Pelvic floor dyssynergia and psychiatric disorders. Does the snake bite its tail?

Psychological and/or psychiatric disorders (PSY) and functional gastrointestinal disorders (FGID) are often linked. Pelvic floor dyssynergia (PFD) is one of the most frequent FGID, but few studies have investigated its possible relationship with PSY. The aim of the present study was to evaluate whether an increased prevalence of PSY, and of what types, exist in patients affected with PFD.

Thirty-four female patients PFD and 34 age- and gender-matched control subjects were evaluated. The prevalence rates of axis I psychiatric disorders (DSM IV) and of pathological temperaments (Schneider-Akiskal criteria) were determined.

PSY were detected in 29 patients (85.3%) and in 11 controls (32.3%), (p=0.000). A family load was present in 7 patients (20.6%) and in 2 controls (5.9%), (NS). Sixteen patients (47.0%) and no control subjects were diagnosed as having axis I psychiatric disorders (p=0.000); anxiety disorders were the most frequently represented condition. A pathological temperament was found in 28 patients (82.3%) (primarily the phobic-anxious temperament) and in 11 control subjects (32.3%),(p=0.000).

This study shows that there is a higher prevalence of PSY in PFD patients than in controls in particular, anxiety disorders and the phobic-anxious temperament. We would recommend that a psychiatric evaluation be carried out in patients with PFD, especially before starting rehabilitation therapy for obstructed defecation, as the presence of psychiatric disorders could alter the course and decrease the efficacy of such a rehabilitation program.