title: Differing coping mechanisms, stress level and anorectal physiology in patients with functional constipation.
abstract: OBJECTIVE
  To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls.
  
  
  METHODS
  Constipation was diagnosed by Rome II criteria. Coping ability and anxiety/depression were assessed by validated questionnaires. Transit time and balloon distension test were performed.
  
  
  RESULTS
  34.5% patients were classified as slow transit type of constipation. The total colonic transit time (56 h vs 10 h, P<0.0001) and rectal sensation including urge sensation (79 mL vs 63 mL, P = 0.019) and maximum tolerable volume (110 mL vs 95 mL, P = 0.03) differed in patients and controls. Constipated subjects had significantly higher anxiety and depression scores and lower SF-36 scores in all categories. They also demonstrated higher scores of 'monitoring' coping strategy (14+/-6 vs 9+/-3, P = 0.001), which correlated with the rectal distension sensation (P = 0.005), urge sensation (P=0.002), and maximum tolerable volume (P = 0.035). The less use of blunting strategy predicted slow transit constipation in both univariate (P = 0.01) and multivariate analysis (P = 0.03).
  
  
  CONCLUSIONS
  Defective or ineffective use of coping strategies may be an important etiology in functional constipation and subsequently reflected in abnormal anorectal physiology.
authors.affiliation: Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China. aoochan@hku.hk
authors.forename: Annie-Oo
authors.initials: AO
authors.lastname: Chan
authors.forename: Cecilia
authors.initials: C
authors.lastname: Cheng
authors.forename: Wai-Mo
authors.initials: WM
authors.lastname: Hui
authors.forename: Wayne-H-C
authors.initials: WH
authors.lastname: Hu
authors.forename: Nina-Y-H
authors.initials: NY
authors.lastname: Wong
authors.forename: K-F
authors.initials: KF
authors.lastname: Lam
authors.forename: Wai-Man
authors.initials: WM
authors.lastname: Wong
authors.forename: Kam-Chuen
authors.initials: KC
authors.lastname: Lai
authors.forename: Shiu-Kum
authors.initials: SK
authors.lastname: Lam
authors.forename: Benjamin-C-Y
authors.initials: BC
authors.lastname: Wong
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology; D003248:Constipation / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012007:Rectum / Q000503:physiopathology; D013315:Stress, Psychological / Q000453:epidemiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires