title: Association between child maltreatment and constipation: a school-based survey using Rome III criteria.
abstract: OBJECTIVE
  Child abuse leads to multiple physical and psychosomatic sequelae. The aim of the present study was to evaluate the association between child abuse and constipation among schoolchildren.
  
  
  METHODS
  Children 13 to 18 years of age were selected from 4 semiurban schools in Gampaha District, Sri Lanka. A self-administered questionnaire was used for data collection. Information regarding sociodemographic factors and gastrointestinal symptoms, child abuse, and somatisation were collected. Constipation was diagnosed using Rome III criteria.
  
  
  RESULTS
  A total of 1792 children were included in the analysis (boys 975 [54.4%], mean age 14.4 years, standard deviation [SD] 1.3 years). One hundred thirty-eight (7.7%) fulfilled Rome III criteria for constipation. The number of children exposed to physical, emotional, and sexual abuse were, respectively, 438 (24.4%), 396 (22.1%), and 51 (2.8%). The prevalence of constipation was significantly higher in those exposed to sexual (5.8% vs 2.6% P = 0.03), emotional (40.9% vs 20.8%, P < 0.0001), and physical abuse (41.6% vs 23.2%, P < 0.0001). Mean somatisation score was higher in the total group of abused children with constipation (mean 18.6, SD 12.5) compared with those without (mean 13.9, SD 12.3; P = 0.027). Children with a history of abuse did not seek health care more often than children without this history. Patient-perceived severity of bowel symptoms was higher in children with physical abuse (23.7 vs 19.7 P = 0.001) and emotional abuse (25.4 vs 19.3 P < 0.0001).
  
  
  CONCLUSIONS
  Childhood constipation shows a significant association with physical, sexual, and emotional abuse. Children with constipation complain of more somatic symptoms and bowel symptoms when they are exposed to abuse.
authors.affiliation: *Faculty of Medicine, Department of Paediatrics †Faculty of Medicine, Department of Physiology, University of Kelaniya, Ragama, Sri Lanka ‡Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Shaman
authors.initials: S
authors.lastname: Rajindrajith
authors.forename: Niranga M
authors.initials: NM
authors.lastname: Devanarayana
authors.forename: Chamila
authors.initials: C
authors.lastname: Lakmini
authors.forename: Vindya
authors.initials: V
authors.lastname: Subasinghe
authors.forename: D G Harendra
authors.initials: DG
authors.lastname: de Silva
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D000293:Adolescent; D002650:Child Abuse, Sexual / Q000706:statistics & numerical data*; D003248:Constipation / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010465:Perception; D015995:Prevalence; D012720:Severity of Illness Index; D012737:Sex Factors; D013001:Somatoform Disorders / Q000453:epidemiology* / Q000523:psychology; D013188:Sri Lanka / Q000453:epidemiology; D011795:Surveys and Questionnaires