Psychological Symptoms and Adverse Childhood Experiences Negatively Impact Coexisting Obstructed Defecation and Fecal Incontinence Symptoms

INTRODUCTION: Many patients with obstructed defecation report concurrent fecal incontinence. However, the impact of psychological factors on coexisting symptoms remains unclear. We aimed to investigate the association between history of adverse childhood experiences (ACEs) and psychological symptoms on the severity of coexisting obstructed defecation and fecal incontinence. METHODS: Retrospective analysis of a prospective IRB registry of patients with primary complaint of obstructed evacuation symptoms who completed validated surveys for assessment of psychological symptoms using the Hospital Anxiety and Depression Scale (HADS), the Adverse Childhood Experiences (ACE) questionnaire, and clinical characteristics including symptom severity. RESULTS: A total of 128 patients with obstructed defecation and fecal incontinence (110 women), average (SD) age 55 (16) years, were included; mean Renzi Obstructed Defecation Syndrome (ODS) score of 9.75 (3.97) and mean Cleveland Clinic Fecal Incontinence (CCFI) score of 9.38 (5.54). ACEs were reported by 60 (47%) and HADS anxiety and depression ≥ 8 by 63 (49%) and 36 (28%) of the cohort, respectively. Patients with ACEs had more severe ODS (not CCFI) scores which correlated with higher HADS anxiety and depression scores. There were no correlations between CCFI and HADS anxiety and depression scores (p > 0.05). Younger patients were more likely to report ACEs, higher HADS, ODS and lower CCFI scores. After adjusting for age, higher depression scores correlated significantly with the severity of both CCFI and ODS scores. CONCLUSIONS: The observed differences in the impact of ACEs and psychological symptoms on coexisting obstructed defecation and fecal incontinence symptoms suggest distinct pathophysiological mechanisms, which could guide targeted treatment strategies across different age groups.