title: 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.
  
  
  METHODS
  A cross-sectional study of a prospectively maintained clinical database.
  
  
  METHODS
  A tertiary referral center for evaluation and physiologic testing for pelvic floor disorders.
  
  
  METHODS
  Women with fecal incontinence or constipation examined during a 6-year period.
  
  
  METHODS
  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.
authors.forename: Laurel R
authors.initials: LR
authors.lastname: Imhoff
authors.forename: Loriel
authors.initials: L
authors.lastname: Liwanag
authors.forename: Madhulika
authors.initials: M
authors.lastname: Varma
mesh_terms: D000328:Adult; D000368:Aged; D003248:Constipation / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D003430:Cross-Sectional Studies; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology*; D011788:Quality of Life; D012720:Severity of Illness Index; D012742:Sex Offenses