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: Atertiary 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 < .001) and diminished quality of life on the FIQL ( P < .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. ©2012 American Medical Association. All rights reserved.