What is the role of psychogenic factors in constipation and how are they approached?

Updated: Mar 30, 2020
  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD  more...
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Some cases of constipation may have a psychogenic component. On one hand, constipation is a frequent somatic expression of psychological distress; on the other, constipation itself may give rise to psychological disturbances.

A history of sexual abuse is observed with unusual frequency in patients who are chronically constipated, particularly those with anismus (dyssynergic defecation). A history of other psychological abnormalities is often found, particularly among patients whose constipation is refractory to medical treatment and have normal bowel transit times and normal results from anorectal studies.

Such factors should be gently explored in patients in whom first-line conservative treatment has failed. Psychiatric referral may be appropriate in such patients when medical evaluation and therapy have been exhausted or when gentle questioning reveals some unexpected information.

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