Patients with Chronic Constipation Experience Psychological Stress as Measured By the POMS2 Test and Salivary Stress Markers

Abstract

Background: Psychological stress is known to lead to the pathogenesis and exacerbation of constipation. Therefore, it is important to understand the stress status in patients with constipation to treat constipation and prevent its exacerbation. Until now, the stress status of patients has been subjectively evaluated mainly by questionnaires, but in recent years it has become possible to objectively evaluate it by measuring stress markers in saliva. This study evaluated the stress status in patients with chronic constipation from both subjective and objective perspectives. Methods: Eighty-four adult females with chronic constipation and 20 healthy adult female volunteers as controls were enrolled in this study. All subjects were subjectively evaluated for their mood using the shortened Profile of Mood StatesSecond Edition (POMS2) and objectively evaluated by measuring salivary stress markers, such as cortisol, chromogen A, oxytocin, and secretory immunoglobulin A (s-IgA) using Enzyme-Linked Immuno Sorbent Assay. Results: In the POMS2 analysis, the T-scores of negative mood subscales, such as Anger–Hostility, Confusion–Bewilderment, Depression–Dejection, Fatigue–Inertia, and Tension–Anxiety were significantly higher in the constipation group than in the control group. In contrast, positive mood subscale scores, such as Vigor–Activity and Friendliness were not significantly different between the two groups. These results significantly increased the total mood disorder score, which comprehensively reflects a negative mood in the constipation group compared to the control group. In the stress marker analyses, cortisol, chromogranin A, and s-IgA concentrations in the constipation group were significantly higher than those in the control group. In contrast, the oxytocin concentration in the constipation group tended to be lower than in the control group. Conclusion: These results suggest that patients with constipation have more stressful negative emotions, such as anxiety, depression, tension, and fatigue than healthy individuals. This study will be important and useful when considering the treatment, exacerbation, or prevention of constipation.