Differences in Symptom Severity and Quality of Life in Patients With Obstructive Defecation and Colonic Inertia
Adriana B Chou1, Jessica N Cohan, Madhulika G Varma
11 Department of Surgery, University of California, San Francisco, San Francisco, California 2 Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California 3 Section of Colorectal Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California.
Background:
Little is known about how obstructive defecation and colonic inertia symptoms contribute to constipation-related quality of life.
Objective:
We sought to characterize the differences in quality of life in patients with severe obstructive defecation and colonic inertia symptoms.
Design:
This study was a cross-sectional analysis of a prospective database.
Setting:
Patients were enrolled at a single tertiary referral center.
Patients:
We included consecutive adults with severe symptoms of obstructive defecation (n = 115) or colonic inertia (n = 90) as measured by the Constipation Severity Instrument.
Main Outcome Measures:
The primary outcomes measured were the Pelvic Floor Distress Inventory, Constipation-Related Quality of Life instrument, Pelvic Floor Impact Questionnaire, and 12-item Short Form Health Survey.
Results:
Although physical examination and anorectal physiology testing were similar between groups, patients with severe obstructive defecation symptoms reported worse pain, distress, and constipation-specific quality of life than patients with severe colonic inertia symptoms (all p < 0.001). Specifically, patients with severe obstructive defecation symptoms showed greater quality-of-life impairment related to eating, bathroom habits, and social functioning (all p ≤ 0.01). Furthermore, patients with severe obstructive defecation symptoms had inferior global quality of life on the 12-item Short Form Health Survey physical component score (p = 0.03) and mental component score (p = 0.06).
Limitations:
The use of patient self-report instruments resulted in a proportion of patients with incomplete data.
Conclusion:
Quality of life was impaired in both groups of patients; however, patients with severe obstructive defecation symptoms were affected to a significantly greater extent. The fact that there were no differences in objective findings on physical examination or anorectal physiology studies highlights the importance of assessing quality of life during the evaluation and treatment of constipated patients.
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