Prevalence of Functional GI Disorders in Women with History of Domestic Violence. Does the Type of Abuse Matter?

Abstract

Purpose: Previous studies have documented a high prevalence of abuse, either physical or sexual, in patients with functional gastrointestinal disorders (FGIDs). However, there is a lack of information regarding prevalence of FGIDs in adults suffering domestic violence. Our aim was to evaluate the prevalence of FGIDs in women with domestic violence and explore if the type of abuse has any relationship with the presence of FGIDs. Methods: 122 women at “Casa de la Mujer”, a Women's Attention Center that gives support to women who experience domestic violence, were invited to participate. Prevalence of FGIDs was assessed using the Rome II integrated questionnaire (Spanish validated version). Physical, psychological and sexual abuse were assessed using a standard self reporting screening instrument, and anxiety-depression levels using the Hospital Anxiety and Depression scale (HAD) questionnaire. Results: 87 (71%) women (mean age 39 ± 11 years) agreed to participate in the study. 85(98%) reported psychological abuse, 66 (76%) physical, and 26 (30%) sexual abuse. Prevalence of FGIDs was 93% (N = 81) and 71 women had more than 1 FGID (mean 3 ± 1). FGIDs reported were: functional dyspepsia 59%, IBS 39%, proctalgia fugax 38%, functional constipation 31%, functional heartburn 22%, bloating 18%, fecal incontinence 13%, dyssynergia fecation 9%, abdominal pain 8%, chest pain 8%, rumination 5%, and dysphagia 2%. 25 women had both dyspepsia and IBS. The mean global score for HAD was 19 ± 7. Women with FGIDs had significantly higher anxiety scores (11 ± 4 vs 6 ± 1, P= 0.005). Fecal incontinence (P= 0.05) and proctalgia fugax (P= 0.04) were more common in women with sexual abuse compared to other types of abuse. Women with sexual abuse had higher global and anxiety scores (HAD) (P < 0.05). Conclusion: Most women who suffer domestic violence experience FGIDs, confirming that abuse plays an important role in FGIDs. Psychological distress, specifically anxiety, was more severe in women with FGIDs. Sexual abuse is associated with functional anorectal disorders. We believe our study has important clinical implications for comprehensive health care of women in situations of abuse and women with FGIDs.