{"paper_id":"04f39cca-6c94-4f6a-b841-dafc2b1ee9da","body_text":"Alteration of defecation function and psychological status in slow transit constipation patients after surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Alteration of defecation function and psychological status in slow transit constipation patients after surgery Zhanwei Fu, Pei Xue, Xuan Zhao, Junjun Ma, Minhua Zheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9239023/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objective To investigate anxiety and depression status in slow transit constipation (STC) patients and the alteration of psychological status after surgery, and to find the relationship between constipation and psychological status. Methods A total of 63 STC patients who received total abdominal colectomy with ileorectal anastomosis (TAC-IRA) were selected. Defecation function, psychological status and quality of life of patients were collected by questionnaires before surgery and 6 months after surgery. Defecation function was evaluated by Wexner score; psychological status was evaluated by self-rating anxiety scale (SAS) and self-rating depression scale (SDS). gastrointestinal quality of life index (GIQLI) was used to evaluate the quality of life. Results There were 42.9% and 57.1% of STC patients in different degrees of anxiety and depression before surgery, and the proportions decreased to 21.6% (p = 0.048) and 54.1% (p = 0.341) after surgery, respectively. Through paired sample T test, Wexner score (p < 0.001) and SAS score (p = 0.0095) were significantly decreased, GIQLI score was significantly increased(p < 0.001). SAS score showed a positive correlation with Wexner score before and after surgery, SDS score showed a positive correlation with Wexner score before surgery, while GIQOL score and Wexner score showed a negative correlation before and after surgery, and all correlation above was statistically significant. Conclusion The severity of constipation is closely related to anxiety, depression. Patients' defecation function, quality of life, anxiety and depression were significantly improved after effective surgical treatment. slow transit constipation total abdominal colectomy anxiety depression Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Constipation is one of the most prevalent gastrointestinal symptoms, with a worldwide prevalence of 15% [ 1 ] . It can be categorized into primary constipation (also known as functional constipation, FC) and secondary constipation. Based on the underlying pathophysiological mechanisms, FC can be further classified into slow transit constipation (STC), normal transit constipation, dyssynergic defecation, and mixed constipation[2]. STC is characterized by significantly prolonged colon transit time and accounts for approximately 22% of FC patients [ 3 ] . For patients with poor response to long-term medical treatment, surgery offers an effective approach to alleviate symptoms and enhance quality of life [ 4 ] . For STC patients, total abdominal colectomy with ileorectal anastomosis (TAC-IRA) currently stands as the most efficacious surgical intervention for intractable constipation (IC) [ 5 ] . Its postoperative relief rate for constipation reaches 100%, while its long-term effectiveness and patient satisfaction rates exceed 90% [ 6 , 7 ] . In clinical practice, there exists a significant correlation between constipation and psychological disorders, with the incidence of depression and anxiety being notably higher in constipated patients than in the general population [ 8 ] . A retrospective study revealed that anxiety and depression were relatively prevalent among constipated patients at 33.3% and 31.5%, respectively [ 9 ] .Furthermore, several studies have indicated that constipation patients with psychological disorders face challenges in achieving satisfactory treatment outcomes [ 10 ] . However, there is insufficient evidence to support the use of surgical intervention in a significant proportion of constipation patients with comorbid psychological disorders, whose symptoms persist despite long-term medication. Therefore, further clinical research is needed to clarify the effectiveness of surgical treatment for this specific subgroup of patients suffering from both constipation and psychological disorders. This study aims to explore the prevalence of anxiety and depression in patients with STC, compare the levels of anxiety and depression before and after surgery, and provide a clinical basis for surgical interventions in constipation patients complicated by psychological disorders. Methods In this study, a total of 92 patients with STC constipation who received TAC-IRA surgery at the Department of Gastrointestinal Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2023 to June 2025 were included. The surgical procedures were performed by an experienced team specializing in constipation surgery, encompassing the entire colon from the distal ileum to the upper rectum, followed by ileorectal anastomosis [ 11 ] . Questionnaires assessing defecation function score, anxiety score, depression score, and quality of life score were administered to all patients before surgery and again at the 6-month postoperative follow-up. This study was registered on ClinicalTrial.gov (ChiCTR20000036473) on 2020, and was approved by the Medical Ethics Committee of Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine(2020245Y). Preoperative written informed consent was obtained from all participating patients, and this study was conducted in accordance with the Declaration of Helsinki 1964. The inclusion criteria of this study were as followed: Preoperative evaluation meeting the diagnostic criteria for Rome IV functional constipation [ 12 ] : ①Presence of two or more symptoms in over 25% of bowel movements or weeks including a. difficulty in defecating; b. Bulky or hard bowel movements; c. Sensation of incomplete evacuation; d. Sensation of anal rectal obstruction and blockage; e. Needing manual assistance for defecation; f. Spontaneous bowel movements less than 3 times per week. ②There is almost no loose stool without laxatives. ③ It is not enough to diagnose irritable bowel syndrome (IBS). The symptoms existed for at least 6 months before diagnosis, and the symptoms met the above diagnostic criteria in the past 3 months; Patients who received TAC-IRA surgery without ileostomy. Complete medical history and data available with successful completion of at least six months' follow-up after the operation. The exclusion criteria of this study were as follows: 1) Identification of secondary constipation patients with clear etiology.; 2) refusal to accept follow-up or missing follow-up patients; 3) Patients unable to independently complete questionnaires; 4) Cases of missing questionnaire information. The basic clinical data of enrolled patients were collected through our center's constipation patient database, including age, gender, and history of psychological illness. Defecation function score, psychological status score, and quality of life score were assessed as follows: defecation function was evaluated using the Wexner score; psychological status was assessed using the self-rating anxiety scale (SAS) and self-rating depression scale (SDS); quality of life was assessed using the gastrointestinal quality of life index (GIQLI). The Wexner Constipation Score is a widely used clinical scoring system for constipation. A total score of 15 or above indicates constipation, with higher scores indicating more severe degrees [ 13 ] . SAS score: it consists of 20 questions, with the total sum multiplied by 1.25 to obtain an integer value. The cut-off value for SAS standard scores in China is set at 50 points, among which: mild anxiety ranges from 50–59 points; moderate anxiety ranges from 60–69 points; severe anxiety corresponds to scores above 70 [ 14 ] . SDS score: it consists of 20 questions, with the total sum multiplied by 1.25 to obtain an integer value. The cut-off value of SDS standard score in China is 53 points, among which: mild depression: 53–62 points; Moderate depression: 63–72 points; Major depression: more than 73 points [ 14 ] . GIQLI: it includes of a total of 36 questions related to gastrointestinal symptoms that reflect the quality of life in patients with gastrointestinal diseases. It serves as a common scale used in clinical studies evaluating the quality-of-life aspect in patients with constipation [ 15 , 16 ] . Statistical Methods All data were statistically analyzed using SPSS 25.0 software package. Continuous numerical variables were expressed as mean ± standard deviation, and paired sample T-test was used to compare preoperative and postoperative scores. The categorical variables are expressed in frequency and percentage using Fisher's exact probability method. Pearson analysis was used for correlation analysis. For all test analyses, bilateral tests were used, and P < 0.05 (bilateral) meant that the difference was statistically significant. Result A total of 68 patients with post-TAC-IRA constipation were included in this study. Ultimately, 63 individuals were enrolled based on the valid questionnaires collected. The main reasons for excluding participants were: \"refusal to accept follow-up or missing follow-up patients\" and \"cases of missing questionnaire information.\" The flow chart of design are presented in Fig. 1 .The mean age of the study population was 38.6 ± 13.5 years, with females accounting for 79.4% of the enrolled population. The detailed basic clinical characteristics are presented in Table 1 . Among the enrolled patients, 42.9% and 57.1% had different anxiety and depression states before surgery, respectively; these proportions decreased to 23.8% (p = 0.037) and 49.2% (p = 0.475) after surgery, as shown in Table 2 . Additionally, there was a decreasing trend observed in both anxiety severity and constipation symptoms, as depicted in Fig. 2 . By conducting paired sample t-tests, it was found that patient's SAS score (p = 0.0095) and Wexner score (p < 0.001) significantly improved after surgery compared to preoperative scores; GIQLI score increased significantly compared to preoperative levels (p < 0.001), while SDS score showed no significant change when compared with preoperative values, as shown in Fig. 3 . Table 1 Clinical characteristics of patients. Clinical characteristics Age 38.6 ± 13.5 Gender Male Female 13(20.6%) 50(79.4%) History of mental illness Depression No 15(23.8%) 48(76.2%) Table 2 Comparison of patients with anxiety and depression before and after operation. Anxiety Preoperation Postoperation Statistical value P value 无 有 36 27 48 15 5.143 0.037 Depression 无 有 27 36 31 32 0.797 0.475 In the correlation analysis between preoperative Wexner score and SAS score, SDS score, and GOQOL score, positive correlations were found between SAS/SDS scores and Wexner score, while a negative correlation was observed between GOQOL score and Wexner score. The correlation coefficients were 0.4234, 0.2199, and − 0.2912 respectively, all of which demonstrated statistical significance, as shown in Fig. 4 . In the correlation analysis of postoperative Wexner score with SAS score, SDS score and GOQOL score, SAS score and SDS score showed a positive correlation with Wexner score, while GOQLI score showed a negative correlation with Wexner score. The respective correlation coefficients were 0.4518 for SAS Score, 0.3814 for SDS Score ,and − 0 .5813 for GOQLI Score, the difference between SAS score and Wexner score, GOQLI score and Wexner score was statistically significant, as shown in Fig. 5 . Discussion The correlation between functional constipation and anxiety, depression, and other psychological disorders has been observed in several clinical studies [ 17 , 18 ] . These studies have shed light on the relationship between psychosomatic disorders and constipation in terms of pathogenesis. Emmanuel et al. discovered a positive correlation between the Comprehensive Health Questionnaire (GHQ-28) scores and anxiety as well as somatic symptoms in women with constipation. Additionally, rectal mucosal blood flow was found to be negatively correlated with anxiety, depression, and somatic symptoms. This suggests that psychopsychological factors may impact defecation function by influencing the autonomic nervous system in women [ 19 ] . Results from the Minnesota Multiphasic Personality Inventory (MMPI) indicate that physical defense mechanisms play a significant role in the development of constipation [ 20 ] . Furthermore, some researchers have identified similar disruptions in intestinal flora composition and metabolic product abnormalities among patients with both constipation and depression [ 21 , 22 ] , highlighting the importance of serotonin and 5-hydroxytryptamine in their shared pathogenesis [ 21 ] . However, Whitehead et al.'s study revealed no significant difference in psychological problems between untreated individuals with constipation compared to healthy controls. They concluded that psychological disorders among patients with constipation were likely caused by changes during medical treatment rather than being inherent to the condition itself [ 23 ] . Overall, it is evident that there exists not only a common pathogenesis but also a mutually reinforcing causal relationship between constipation and psychological illness. This complex interplay contributes to high rates of co-occurrence clinically while posing challenges for effective treatment. In this study, there was a positive correlation between the degree of anxiety and the severity of constipation before and after surgery. Prior to surgery, 42.9% and 57.1% of patients experienced anxiety and depression, respectively, which was significantly higher than the general medical population in China [ 24 ] . The GIQLI score for patients with constipation was only 90.76 ± 20.25, indicating a significant negative impact on their quality of life due to constipation symptoms that were also negatively correlated with the severity of constipation. Following TAC-IRA treatment, both constipation symptoms and quality of life showed significant improvement among patients along with a decrease in the number of individuals experiencing anxiety and depression as well as reduced severity levels for these psychological health conditions. These findings suggest that TAC-IRA effectively enhances defecation function in patients with comorbid anxiety and depression while positively influencing further reduction in these psychological disorders. However, it is important to note that some patients still experience psychological illness, especially depression after improvements in defecation function and quality of life have been achieved. This may be attributed to ongoing recovery time required for psychological health disorders or other causes unrelated to constipation necessitating additional psychological treatment options. There are still several limitations in this study. Firstly, the sample size of this study is small and retrospective, leading to inevitable bias. Secondly, only a minority of the enrolled patients in this study were aware of their psychological illness and received relevant treatment prior to surgery, while not all patients underwent professional evaluation and treatment by psychotherapy doctors, resulting in heterogeneity within the enrolled population. Thirdly, this study solely assessed the anxiety and depression state of patients through self-assessment questionnaires, which may not fully or accurately reflect their psychological condition. Fourthly, this study solely compared the psycho-psychological changes of constipated patients before and after surgical treatment; thus it cannot establish a comprehensive relationship between psychological state and constipation for the majority of patients receiving medical treatment. The intricate association between psychological disorders and constipation necessitates further exploration through high-quality clinical research as well as basic research to clarify its pathogenesis. Conclusion Constipation not only significantly impacts patients' quality of life, but also exhibits a clear correlation with anxiety, depression, and other psychological disorders. In this study, effective surgical treatment led to notable improvements in defecation function, quality of life and anxiety levels among constipated patients. Following the enhancement of bowel movement through surgery, there was a corresponding trend towards ameliorating psychological disorders in these individuals. However, it is crucial to closely monitor subjective symptoms as well as psychological and emotional changes during postoperative follow-up while considering adjunctive drug therapy or psychotherapy if necessary. Nonetheless, comprehending the intricate relationship between psychological illness and constipation along with advancing treatment modalities necessitates high-quality clinical research and fundamental investigations in the future. Abbreviations FC functional constipation, STC slow transit constipation IC intractable constipation () TAC-IRA total abdominal colectomy with ileorectal anastomosis SAS self-rating anxiety scale SDS self-rating depression scale GIQLI gastrointestinal quality of life index GHQ-28 Comprehensive Health Questionnaire MMPI Minnesota Multiphasic Personality Inventory Declarations Funding This study was supported by Key Subject Construction Project of Shanghai Municipal Commission of Health and Family Planning (No.shslczdzk00102) Ethics approval and consent to participate This study was registered on ClinicalTrial.gov (ChiCTR20000036473) on 2020, and was approved by the Medical Ethics Committee of Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine(2020245Y). Preoperative written informed consent was obtained from all participating patients, and this study was conducted in accordance with the Declaration of Helsinki 1964. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding information: Key Subject Construction Project of Shanghai Municipal Commission of Health and Family Planning (No.shslczdzk00102) Author Contribution Conceptualization, Zhanwei Fu and Minhua Zheng; data curation, Pei Xue and Xuan Zhao; formal analysis, Zhanwei Fu and Pei Xue; writing-original draft, Zhanwei Fu, Pei Xue and Xuan Zhao; writing-review and editing, Junjun Ma and Minhua Zheng; All authors have read and agreed to the published version of the manuscript. Acknowledgements We thank all the authors and reviewers who participated in this study. Data Availability The data analyzed in the study are available from the corresponding author upon reasonable request. References Bharucha AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology. 2020;158(5):1232–49. .e3.https://doi.org/10.1053/j.gastro.2019.12.034 . Lembo A, Camilleri M. Chronic constipation. N Engl J Med. 2003;349(14):1360–8. .https://doi.org/10.1056/NEJMra020995 . Cangemi DJ, Flanagan R, Barshop K, Kuo B, Staller K. Colonic Stool Burden a Useful Surrogate for Slow Transit Constipation as Determined by a Radiopaque Transit Study. Am J Gastroenterol. 2019;114(3):519–23. https://doi.org/10.14309/ajg.0000000000000149 . Bassotti G, Blandizzi C. Understanding and treating refractory constipation. World J Gastrointest Pharmacol Ther. 2014;5(2):77–85. https://doi.org/10.4292/wjgpt.v5.i2.77 . Paquette IM, Varma M, Ternent C, Melton-Meaux G, Rafferty JF, Feingold D, et al. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the Evaluation and Management of Constipation. Dis Colon Rectum. 2016;59(6):479–92. https://doi.org/10.1097/dcr.0000000000000599 . Arebi N, Kalli T, Howson W, Clark S, Norton C. Systematic review of abdominal surgery for chronic idiopathic constipation. Colorectal Dis. 2011;13(12):1335–43. .https://doi.org/10.1111/j.1463-1318.2010.02465.x . Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum. 1997;40(3):273–9. .https://doi.org/10.1007/bf02050415 . Cheng C, Chan AO, Hui WM, Lam SK. Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population-based study. Aliment Pharmacol Ther. 2003;18(3):319–26. https://doi.org/10.1046/j.1365-2036.2003.01663.x . Hosseinzadeh ST, Poorsaadati S, Radkani B, Forootan M. Psychological disorders in patients with chronic constipation. Gastroenterol Hepatol Bed Bench. 2011;4(3):159–63. Levy RL, Olden KW, Naliboff BD, Bradley LA, Francisconi C, Drossman DA, et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology. 2006;130(5):1447–58. .https://doi.org/10.1053/j.gastro.2005.11.057 . 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MMPI assessment of patients with functional bowel disorders. Dis Colon Rectum. 1993;36(6):593–6. .https://doi.org/10.1007/bf02049867 . Israelyan N, Del Colle A, Li Z, Park Y, Xing A, Jacobsen JPR, et al. Effects of Serotonin and Slow-Release 5-Hydroxytryptophan on Gastrointestinal Motility in a Mouse Model of Depression. Gastroenterology. 2019;157(2):507–21. e4.https://doi.org/10.1053/j.gastro.2019.04.022 . Xie L, Xu C, Fan Y, Li Y, Wang Y, Zhang X, et al. Effect of fecal microbiota transplantation in patients with slow transit constipation and the relative mechanisms based on the protein digestion and absorption pathway. J Transl Med. 2021;19(1):490. https://doi.org/10.1186/s12967-021-03152-2 . Whitehead WE, Crowell MD. Psychologic considerations in the irritable bowel syndrome. Gastroenterol Clin North Am. 1991;20(2):249–67. Wang S, Sun Q, Zhai L, Bai Y, Wei W, Jia L. The Prevalence of Depression and Anxiety Symptoms among Overweight/Obese and Non-Overweight/Non-Obese Children/Adolescents in China: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019;16(3). https://doi.org/10.3390/ijerph16030340 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviews received at journal 05 Apr, 2026 Reviewers agreed at journal 04 Apr, 2026 Reviewers invited by journal 02 Apr, 2026 Editor assigned by journal 02 Apr, 2026 Editor invited by journal 02 Apr, 2026 Submission checks completed at journal 01 Apr, 2026 First submitted to journal 01 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9239023\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":619140929,\"identity\":\"b5937662-090f-43a3-a9e4-99271ed38441\",\"order_by\":0,\"name\":\"Zhanwei Fu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zhanwei\",\"middleName\":\"\",\"lastName\":\"Fu\",\"suffix\":\"\"},{\"id\":619140930,\"identity\":\"08ad784d-e5f8-4755-b499-50386222fe2c\",\"order_by\":1,\"name\":\"Pei Xue\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Pei\",\"middleName\":\"\",\"lastName\":\"Xue\",\"suffix\":\"\"},{\"id\":619140933,\"identity\":\"2fea5b7d-617c-4cae-ba27-962915870d47\",\"order_by\":2,\"name\":\"Xuan Zhao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xuan\",\"middleName\":\"\",\"lastName\":\"Zhao\",\"suffix\":\"\"},{\"id\":619140935,\"identity\":\"2897ebc6-06da-4b6c-a118-1608fb19285c\",\"order_by\":3,\"name\":\"Junjun Ma\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Junjun\",\"middleName\":\"\",\"lastName\":\"Ma\",\"suffix\":\"\"},{\"id\":619140936,\"identity\":\"71963f39-ec21-44f0-9e73-80543ad4f93f\",\"order_by\":4,\"name\":\"Minhua Zheng\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYFACHgaGBCDFD8TMxGphbABpkWyAauEhSguIMjhArBb5aWePP3jwyybf+Ebywc8FDHfk7AlpYZydl9iQ2Jdmue1GWrL0DIZnxgRtYZbOMWxI7DlsYHYjx0Cah+FwYg8hLWwQLf8NjGfkf/4N1FJPUAsPSEvCjwMGBhI5bCBbEgg6TAKoZUZiQ7KBxJlnZtY8BocNew4Q0CI/O8fg448/dgb87cmPb/NUHJZnbyBkDQgwtgEJgQQgYUCMcjD4A8T8hBw0CkbBKBgFIxYAAOKLPicFq5cjAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Minhua\",\"middleName\":\"\",\"lastName\":\"Zheng\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-03-27 02:08:15\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-9239023/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9239023/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":106725019,\"identity\":\"3b6ecc37-4bbc-49d5-84c9-72b887d37128\",\"added_by\":\"auto\",\"created_at\":\"2026-04-12 18:31:02\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":248933,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFlow chart of the design.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9239023/v1/6335db5309d7be49ca4fabbf.png\"},{\"id\":106724708,\"identity\":\"3e38eed6-998d-4bb0-8737-ec95ed26130d\",\"added_by\":\"auto\",\"created_at\":\"2026-04-12 18:29:19\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":174874,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eComparison of anxiety and depression grades before and after surgery. (A) Anxiety grades before and after surgery; (B) Depression grades before and after surgery.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9239023/v1/ef8d16bafa004e441c764e8a.png\"},{\"id\":106534957,\"identity\":\"a84ba250-e843-4453-94ae-afaaf2ef95fb\",\"added_by\":\"auto\",\"created_at\":\"2026-04-09 15:07:32\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":136590,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eAlterations in defecation function, mental state and quality of life of patients before and after surgery. (A) SAS score before and after surgery; (B) SDS score before and after surgery; (C) Wexner score before and after surgery; (D) GIQLI score before and after surgery. (Note: \\\"**\\\" : P ≤ 0.01; \\\"****\\\" : P ≤ 0.0001)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9239023/v1/6aaae8e7d0c34462dc8df1c2.png\"},{\"id\":106534961,\"identity\":\"fba9c3b0-4efc-48c6-9e2b-1915114ec990\",\"added_by\":\"auto\",\"created_at\":\"2026-04-09 15:07:33\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":216563,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCorrelation analysis of preoperative defecation function, psychological state and quality of life. (A) Correlation analysis between SAS score and Wexner score; (B) Correlation analysis between SDS score and Wexner score; (C) Correlation analysis between GIQLI score and Wexner score.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9239023/v1/d009e9c10638f5dbcabfccb1.png\"},{\"id\":106534960,\"identity\":\"39fb6b67-6f93-4270-b7e4-548bcd6d47e8\",\"added_by\":\"auto\",\"created_at\":\"2026-04-09 15:07:33\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":70819,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCorrelation analysis of postoperative defecation function, psychological state and quality of life. (A) Correlation analysis between SAS rating and Wexner rating; (B) Correlation analysis between SDS score and Wexner score; (C) Correlation analysis between GIQLI score and Wexner score.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image5.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9239023/v1/7c004d1ea74757c6204086be.png\"},{\"id\":106726968,\"identity\":\"8c499da3-8f85-4564-bce2-83d08e86b17f\",\"added_by\":\"auto\",\"created_at\":\"2026-04-12 18:37:49\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1262597,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9239023/v1/f32f186a-5ddb-431b-9b0a-20502a680c27.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Alteration of defecation function and psychological status in slow transit constipation patients after surgery\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eConstipation is one of the most prevalent gastrointestinal symptoms, with a worldwide prevalence of 15%\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. It can be categorized into primary constipation (also known as functional constipation, FC) and secondary constipation. Based on the underlying pathophysiological mechanisms, FC can be further classified into slow transit constipation (STC), normal transit constipation, dyssynergic defecation, and mixed constipation[2]. STC is characterized by significantly prolonged colon transit time and accounts for approximately 22% of FC patients\\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e. For patients with poor response to long-term medical treatment, surgery offers an effective approach to alleviate symptoms and enhance quality of life\\u003csup\\u003e[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e. For STC patients, total abdominal colectomy with ileorectal anastomosis (TAC-IRA) currently stands as the most efficacious surgical intervention for intractable constipation (IC)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e. Its postoperative relief rate for constipation reaches 100%, while its long-term effectiveness and patient satisfaction rates exceed 90%\\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eIn clinical practice, there exists a significant correlation between constipation and psychological disorders, with the incidence of depression and anxiety being notably higher in constipated patients than in the general population\\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e. A retrospective study revealed that anxiety and depression were relatively prevalent among constipated patients at 33.3% and 31.5%, respectively\\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e.Furthermore, several studies have indicated that constipation patients with psychological disorders face challenges in achieving satisfactory treatment outcomes\\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. However, there is insufficient evidence to support the use of surgical intervention in a significant proportion of constipation patients with comorbid psychological disorders, whose symptoms persist despite long-term medication. Therefore, further clinical research is needed to clarify the effectiveness of surgical treatment for this specific subgroup of patients suffering from both constipation and psychological disorders.\\u003c/p\\u003e \\u003cp\\u003eThis study aims to explore the prevalence of anxiety and depression in patients with STC, compare the levels of anxiety and depression before and after surgery, and provide a clinical basis for surgical interventions in constipation patients complicated by psychological disorders.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eIn this study, a total of 92 patients with STC constipation who received TAC-IRA surgery at the Department of Gastrointestinal Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2023 to June 2025 were included. The surgical procedures were performed by an experienced team specializing in constipation surgery, encompassing the entire colon from the distal ileum to the upper rectum, followed by ileorectal anastomosis\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/sup\\u003e. Questionnaires assessing defecation function score, anxiety score, depression score, and quality of life score were administered to all patients before surgery and again at the 6-month postoperative follow-up. This study was registered on ClinicalTrial.gov (ChiCTR20000036473) on 2020, and was approved by the Medical Ethics Committee of Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine(2020245Y). Preoperative written informed consent was obtained from all participating patients, and this study was conducted in accordance with the Declaration of Helsinki 1964.\\u003c/p\\u003e \\u003cp\\u003eThe inclusion criteria of this study were as followed:\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePreoperative evaluation meeting the diagnostic criteria for Rome IV functional constipation \\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/sup\\u003e: ①Presence of two or more symptoms in over 25% of bowel movements or weeks including a. difficulty in defecating; b. Bulky or hard bowel movements; c. Sensation of incomplete evacuation; d. Sensation of anal rectal obstruction and blockage; e. Needing manual assistance for defecation; f. Spontaneous bowel movements less than 3 times per week. ②There is almost no loose stool without laxatives. ③ It is not enough to diagnose irritable bowel syndrome (IBS). The symptoms existed for at least 6 months before diagnosis, and the symptoms met the above diagnostic criteria in the past 3 months;\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients who received TAC-IRA surgery without ileostomy.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eComplete medical history and data available with successful completion of at least six months' follow-up after the operation.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003cp\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe exclusion criteria of this study were as follows:\\u003c/p\\u003e \\u003cp\\u003e1) Identification of secondary constipation patients with clear etiology.;\\u003c/p\\u003e \\u003cp\\u003e2) refusal to accept follow-up or missing follow-up patients;\\u003c/p\\u003e \\u003cp\\u003e3) Patients unable to independently complete questionnaires;\\u003c/p\\u003e \\u003cp\\u003e4) Cases of missing questionnaire information.\\u003c/p\\u003e \\u003cp\\u003eThe basic clinical data of enrolled patients were collected through our center's constipation patient database, including age, gender, and history of psychological illness. Defecation function score, psychological status score, and quality of life score were assessed as follows: defecation function was evaluated using the Wexner score; psychological status was assessed using the self-rating anxiety scale (SAS) and self-rating depression scale (SDS); quality of life was assessed using the gastrointestinal quality of life index (GIQLI).\\u003c/p\\u003e \\u003cp\\u003eThe Wexner Constipation Score is a widely used clinical scoring system for constipation. A total score of 15 or above indicates constipation, with higher scores indicating more severe degrees \\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eSAS score: it consists of 20 questions, with the total sum multiplied by 1.25 to obtain an integer value. The cut-off value for SAS standard scores in China is set at 50 points, among which: mild anxiety ranges from 50–59 points; moderate anxiety ranges from 60–69 points; severe anxiety corresponds to scores above 70\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eSDS score: it consists of 20 questions, with the total sum multiplied by 1.25 to obtain an integer value. The cut-off value of SDS standard score in China is 53 points, among which: mild depression: 53–62 points; Moderate depression: 63–72 points; Major depression: more than 73 points \\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eGIQLI: it includes of a total of 36 questions related to gastrointestinal symptoms that reflect the quality of life in patients with gastrointestinal diseases. It serves as a common scale used in clinical studies evaluating the quality-of-life aspect in patients with constipation \\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eStatistical Methods\\u003c/p\\u003e \\u003cp\\u003eAll data were statistically analyzed using SPSS 25.0 software package. Continuous numerical variables were expressed as mean ± standard deviation, and paired sample T-test was used to compare preoperative and postoperative scores. The categorical variables are expressed in frequency and percentage using Fisher's exact probability method. Pearson analysis was used for correlation analysis. For all test analyses, bilateral tests were used, and P \\u0026lt; 0.05 (bilateral) meant that the difference was statistically significant.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Result\",\"content\":\"\\u003cp\\u003eA total of 68 patients with post-TAC-IRA constipation were included in this study. Ultimately, 63 individuals were enrolled based on the valid questionnaires collected. The main reasons for excluding participants were: \\u0026quot;refusal to accept follow-up or missing follow-up patients\\u0026quot; and \\u0026quot;cases of missing questionnaire information.\\u0026quot; The flow chart of design are presented in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.The mean age of the study population was 38.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.5 years, with females accounting for 79.4% of the enrolled population. The detailed basic clinical characteristics are presented in Table \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Among the enrolled patients, 42.9% and 57.1% had different anxiety and depression states before surgery, respectively; these proportions decreased to 23.8% (p\\u0026thinsp;=\\u0026thinsp;0.037) and 49.2% (p\\u0026thinsp;=\\u0026thinsp;0.475) after surgery, as shown in Table \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. Additionally, there was a decreasing trend observed in both anxiety severity and constipation symptoms, as depicted in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. By conducting paired sample t-tests, it was found that patient\\u0026apos;s SAS score (p\\u0026thinsp;=\\u0026thinsp;0.0095) and Wexner score (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) significantly improved after surgery compared to preoperative scores; GIQLI score increased significantly compared to preoperative levels (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), while SDS score showed no significant change when compared with preoperative values, as shown in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e.\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eClinical characteristics of patients.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eClinical characteristics\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e38.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e13(20.6%)\\u003c/p\\u003e\\n \\u003cp\\u003e50(79.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHistory of mental illness\\u003c/p\\u003e\\n \\u003cp\\u003eDepression\\u003c/p\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e15(23.8%)\\u003c/p\\u003e\\n \\u003cp\\u003e48(76.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eComparison of patients with anxiety and depression before and after operation.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAnxiety\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePreoperation\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePostoperation\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStatistical value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e无\\u003c/p\\u003e\\n \\u003cp\\u003e有\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e36\\u003c/p\\u003e\\n \\u003cp\\u003e27\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e48\\u003c/p\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5.143\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.037\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDepression\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e无\\u003c/p\\u003e\\n \\u003cp\\u003e有\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e27\\u003c/p\\u003e\\n \\u003cp\\u003e36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e31\\u003c/p\\u003e\\n \\u003cp\\u003e32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.797\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.475\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eIn the correlation analysis between preoperative Wexner score and SAS score, SDS score, and GOQOL score, positive correlations were found between SAS/SDS scores and Wexner score, while a negative correlation was observed between GOQOL score and Wexner score. The correlation coefficients were 0.4234, 0.2199, and \\u0026minus;\\u0026thinsp;0.2912 respectively, all of which demonstrated statistical significance, as shown in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e. In the correlation analysis of postoperative Wexner score with SAS score, SDS score and GOQOL score, SAS score and SDS score showed a positive correlation with Wexner score, while GOQLI score showed a negative correlation with Wexner score. The respective correlation coefficients were 0.4518 for SAS Score, 0.3814 for SDS Score ,and \\u0026minus;\\u0026thinsp;0 .5813 for GOQLI Score, the difference between SAS score and Wexner score, GOQLI score and Wexner score was statistically significant, as shown in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe correlation between functional constipation and anxiety, depression, and other psychological disorders has been observed in several clinical studies \\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/sup\\u003e. These studies have shed light on the relationship between psychosomatic disorders and constipation in terms of pathogenesis. Emmanuel et al. discovered a positive correlation between the Comprehensive Health Questionnaire (GHQ-28) scores and anxiety as well as somatic symptoms in women with constipation. Additionally, rectal mucosal blood flow was found to be negatively correlated with anxiety, depression, and somatic symptoms. This suggests that psychopsychological factors may impact defecation function by influencing the autonomic nervous system in women\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/sup\\u003e. Results from the Minnesota Multiphasic Personality Inventory (MMPI) indicate that physical defense mechanisms play a significant role in the development of constipation\\u003csup\\u003e[\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e. Furthermore, some researchers have identified similar disruptions in intestinal flora composition and metabolic product abnormalities among patients with both constipation and depression\\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e, highlighting the importance of serotonin and 5-hydroxytryptamine in their shared pathogenesis \\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]\\u003c/sup\\u003e. However, Whitehead et al.'s study revealed no significant difference in psychological problems between untreated individuals with constipation compared to healthy controls. They concluded that psychological disorders among patients with constipation were likely caused by changes during medical treatment rather than being inherent to the condition itself\\u003csup\\u003e[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]\\u003c/sup\\u003e. Overall, it is evident that there exists not only a common pathogenesis but also a mutually reinforcing causal relationship between constipation and psychological illness. This complex interplay contributes to high rates of co-occurrence clinically while posing challenges for effective treatment.\\u003c/p\\u003e \\u003cp\\u003eIn this study, there was a positive correlation between the degree of anxiety and the severity of constipation before and after surgery. Prior to surgery, 42.9% and 57.1% of patients experienced anxiety and depression, respectively, which was significantly higher than the general medical population in China\\u003csup\\u003e[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]\\u003c/sup\\u003e. The GIQLI score for patients with constipation was only 90.76\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;20.25, indicating a significant negative impact on their quality of life due to constipation symptoms that were also negatively correlated with the severity of constipation. Following TAC-IRA treatment, both constipation symptoms and quality of life showed significant improvement among patients along with a decrease in the number of individuals experiencing anxiety and depression as well as reduced severity levels for these psychological health conditions. These findings suggest that TAC-IRA effectively enhances defecation function in patients with comorbid anxiety and depression while positively influencing further reduction in these psychological disorders. However, it is important to note that some patients still experience psychological illness, especially depression after improvements in defecation function and quality of life have been achieved. This may be attributed to ongoing recovery time required for psychological health disorders or other causes unrelated to constipation necessitating additional psychological treatment options.\\u003c/p\\u003e \\u003cp\\u003eThere are still several limitations in this study. Firstly, the sample size of this study is small and retrospective, leading to inevitable bias. Secondly, only a minority of the enrolled patients in this study were aware of their psychological illness and received relevant treatment prior to surgery, while not all patients underwent professional evaluation and treatment by psychotherapy doctors, resulting in heterogeneity within the enrolled population. Thirdly, this study solely assessed the anxiety and depression state of patients through self-assessment questionnaires, which may not fully or accurately reflect their psychological condition. Fourthly, this study solely compared the psycho-psychological changes of constipated patients before and after surgical treatment; thus it cannot establish a comprehensive relationship between psychological state and constipation for the majority of patients receiving medical treatment. The intricate association between psychological disorders and constipation necessitates further exploration through high-quality clinical research as well as basic research to clarify its pathogenesis.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eConstipation not only significantly impacts patients' quality of life, but also exhibits a clear correlation with anxiety, depression, and other psychological disorders. In this study, effective surgical treatment led to notable improvements in defecation function, quality of life and anxiety levels among constipated patients. Following the enhancement of bowel movement through surgery, there was a corresponding trend towards ameliorating psychological disorders in these individuals. However, it is crucial to closely monitor subjective symptoms as well as psychological and emotional changes during postoperative follow-up while considering adjunctive drug therapy or psychotherapy if necessary. Nonetheless, comprehending the intricate relationship between psychological illness and constipation along with advancing treatment modalities necessitates high-quality clinical research and fundamental investigations in the future.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eFC functional constipation,\\u003c/p\\u003e\\u003cp\\u003eSTC slow transit constipation\\u003c/p\\u003e\\u003cp\\u003eIC intractable constipation ()\\u003c/p\\u003e\\u003cp\\u003eTAC-IRA total abdominal colectomy with ileorectal anastomosis\\u003c/p\\u003e\\u003cp\\u003eSAS self-rating anxiety scale\\u003c/p\\u003e\\u003cp\\u003eSDS self-rating depression scale\\u003c/p\\u003e\\u003cp\\u003eGIQLI gastrointestinal quality of life index\\u003c/p\\u003e\\u003cp\\u003eGHQ-28 Comprehensive Health Questionnaire\\u003c/p\\u003e\\u003cp\\u003eMMPI Minnesota Multiphasic Personality Inventory\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eFunding\\u003c/h2\\u003e\\n\\u003cp\\u003eThis study was supported by Key Subject Construction Project of Shanghai Municipal Commission of Health and Family Planning (No.shslczdzk00102)\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was registered on ClinicalTrial.gov (ChiCTR20000036473) on 2020, and was approved by the Medical Ethics Committee of Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine(2020245Y). Preoperative written informed consent was obtained from all participating patients, and this study was conducted in accordance with the Declaration of Helsinki 1964.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\n\\u003ch2\\u003eFunding information:\\u003c/h2\\u003e\\n\\u003cp\\u003eKey Subject Construction Project of Shanghai Municipal Commission of Health and Family Planning (No.shslczdzk00102)\\u003c/p\\u003e\\n\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\n\\u003cp\\u003eConceptualization, Zhanwei Fu and Minhua Zheng; data curation, Pei Xue and Xuan Zhao; formal analysis, Zhanwei Fu and Pei Xue; writing-original draft, Zhanwei Fu, Pei Xue and Xuan Zhao; writing-review and editing, Junjun Ma and Minhua Zheng; All authors have read and agreed to the published version of the manuscript.\\u003c/p\\u003e\\n\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e\\n\\u003cp\\u003eWe thank all the authors and reviewers who participated in this study.\\u003c/p\\u003e\\n\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\n\\u003cp\\u003eThe data analyzed in the study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eBharucha AE, Lacy BE. 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J Transl Med. 2021;19(1):490. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1186/s12967-021-03152-2\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12967-021-03152-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWhitehead WE, Crowell MD. Psychologic considerations in the irritable bowel syndrome. Gastroenterol Clin North Am. 1991;20(2):249\\u0026ndash;67.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWang S, Sun Q, Zhai L, Bai Y, Wei W, Jia L. The Prevalence of Depression and Anxiety Symptoms among Overweight/Obese and Non-Overweight/Non-Obese Children/Adolescents in China: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019;16(3). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.3390/ijerph16030340\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph16030340\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-gastroenterology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bmge\",\"sideBox\":\"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bmge/default.aspx\",\"title\":\"BMC Gastroenterology\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"slow transit constipation, total abdominal colectomy, anxiety, depression\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9239023/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9239023/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjective\\u003c/h2\\u003e \\u003cp\\u003eTo investigate anxiety and depression status in slow transit constipation (STC) patients and the alteration of psychological status after surgery, and to find the relationship between constipation and psychological status.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eA total of 63 STC patients who received total abdominal colectomy with ileorectal anastomosis (TAC-IRA) were selected. Defecation function, psychological status and quality of life of patients were collected by questionnaires before surgery and 6 months after surgery. Defecation function was evaluated by Wexner score; psychological status was evaluated by self-rating anxiety scale (SAS) and self-rating depression scale (SDS). gastrointestinal quality of life index (GIQLI) was used to evaluate the quality of life.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThere were 42.9% and 57.1% of STC patients in different degrees of anxiety and depression before surgery, and the proportions decreased to 21.6% (p\\u0026thinsp;=\\u0026thinsp;0.048) and 54.1% (p\\u0026thinsp;=\\u0026thinsp;0.341) after surgery, respectively. Through paired sample T test, Wexner score (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and SAS score (p\\u0026thinsp;=\\u0026thinsp;0.0095) were significantly decreased, GIQLI score was significantly increased(p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). SAS score showed a positive correlation with Wexner score before and after surgery, SDS score showed a positive correlation with Wexner score before surgery, while GIQOL score and Wexner score showed a negative correlation before and after surgery, and all correlation above was statistically significant.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eThe severity of constipation is closely related to anxiety, depression. Patients' defecation function, quality of life, anxiety and depression were significantly improved after effective surgical treatment.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Alteration of defecation function and psychological status in slow transit constipation patients after surgery\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-04-09 15:07:28\",\"doi\":\"10.21203/rs.3.rs-9239023/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-04-27T06:14:58+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"170098808863924697093698835576697115742\",\"date\":\"2026-04-20T06:56:34+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-04-05T21:48:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"330927594114948273385982618982106151353\",\"date\":\"2026-04-04T16:39:55+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-04-02T16:04:14+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-04-02T15:57:12+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-04-02T12:57:06+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-04-02T02:03:21+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Gastroenterology\",\"date\":\"2026-04-02T01:59:13+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-gastroenterology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bmge\",\"sideBox\":\"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bmge/default.aspx\",\"title\":\"BMC Gastroenterology\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"fdbecf1c-b06f-4510-8e52-eee3a32669b8\",\"owner\":[],\"postedDate\":\"April 9th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-09T15:07:28+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-04-09 15:07:28\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9239023\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9239023\",\"identity\":\"rs-9239023\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}