Sleep Disturbance a Marker for Anxiety and Depression in Functional Anorectal Pain

Patients with functional anorectal pain frequently report symptoms of depression and anxiety, and contributing factors include marital status, pain duration and severity, and sleep disturbance.

Authors of a cross-sectional study published in the Journal of Pain Research reported a high prevalence of depression and anxiety among patients with functional anorectal pain, and sleep disturbance was identified as being significantly associated with increased risk for depressive and anxiety symptoms.

Patients (N=100) with functional anorectal pain (FAP) were recruited at SuBei Hospital in China in 2021 to participate in this study. The study participants responded to a questionnaire that evaluated patient characteristics and contained the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) instruments for depression and anxiety, respectively.

The study population consisted of 77% women, 41% of participants were aged 40 to 59 years, 81% were married, and 55% were employed. Sleep disturbances were reported by 42% of study participants, and 11% reported a history of anal surgery.

The majority of patients reported they had been experiencing FAP for at least 3 months (67%), mean visual analogue scale (VAS) pain scores were 3.70±2.51, mean PHQ-9 scores were 6.54±5.22, and mean GAD-7 scores were 4.79±4.55 points. Overall, 55.0% of patients had scores indicative of symptoms of depression, and 46.0% had scores indicative of symptoms of anxiety.

There is a need for psychologists to be involved in the treatment of patients with FAP.

In the univariate analyses, depression was related with gender, level of education, marital status, alcohol consumption, disease duration, sleep disturbance, and history of anal surgery, and anxiety was related with gender, marital status, sleep disturbance, and history of anal surgery.

In the multivariate analysis, depression was associated with sleep disturbance (odds ratio [OR], 32.471; 95% CI, 18.155-56.598; P =0.00), functional anorectal pain for more than 3 months (OR, 11.178; 95% CI, 10.539-23.202; P =.017), unmarried marital status (OR, 8.519; 95% CI, 2.309-16.929; P =.049), and female gender (OR, 8.267; 95% CI, 2.208-15.596; P =.031).

Predictors for anxiety included sleep disturbance (OR, 19.329; 95% CI, 4.024-26.835; P =0.00), unmarried marital status (OR, 9.293; 95% CI, 3.407-17.387; P =.021), and higher VAS pain scores (OR, 0.357; 95% CI, 0.211-0.603; P =0.00).

A major limitation of this study was its cross-sectional design, which did not allow for causal comparisons to be made.

These data indicate that among study participants with functional anorectal pain, more than half had symptoms of depression and nearly half had symptoms of anxiety. Patients reporting disturbed sleep and those who are unmarried may be at increased risk for both depression and anxiety. The study authors suggest that “[t]here is a need for psychologists to be involved in the treatment of patients with [functional anorectal pain]. Multidisciplinary treatment may be a better treatment way.”


Dong L, Sun T, Tong P, Guo J, Ke X. Prevalence and correlates of depression and anxiety in patients with functional anorectal pain. J Pain Res. 2023;16:225-232. doi:10.2147/JPR.S400085