Sexual and physical abuse are not associated with rectal hypersensitivity in patients with irritable bowel syndrome
Open accessAbstract
Background: Patients with irritable bowel syndrome (IBS) have reduced pain thresholds for rectal distension. In addition, the prevalence of sexual/physical abuse in referred IBS patients is high and is associated with greater pain reporting, poorer health status, and poorer outcome. This lead to a hypothesis that abuse history may sensitise patients to report pain at a lower threshold. Aim: To compare rectal pain thresholds in women with IBS who had a history of severe abuse to IBS women with no history of abuse. Methods: We studied 74 IBS patients with a history of severe physical and/or sexual abuse and 85 patients with no history of abuse. Abuse history was assessed by a previously validated self-report abuse screening questionnaire. Rectal sensory thresholds were assessed using an electronic barostat and determined by the ascending method of limit (AML) and by the tracking technique. Results: IBS patients with a history of severe abuse had significantly higher rectal pain thresholds, as measured by AML (F (1, 111) = 6.06; p = 0.015) and the tracking technique (F (1, 109) = 5.21; p = 0.024). Patients with a history of severe abuse also reported a significantly higher threshold for urgency to defecate (F (1, 113) = 11.23; p = .001). Conclusion: Severe sexual/physical abuse is associated with higher urge and pain thresholds for rectal distension in IBS patients. This suggests that the greater pain reporting and poorer health status in IBS patients with abuse history are not related to increased rectal pain sensitivity. Further studies are needed to determine the causes of these findings.
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The findings are consistent with reports that women experiencing violence have adverse health outcomes and with other systematic reviews associating pain symptoms or syndromes with some type of adult or childhood abuse.
“Our findings are consistent with reports that women experiencing violence have adverse health outcomes [18–21], and with other systematic reviews that associate some pain symptoms/syndromes with some type of adult or childhood abuse [30–34].”
From The association between violence against women and chronic pain: a systematic review and meta-analysis (2024) · cites this paper as [20]
The introduction reports prior findings associating abuse history with greater pain reporting and poorer health in patients with IBS. But this paper is an original study, not a systematic review, and its Discussion says its own groups did not differ in clinical symptom ratings. It therefore supports the general association as background, not the claim that this cited work is a systematic review establishing it. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe most common diagnoses in victimized individuals are pelvic pain, fibromyalgia, irritable bowel syndrome/bowel symptoms, abdominal pain, migraine/headache, back pain, chest pain, and neck pain, which tend to become chronic.
“The most common diagnosis of victimized are pelvic pain [13], fibromyalgia [14], irritable bowel syndrome/bowel symptoms [15], abdominal pain [16], migraine/headache [17], back pain [18], chest pain [19], and neck pain [20], which tend to become chronic as well as the pain derived from them.”
From The Risk Factors of Chronic Pain in Victims of Violence: A Scoping Review (2023) · cites this paper as [15]
Physical and psychological stress, cognition, and early life experience can affect intestinal sensory perception.
“For example, it has been shown that physical and psychological stress (112), cognition (e.g., attention vs. distraction to aversive stimulus) (55), and early life experience (e.g., sexual and physical abuse) (39, 149) can affect intestinal sensory perception.”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [149]
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- Authors
- Ringel, Y., Whitehead, W. E., Toner, B. B., Diamant, N. E., Hu, Y., Jia, H., Bangdiwala, S. I., & Drossman, D. A.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Centre for Addiction and Mental Health (CA)
- University of Toronto (CA)
- Corresponding author
- Ringel, Y
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2004-05-11
- Volume
- 53
- Issue
- 6
- Pages
- 838-842
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC1774075
- OpenAlex
- W2156488577
- Cited by
- 72
- References
- 41
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 5 · 2015: 2 · 2014: 2 · 2013: 2 · 2012: 5
- FWCI
- 4.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- UNC Libraries
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Keywords
- irritable bowel syndrome, sexual abuse, physical abuse, rectal hypersensitivity, rectal distension, fecal urgency, women, abuse history
- MeSH terms
- Adult, Analysis of Variance, Female, Humans, Rectum, Sex Offenses, Pain Threshold, Domestic Violence, Irritable Bowel Syndrome
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