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Original Article
Dec 2012

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

Author Affiliations

Author Affiliations: Departments of Surgery, University of California, San Francisco (UCSF)–East Bay, Oakland (Dr Imhoff) and UCSF, San Francisco (Ms Liwanag and Dr Varma).

Arch Surg. 2012;147(12):1123-1129. doi:10.1001/archsurg.2012.1144

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 < .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.