Alexithymia in Functional Defecation Disorder: The Incidence and the Effect on Treatment

Abstract

Objective: We aimed to investigate the prevalence of alexithymia in patients with functional defecation disorder (FDD) and its impact on treatment outcomes.

Methods: FDD patients who underwent high-resolution anorectal manometry and balloon expulsion test were enrolled. Symptoms, anorectal function, and treatment efficacy were assessed at baseline and after 4-week medication.

Results: Alexithymia was present in 29.5% of all 129 FDD patients. Compared to the non-alexithymia group, the alexithymia group had higher baseline scores for the Patient Assessment of Constipation-Symptoms (PAC-SYM) (19.0 vs. 15.0, p = 0.03), Patient Assessment of Constipation-Quality of Life (PAC-QOL) (67.0 vs. 26.0, p < 0.001), Zung's Self-Rating Anxiety Scale (SAS) (44.5 vs. 30.0, p < 0.001), and Self-Rating Depression Scale (SDS) (48.0 vs. 33.0, p < 0.001). Moreover, the improvements in post-treatment complete spontaneous bowel movements (CSBMs) (0.0 vs. 1.5, p = 0.041), PAC-SYM (0.0 vs. −11.5, p < 0.001), PAC-QOL (0.0 vs. −16.0, p < 0.001), SAS (0.0 vs. −1.0, p < 0.001), and SDS (0.0 vs. −3.0, p < 0.001) scores were less significant in the alexithymia group than in the non-alexithymia group. A high Toronto Alexithymia Scale-20 score was an independent risk factor for drug therapy failure in FDD patients (odds ratio 0.949, 95% confidence interval 0.919–0.980, p = 0.001).

Conclusion: Alexithymia is prevalent in FDD patients and significantly affects symptom severity, quality of life, mental state, and treatment outcomes.

Keywords

affective symptoms / functional defecation disorder / quality of life / symptom assessment / treatment effects

RIGHTS & PERMISSIONS

2025 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.