Colectomy Improves Anxiety, Not Depression, in Constipation Patients

A new observational cohort study published in BMC Gastroenterology reports that total abdominal colectomy with ileorectal anastomosis (TAC-IRA) is associated with significant improvements in constipation severity, quality of life, and anxiety symptoms, but not depression, six months after surgery. The research, conducted by a team including Zhanwei Fu and Minhua Zheng, addresses a gap in understanding how major surgical interventions for slow transit constipation (STC) affect the psychological well-being of patients. While chronic constipation is frequently comorbid with anxiety and depression, the specific impact of surgical treatment on these mental health outcomes had remained unclear prior to this investigation.

The study included 63 patients diagnosed with slow transit constipation who underwent TAC-IRA. STC is a severe subtype of constipation that may require surgery. The researchers assessed defecation function, psychological status, and quality of life at two distinct time points: before the surgery and six months after the procedure.

To quantify these changes, the study employed several validated clinical scales. Defecation function was evaluated using the Wexner score. Psychological status was measured using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Additionally, the Gastrointestinal Quality of Life Index (GIQLI) was used to assess quality of life. Statistical analyses included paired t-tests to compare mean scores before and after surgery, McNemar’s test to evaluate changes in categorical psychological status, and Pearson correlation analysis to examine relationships between bowel function and psychological metrics.

Before the surgical intervention, a substantial proportion of the cohort exhibited psychological distress. Specifically, 42.9% of the patients met the criteria for anxiety, while 57.1% had depression. Following the TAC-IRA procedure and the subsequent six-month recovery period, the proportion of patients with anxiety decreased significantly to 23.8%, a change that was statistically significant with a P-value of less than 0.001. In contrast, the proportion of patients with depression decreased slightly to 50.8%, but this change did not reach statistical significance, with a P-value of 0.07.

The analysis of continuous scores further supported these findings. Paired t-tests revealed significant reductions in both the Wexner score and the SAS score after surgery. The Wexner score decreased significantly with a P-value of less than 0.001. The SAS score, reflecting anxiety levels, also showed a significant reduction with a P-value of 0.01. Conversely, the SDS score, which measures depression, did not change significantly, with a P-value of 0.143. The GIQLI score increased significantly after surgery with a P-value of 0.002.

Correlation analyses provided additional context for these outcomes. The SAS score was positively correlated with the Wexner score both before and after surgery. The SDS score was positively correlated with the Wexner score after surgery but not before surgery. The GIQLI score was negatively correlated with the Wexner score both before and after surgery.

The authors conclude that in this observational cohort, TAC-IRA was associated with significant improvements in constipation, quality of life, and anxiety symptoms, but not depression, at six months. The changes in anxiety and quality of life were correlated with improvements in bowel function. However, the study explicitly notes that causality cannot be established due to the uncontrolled design of the research. As an observational cohort study without a control group, the findings suggest associations rather than definitive causal effects.

Subject of Research: Impact of total abdominal colectomy with ileorectal anastomosis on defecation function and psychological status in patients with slow transit constipation

Article Title: Changes in defecation function and psychological status following total abdominal colectomy with ileorectal anastomosis in patients with slow transit constipation: an observational cohort study

Article References: Fu, Z., Xue, P., Zhao, X., Ma, J., & Zheng, M. (2026). Changes in defecation function and psychological status following total abdominal colectomy with ileorectal anastomosis in patients with slow transit constipation: an observational cohort study. BMC Gastroenterology. https://doi.org/10.1186/s12876-026-05428-7

Image Credits: AI Generated

DOI: 10.1186/s12876-026-05428-7

Keywords: slow transit constipation, total abdominal colectomy, ileorectal anastomosis, anxiety, depression, quality of life, observational cohort, gastroenterology, Wexner score, psychological status, Changes, defecation