Psychosomatic Medicine 13:112-116 (1951)
© 1951 American Psychosomatic Society

Physiologic and Psychodynamic Mechanisms in Constipation and Diarrhea

¹ Chicago Institute for Psychoanalysis

Constipation and diarrhea are symptoms related to disorders of the lower portions of the gastrointestinal tract. In the past, little consideration has been given to the precise portions of the tract involved in these symptoms.

The lower alimentary tract is divisible into two distinct functional units: that of the colon and rectum which are regulated by the autonomic nervous system, and that of the external anal sphincter which is under voluntary control in consequence of previous toilet training. Disorders of the colon and rectum express themselves either in an increased secretion and motility resulting in diarrhea, or a decreased activity with resulting constipation. Disorders of the anal sphincter are best analyzed in terms that are also applicable to the vesical sphincter, viz., retention, frequency, and incontinence. Thus, constipation may be the result of increased retention, and diarrhea the result of an increased frequency. Whereas the disorders of colonic function are related to the dynamics of the vegetative neuroses, the dysfunctions of the anal sphincter are related to the dynamics of hysterical conversion symptoms.

The usual psychoanalytic formulations concerning constipation and diarrhea are inadequate because they can account only for dysfunctions of the anal sphincter. A new hypothesis of the physiologic basis and of the psychodynamics of colonic dysfunctions is presented. It is suggested that colonic activation and inhibition, leading to diarrhea and constipation, represent the physiologic sequelae of certain alteration in the upper gastrointestinal tract. Constipation is regarded as the remote physiologic consequence of a state of increased vagal excitation; and diarrhea is interpreted as the result of a sudden decrease in vagal tonus. Psychologic factors of etiologic significance in colonic dysfunctions are related to mobilization and inhibition of oral-incorporative tendencies. The symptoms themselves which result from colonic dysfunctions have no primary psychologic meaning.