Sexual and physical abuse are not associated with rectal hypersensitivity in patients with irritable bowel syndrome

Abstract

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.

Figure 1

Association of sexual abuse history with rectal pain thresholds. Patients with irritable bowel syndrome with a history of severe abuse had significantly higher rectal pain thresholds, as measured by the ascending method of limit (AML) and by the tracking technique. *p<0.03.

Figure 2

Association of sexual abuse history with urge sensation thresholds. Patients with irritable bowel syndrome with a history of severe abuse had significantly higher urge sensation thresholds, as measured by the ascending method of limit (AML). ***p<0.001.