Did you know that constipation and psychology have something to do with it too?

What is generally called constipation is medically known as functional constipation. In recent years, many studies have found that psychosomatic factors have a significant impact on the occurrence of functional constipation, the patient’s own feelings and clinical manifestations, and the incidence of psychological disorders in patients is also higher. At present, the mechanism of functional constipation caused by psychosomatic factors is not very clear. Some studies believe that psychological disorders can not only inhibit the innervation of the colon by peripheral autonomic nerves, but also affect the vegetative nervous system through the cerebral cortex, especially the parasympathetic nerves and cause constipation. For example, anger enhances the contraction of the digestive tract, increases mucosal blood supply and gastric acid secretion, and fear inhibits upper gastrointestinal tract dynamics. Psychological factors interact with gastrointestinal dynamics and sensation through the brain-gut axis. Extrinsic stimuli or intestinal messages are connected to higher nerve centers via neural links to influence gastrointestinal sensation, motility, and secretion. The regulation of these links is in turn accomplished through a variety of brain-gut peptides. The various psychological abnormalities in patients with functional constipation, coupled with the influence of external factors, constitute a constant stimulation of the central nervous system, causing the abnormal secretion of a variety of brain-gut peptides in the body, thus affecting gastrointestinal tract function. The autonomic nervous system is responsible for the steady regulation of intestinal function, and it is also the main regulator of the central influence on internal organs. The sympathetic nerves act primarily as inhibitors of the GI tract. Some diseases that can affect autonomic function, such as Parkinson’s disease and diabetes, can severely affect GI function. The pelvic parasympathetic nerves are thought to play an important role in colonic motility in humans. STC can occur in patients with pelvic parasympathetic nerve damage after birth or pelvic surgery.Studies of electrical activity of the bowel have shown that patients with this phenotype have markedly reduced fasting and postprandial colonic propulsive electrical activity manifested as slowed frequency and shortened duration. Sigmoid compliance is reduced and the maximum tolerance of the intestinal wall to intestinal contents is lower than normal, resulting in reduced rectal responsiveness and sluggishness due to slow passage of intestinal contents and slowed rectal filling. It has also been shown that various types of neurologic changes occur in the pelvic parasympathetic nerves of STC patients, including neural axonal vacuolar degeneration, loss of myenteric neurons, and non-specific plexus degeneration. These studies suggest that vagal, and especially pelvic parasympathetic, damage has an important role in STC, and that decreased parasympathetic activity leads to constipation. Psycho-behavioral intervention therapy is a comprehensive treatment method that applies the principles and methods of psychology to analyze the patient’s psychological state and existing problems through a combination of psychological support, behavioral intervention, and medication. It includes the following aspects. 1, supportive therapy: supportive therapy, also known as general psychotherapy, is based on guidance, persuasion, comfort, encouragement, support, assurance as the main content, to support the patient to cope with emotional difficulties and psychological problems. The therapy requires health care workers to communicate with patients, listen to them patiently, help them establish confidence in overcoming the disease, and at the same time, carry out appropriate related knowledge education to reduce patients’ anxiety, and ultimately achieve the therapeutic purpose. 2, cognitive behavioral therapy: cognitive behavioral therapy that allows patients to recognize and find out the bad ideas, feelings and behaviors, fully understand the relationship between stress, emotions, symptoms, and gradually improve their abnormal psychology and behavior, so that it is more appropriate and rational direction. Cognitive behavioral therapy is a longer cognitive education for patients by professional therapists, so that patients have a correct evaluation of themselves, understand the causes of their own illnesses and the impact of their illnesses, aiming to help patients establish an effective coping mechanism; while educational therapy only allows patients to learn disease-related knowledge on their own, and then contact with professional therapists. 3, relaxation therapy: relaxation therapy refers to a certain amount of muscle contraction, relaxation and repeated alternating training to consciously control their own physiological and psychological activities, reduce the level of arousal, improve the physical and psychological dysfunction, and finally achieve the purpose of physical and mental relaxation. 4.Biofeedback therapy: This therapy is a combination of relaxation therapy and biofeedback technology, which is a new psychotherapeutic technology developed on the basis of behavioral therapy. Randomized controlled studies have shown that the effect of biofeedback therapy is better than laxatives, skeletal muscle relaxation drugs and muscle relaxation training, and the efficacy lasts for 1-2 years, this treatment is mainly effective for patients with constipation who have synergistic dysfunction of the pelvic floor muscles and it can improve the intestinal transmission function. In conclusion, some of the patients with functional constipation are difficult cases, and most of them are related to psychological disorders. For this group of constipated patients, laxatives are used with caution. Antidepressant medication has some effect. However, supportive therapy, cognitive-behavioral therapy, relaxation therapy, and biofeedback therapy must be used to get rid of the pain of constipation at all.