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Psychological stress in patients with anal fistula

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

Psychological stress is known to affect the immunologic system and the inflammatory response. The aim of this study was to assess the presence of psychological stress, anxiety, and depression in patients with anal fistula.

Methods

Consecutive patients with anal fistula, hemorrhoids, and normal volunteers were studied prospectively. Stressful life events were recorded and subjects were asked to complete the state-trait anxiety inventory (STAI), a depression scale, and three different reactive graphic tests (RGT).

Results

Seventy-eight fistula patients, 73 patients with grade III–IV hemorrhoids, and 37 normal volunteers were enrolled.

Of the fistula patients, 65 (83 %) reported one or more stressful events in the year prior to diagnosis, compared to 16 (22 %) of the hemorrhoid patients (P = 0.001). There were no significant differences in the percentage of subjects with abnormal trait anxiety (i.e., proneness for anxiety) and depression scores between fistula patients, hemorrhoid patients, and controls. Fistula patients had significantly higher (i.e., better) scores compared to hemorrhoid patients in two of three RGT and significantly lower (i.e., worse) scores in all three RGT compared to healthy volunteers.

Of 37 patients followed up for a median of 28 months (range 19–41 months) after surgery, 8 (21.6 %) had persistent or recurrent sepsis. There was no significant difference in depression, STAI, and RGT scores between patients with sepsis and patients whose fistula healed.

Conclusion

Our results suggest that an altered emotional state plays an important role in the pathogenesis of anal fistula and underline the importance of psychological screening in patients with anorectal disorders.

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Acknowledgments

The authors wish to thank Dr. Liana Spazzafumo for her statistical advice, Dr. Vlasta Pozdemny for reviewing the English language, and Ms. Caterina De Bono who helped with the follow-up of the patients.

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Authors and Affiliations

  1. Coloproctology Unit, Parioli Clinic, Rome, Italy

    V. M. Cioli & M. Pescatori

  2. Department of Surgery, Tulane University School of Medicine, 1340 Tulane Avenue, New Orleans, LA, 70119, USA

    G. Gagliardi

Authors
  1. V. M. Cioli
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  2. G. Gagliardi
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  3. M. Pescatori
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Corresponding author

Correspondence to G. Gagliardi.

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Cioli, V.M., Gagliardi, G. & Pescatori, M. Psychological stress in patients with anal fistula. Int J Colorectal Dis 30, 1123–1129 (2015). https://doi.org/10.1007/s00384-015-2245-3

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  • DOI: https://doi.org/10.1007/s00384-015-2245-3

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