reuters Health.

These findings also echo existing evidence that patients with chronic constipation have higher rates of depression and anxiety, according to the researchers.

``These studies reinforce the importance of psychological treatments in some patients with constipation, rather than just relying on laxatives or enemas,'' Emmanuel said.

He noted that he and his colleagues have found in other research that psychological therapy improves both emotional health and bowel function in patients with chronic constipation. Specifically, he said, a behavioral therapy called biofeedback was shown to improve activity in nerve pathways to the gut.

SOURCE: Gut 2001;49:209-213.


Reference Source 89

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