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onic constipation, a functional bowel disorder, affects approximately 14% of adults worldwide [1]. Slow transit constipation (STC) is the major cause of chronic constipation which is characterized by markedly prolonged colonic transit time as a result of the colonic motility function disorde

Usually, patients with STC suffer from a common sense of abdominal pain, nausea, depression and sickness, which seriously influence their social ability and health-related quality of life [4–6

Current clinical treatments include cathartics, prokinetics and aggressive surgery which can increase bowel movement frequency to a certain degree.

However, pharmacological interventions is prone to drug dependency and relapse after drug withdrawal [3]

Surgical treatments such as subtotal colectomy and total colectomy in STC patients may adversely affect the quality of life due to the risk of postoperative diarrhea or incontinence, and result in a heavy healthcare burden

The enteric nervous system (ENS), located in the intestinal wall, regulates various functions including contraction of intestine, homeostasis and blood flow [10]. As the ‘second brain’, the ENS contains large amounts of neurons working independently from the central nervous system [11]. Researches have identified that STCs are mostly caused by disorders of the relevant nerves, especially the ENS [12,13].

McCallum et al. [35] found that gastric electrical stimulation in combination with pharmacological treatment could also enhance emptying in patients with gastroparesis. Especially, gastric electrical stimulation has been approved as a clinical therapy method for gastroparesis and obesity in European and American countries [36].

we employed pulse train stimulation and implanted electrodes at the proximal colon in dogs.

After CES treatment, we observed the colonic transit time of the sham treatment group was longer than that of CES treatment and control groups, and electrical stimulation significantly enhanced the colonic electromyogram (EMG) signal.

histopathology and TEM analysis showed increased ganglia and synaptic vesicles existing in the colon myenteric plexus of the CES treatment group as compared with that of the sham CES group

Our results suggested that CES might reduce the degeneration of the myenteric plexus neurons, thereby contributing to the therapeutic effect on STC beagles.

the defecating frequency and the feces characteristics of STC beagles returned to normal after CES treatment. The result indicated that CES could improve the symptoms of STC.

The colonic EMG signal was strongly promoted by CES

Especially, the colonic EMG signal of the beagles with STC was remarkably enhanced by CES (Figure 3), indicating that CES could not only improve the colonic content emptying, but also enhance the EMG signal to promote colonic motility.

Colonic electrical stimulation (CES), a valuable alternative for the treatment of STC, was reported to improve the colon motility by adjusting the bioelectrical activity in animal models or patients with STC [17]. However, little report focuses on the underlying nervous mechanism to normalize the delayed colonic emptying and relieve symptoms. We hypothesized that CES may also repair the disorders of the relevant nerves and then improve the colonic motility.

The first study regarding the CES to modulate colonic motility was performed by Hughes et al. [37]. Since then, many researchers employed short-pulse CES in canine descending colon or pig cecum [20,21,38]. Researchers also applied long-pulse CES to stimulate the colon of human or animals [39]

Recently, studies showed that the prokinetic effect of pulse train CES is better than that of short-pulse CES or long-pulse CES [25]

Our study indicated that CES could enhance the colonic motility, and then accelerate the colonic content emptying. Thereafter, we investigated the underlying mechanism and presumed that CES might improve the STC symptom through the repairment of the ENS.

The neuropathy in ENS is considered to be responsible for various kinds of disordered motility including STC and the related pathophysiologic symptoms [40]. In agreement with this view, our study discovered the decreased number of ganglia in the myenteric plexus, as well as the destruction of the enteric nerve axon terminals and synaptic vesicles in the sham CES group beagles

The present study proves that CES with pulse trains has curative effects on the colonic motility and content emptying in STC beagles. The up-regulation of intestinal nerve related proteins such as SYP, PGP9.5, CAD and S-100B in the colonic myenteric plexus suggests that CES might reduce the degeneration of the myenteric plexus neurons, thereby producing the therapeutic effect on STC beagles. Further investigation for the underlying mechanism of nerve regeneration is necessary to better understand how CES promotes the recovery of delayed colonic motility induced by STC.

What happens inside a person’s head can have damaging effects throughout the body, as well as the other way around. An untreated mental illness can significantly increase the risk of becoming physically ill, and physical disorders may result in behaviors that make mental conditions worse.

In studies that tracked how patients with breast cancer fared, for example, Dr. David Spiegel and his colleagues at Stanford University School of Medicine showed decades ago that women whose depression was easing lived longer than those whose depression was getting worse. His research and other studies have clearly shown that “the brain is intimately connected to the body and the body to the brain,”

“The body tends to react to mental stress as if it was a physical stress.”

Anxiety disorders affect nearly 20 percent of American adults. That means millions are beset by an overabundance of the fight-or-flight response that primes the body for action.

“We often talk about depression as a complication of chronic illness,” Dr. Frownfelter wrote in Medpage Today in July. “But what we don’t talk about enough is how depression can lead to chronic disease. Patients with depression may not have the motivation to exercise regularly or cook healthy meals. Many also have trouble getting adequate sleep.”

These protective actions stem from the neurotransmitters epinephrine and norepinephrine, which stimulate the sympathetic nervous system and put the body on high alert. But when they are invoked too often and indiscriminately, the chronic overstimulation can result in all manner of physical ills, including digestive symptoms like indigestion, cramps, diarrhea or constipation, and an increased risk of heart attack or stroke.

While it’s normal to feel depressed from time to time, more than 6 percent of adults have such persistent feelings of depression that it disrupts personal relationships, interferes with work and play, and impairs their ability to cope with the challenges of daily life

“Depression diminishes a person’s capacity to analyze and respond rationally to stress,” Dr. Spiegel said. “They end up on a vicious cycle with limited capacity to get out of a negative mental state.”

Although persistent anxiety and depression are highly treatable with medications, cognitive behavioral therapy and talk therapy, without treatment these conditions tend to get worse.

When you’re stressed, the brain responds by prompting the release of cortisol, nature’s built-in alarm system. It evolved to help animals facing physical threats by increasing respiration, raising the heart rate and redirecting blood flow from abdominal organs to muscles that assist in confronting or escaping danger.

Improving sleep is especially helpful, Dr. Spiegel said, because “it enhances a person’s ability to regulate the stress response system and not get stuck in a mental rut.”