Exacerbation of Symptom Severity of Pelvic Floor Disorders in Women Who Report a History of Sexual Abuse

Abstract

Objective: To examine the effect of previous sexual abuse or assault (SAA) on symptom severity, quality of life, and physiologic measures in women with fecal incontinence or constipation. Design: A cross-sectional study of a prospectively maintained clinical database. Setting: A tertiary referral center for evaluation and physiologic testing for pelvic floor disorders. Patients: Women with fecal incontinence or constipation examined during a 6-year period. Main Outcome Measures: Symptom severity and quality of life were measured with the Fecal Incontinence Severity Index (FISI), Fecal Incontinence Quality of Life Scale (FIQL), Constipation Severity Instrument (CSI), Constipation-Related Quality of Life measure (CR-QOL), and 12-Item Short Form Health Survey (SF-12). Physiologic variables were ascertained with anorectal manometry, electromyography, and endoanal ultrasonography. Results: Of the 1781 women included, 213 (12.0%) reported SAA. These women were more likely to be white, to report a psychiatric illness, and to have a prior hysterectomy or episiotomy. On bivariate analysis, women with prior SAA had increased symptom severity on the FISI (P = .002) and CSI (P Ͻ .001) and diminished quality of life on the FIQL (P Ͻ .001), CR-QOL (P=.009), and SF-12 (P =.002 to P=.004). Physiologic variables did not differ significantly between patients with and without prior SAA. Conclusions: A history of SAA significantly alters disease perception in fecal incontinence and constipation, but the disorders do not result from increased physiologic alterations. We must elicit a history of SAA in these patients, because the history may play a role in the discrepancy between symptom reporting and objective measurements and may modify treatment recommendations.

Sexual Abuse History and Pelvic Floor Disorders in Women

“…The relation of fecal incontinence to sexual abuse may have more to do with symptom perception and severity. Imhoff et al found that women who have experienced sexual abuse or sexual assault have greater symptom severity for fecal incontinence, 17 again underscoring the importance of asking all patients about a history of sexual abuse.…”

Características dos casos de violência sexual contra mulheres adolescentes e adultas notificados pelos serviços públicos de saúde em Santa Catarina, Brasil

“…Causa danos profundos no bem-estar físico, sexual, reprodutivo, emocional, mental e social das vítimas 6 . Na violência sexual contra mulher a penetração vaginal está presente na maioria das agressões, de acordo com as literaturas nacional 4 e internacional 17 , submetendo-as ao risco de gravidez indesejada e infecções sexualmente transmissíveis (IST), incluindo o HIV e a hepatite viral 4 .…”

The Prevalence of Suspected Child Abuse in Children With Constipation: A Case-control Study

“…Next to the previously described methodologic challenges in diagnosing CAN in children, pathophysiologic differences between adults and children with FC could also play a role. As the association between CAN and FC is mostly described in adults with slow-transit constipation and pelvic oor dyssynergia [4][5][6][7][8][9][10] , these types of constipation are less commonly acknowledged in young children. It could also be hypothesized that constipation, as a symptom of CAN, will develop over time and the association in young children is therefore not present yet.…”

“…2,3 In adults suffering from functional defecation disorders, such as slow-transit constipation and pelvic oor dyssynergia, a possible association with child abuse has been described, with 12%-44% of patients with constipation reporting a history of physical or sexual abuse. [4][5][6][7][8][9][10] In addition, abused adult patients reported more severe symptoms of constipation 7 , decreased quality of life 7 and more frequent use of surgical strategies 8 as compared to patients with no history of child abuse. Early detection of abuse is therefore important in the work-up of both pediatric and adult patients with FC.…”