Psychological Assessment of Patients with Proctological Disorders

  • Annalisa Russo
  • Mario Pescatori


A multidisciplinary team, which includes either a psychologist or a psychiatrist, should follow these specialized patients from their first visit to the final steps of their treatment and the definitive resolution of their problem using a “holistic approach.” The great advantage of a team psychologist—and a psychological perspective—in a dedicated coloproctology unit is in “flagging” patients who are likely, by virtue of their preexisting psychological and biosocial problems, not to benefit from surgery or to have symptom recidivism after surgery. Moreover, it is crucial that patients be afforded a range of non-surgical therapies for pelvic floor dysfunction as part of this holistic approach. The factors that are predictive for non-surgical success are still being evaluated in many units.


Irritable Bowel Syndrome Chronic Constipation Express Emotion Chronic Pelvic Pain Pudendal Neuropathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Garvey M, Noyes R, and Yates W. Frequency of constipation in major depression: relationship to other clinical variables. Psychosomatics. 1990;31:204–6.PubMedGoogle Scholar
  2. 2.
    Nehra V, Bruce BK, Rath-Harvey DM, Pemberton JH, and Camilleri M. Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. Am J Gastroenterol. 2000;95:1755–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Devroede G. Psychophysiological considerations in subjects with chronic idiopathic constipation. In: Wexner SD and Bartolo DCC, editors. Constipation: etiology, evaluation and management. London: Butterworth Heinemann; 1995. p. 103–34.Google Scholar
  4. 4.
    Ayabaca SM, Zbar AP, and Pecatori M. Anal continence after rectocele repair. Dis Colon Rectum. 2002;45:63–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Berkelmans I, Leroi AM, Weber J, and Denis P. Fecal incontinence with transitory absence of anal contraction in two sexually or physically abused women. Eur J Gastroenterol. 1996;8:235–8.CrossRefGoogle Scholar
  6. 6.
    Mavrantonis C and Wexner SD. A clinical approach to fecal incontinence. J Clin Gastroenterol. 1988;27:108–21.CrossRefGoogle Scholar
  7. 7.
    Byrne CM, Pager CK, Rex J, Roberts R, and Solomon MJ. Assessment of quality of life in the treatment of patients with neuropathic fecal incontinence. Dis Colon Rectum. 2002;45:1431–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, and Rao SSC. Functional disorders of the anus and rectum. Gut. 1999;Suppl II:1155–9.Google Scholar
  9. 9.
    Magni G, Salmi A, De Leo D, and Ceola A. Chronic pelvic pain and depression. Psychopathology. 1984;17:132–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Renzi C and Pescatori M. Psychological aspects in proctalgia. Dis Colon Rectum. 2000;43:535–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Wesselman U, Burnett AL, and Heinberg LJ. The urogenital and rectal pain syndrome. Pain. 1997;73:269–94.CrossRefGoogle Scholar
  12. 12.
    Merluzzi TV, Nairn RC, Hegde K, Martinez Sanchez MA, and Dunn L. Selfefficacy for coping with cancer: revision of the cancer behaviour inventory (version 2.0). Psycho-oncology. 2001;10:206–17.PubMedCrossRefGoogle Scholar
  13. 13.
    Ciaramella A and Poli P. Assessment of depression among cancer patients: the role of pain, cancer and treatment. Psycho-oncology. 2001;10:156–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Parker PA, Baile WF, De Moor C, and Cohen L. Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psychooncology. 2003;12:183–93.PubMedCrossRefGoogle Scholar
  15. 15.
    Rourke MT, Stuber ML, Hobbie WL, and Kazak AE. Posttraumatic stress disorder: understanding the psychosocial impact of surviving childhood cancer into young adulthood. J Pediatric Nurs. 1999;16:115–6.CrossRefGoogle Scholar
  16. 16.
    Kazak AE, Simms S, and Rourke MT. Family system practice in pediatric psychology. J Pediatric Psychol. 2002;27(2):133–43.CrossRefGoogle Scholar
  17. 17.
    Kazak AE, Barakat L, Meeske K, et al. Posttraumatic stress, family functioning and social support in survivors of childhood cancer and their mothers and fathers. J Consult Clin Psychol. 1997;65:120–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Kazak AE. Effective psychosocial intervention for children with cancer [editorial]. Med Pediatr Oncol. 1999;32:292–3.PubMedCrossRefGoogle Scholar
  19. 19.
    Vaughn CE, Leff J, and Sarner M. Relatives’ expressed emotion and the course of inflammatory bowel disease. J Psychosom Res. 1999;47:461–9.PubMedCrossRefGoogle Scholar
  20. 20.
    McMahon AW, Schmitt P, Patterson JF, and Rothman E. Personality differences between inflammatory bowel disease patients and their healthy siblings. Psychosom Med. 1973;35:35–91.Google Scholar
  21. 21.
    Brown GW, Birley JLT, and Wing JK. Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry. 1976;121:241–58.CrossRefGoogle Scholar
  22. 22.
    Vaughn CE and Leff J. The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. Br J Psychiatry. 1976;129:125–37.PubMedCrossRefGoogle Scholar
  23. 23.
    Sewitch MJ, Abrahamowicz M, Bitton A, Daly D, Wild GE, Cohen A, Katz S, Szego PL, and Dobkin PL. Psychological support and disease activity in patients with inflammatory bowel disease. Am J Gastroenterol. 2001;96:1470–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Koloski NA, Talley NJ, and Boyce PM. Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia: a critical review of the literature on symptom and psychological factors. Am J Gastroenterol. 2001;96:1340–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Sullivan ES, Jenkins PL, and Blewett AE. Irritable bowel syndrome and family history of psychiatry disorder: a preliminary study. Gen Hosp Psychiatry. 1995;17:43–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Kaplan DS, Masand PS, and Gupta S. The relationship of irritable bowel syndrome (IBS) and panic disorder. Ann Clin Psychiatry. 1996;8:81–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Delvaux M, Denis P, and Allemand H. Sexual abuse is more frequently reported by IBS patients than by patients with organic digestive diseases or controls. Results of a multicentre inquiry. Eur J Gastroenterol. 1997;9:345–52.Google Scholar
  28. 28.
    Sandler DS, Drossman DA, Nathan HP, and McKee DC. Symptom complaints and health care seeking behaviour in subjects with bowel dysfunction. Gastroenterology. 1984;87:314–8.PubMedGoogle Scholar
  29. 29.
    Drossman DA. Do psychological factors define symptom severity and patient status in Irritable Bowel Syndrome? Am J Med. 1999;107:41–50.CrossRefGoogle Scholar
  30. 30.
    Lydiard RB and Falsetti SA. Experience with anxiety and depression treatment studies: implications for designing irritable bowel syndrome clinical trials. Am J Med. 1999;107:65–73.CrossRefGoogle Scholar
  31. 31.
    Whitehead WE. Behavioral medicine approaches to gastrointestinal disorders. J Consult Clin Psychol. 1992;60:605–12.PubMedCrossRefGoogle Scholar
  32. 32.
    Strickland MC and Heymen S. Psychiatric treatment of constipation. In: Wexner SD and Bartolo DCC, editors. Constipation: etiology, evaluation & management. London: Butterworth Heinemann; 1994.Google Scholar
  33. 33.
    Devroede G. Psychological considerations in subjects with chronic idiopathic constipation. In: Wexner SD and Bartolo DCC, editors. Constipation: etiology, evaluation & management. London: Butterworth Heinemann; 1994.Google Scholar
  34. 34.
    Rimsza ME, Berg RA, and Locke C. Sexual abuse: somatic and emotional reactions Child Ab Negl. 1988;12:201–8.Google Scholar
  35. 35.
    Leroi AM, Bernier C, Watier A, et al. Prevalence of sexual abuse among patients with functional disorders of the lower gastrointestinal tract. Int J Colorectal Dis. 1995;10:200–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Kristal H. Alexithymia and psychotherapy. Am J Psychother. 1979;33:17–31.Google Scholar
  37. 37.
    Kumar D, Thompson PD, Wingate DL, Vesselinova-Jenkins CK, and Libby G. Abnormal REM sleep in the irritable bowel syndrome. Gastroenterology. 1992;103:12–7.PubMedGoogle Scholar
  38. 38.
    Devroede G, Bouchoucha M, and Girard G. Constipation, anxiety and personality. What carries first? In: Bueno L, Collins S, and Junior JL, editors. Stress and digestive motility. London: JohnLibbey; 1989. p. 55–60.Google Scholar
  39. 39.
    Devroede G, Roy T, Bouchoucha M, et al. Idiopathic constipation by colonic dysfunction: relationship with personality and anxiety. Dig Dis Sci. 1989;34:1428–33.PubMedCrossRefGoogle Scholar
  40. 40.
    Drossman DA, McKee DC, Sandler RS, et al. Psychological factors in the irritable bowel syndrome. A multivariate study of patients and non patients with irritable bowel syndrome. Gastroenterology 1988;95:701–8.PubMedGoogle Scholar
  41. 41.
    Devroede G. Constipation and sexuality. Med Asp Human Sex. 1990 Feb:40–6.Google Scholar
  42. 42.
    Ripetti V, Caputo D, Ausania F, Esposito E, Bruni R, and Arullani A. Sacral nerve neuromodulation improves physical, psychological and social quality of life in patients with fecal incontinence. Tech Coloproctol. 2002;6:147–52.PubMedCrossRefGoogle Scholar
  43. 43.
    Pescatori M. Anal rectoceles and the Iceberg Syndrome. Urodynamica. Forthcoming 2004.Google Scholar
  44. 44.
    Parks AG, Porter NH, and Hardcastle J. The syndrome of the descending perineum. Proc R Soc Med. 1966;59:477–82.PubMedGoogle Scholar
  45. 45.
    Renzi C, Peticca L, and Pescatori M. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results. Int J Colorectal Dis. 2000;15:313–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Loening-Baucke V, Cruikshank B, and Savage C. Defecation dynamics and behavior profiles in encopretic children. Pediatrics. 1987;80:672–9.PubMedGoogle Scholar
  47. 47.
    Machover K. Personality projection in the drawing of the human figure: a method of personality investigation. Springfield: Charles Thomas; 1949.Google Scholar
  48. 48.
    Castellazzi VL and Nannini MF. Il disegno della figura umana come tecnica proiettiva. Rome: Libreria Ateneo Salesiano; 1992.Google Scholar
  49. 49.
    Renzi C and Pescatori M. Family drawing with clinical approach to patients with chronic constipation: preliminary data. Neurogastroenterology. 2002;56–8.Google Scholar
  50. 50.
    Tusek DL, Church JM, Strong SA, Grass JA, and Fazio VW. Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery. Dis Colon Rectum. 1997;40:172–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Mathias JM. Guided imagery tapes help surgical patients. OR Manager. 1998;14:18–9.Google Scholar
  52. 52.
    Perozo SE, Ferrara A, Patankar SK, Larach SW, and Williamson PR. Biofeedback with home trainer programme is effective for both incontinence and pelvic floor dysfunction. Tech Coloproctol. 1997;5:6–9.Google Scholar
  53. 53.
    Peticca L, Pietroletti R, Ayabaca SM, and Pescatori M. Combined biofeedback physiotherapy and electrostimulation for fecal incontinence. Tech Coloproctol. 2000;4:157–61.CrossRefGoogle Scholar
  54. 54.
    Pucciani F, Iozzi L, Masi A, Cianchi F, and Cortesini C. Multimodal rehabilitation for faecal incontinence: experience of an Italian center devoted to faecal disorder rehabilitation. Tech Coloproctol. 2003;7:139–47.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2005

Authors and Affiliations

  • Annalisa Russo
    • 1
  • Mario Pescatori
    • 1
  1. 1.Coloproctology UnitVilla Flaminia HospitalRomeItaly

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