To evaluate the links between gastrointestinal disorders and sexual abuse, we asked 344 patients consulting in a specialized tertiary care university hospital or a gastroenterologist in private practice, if they had been sexually abused. Forty per cent of patients suffering from lower functional digestive disorder gave a history of having been victims of sexual abuse in contrast to only 10% of patients with organic diseases (P < 0.0003). The prevalence was similar in private practice and in the university hospital. Abused patients were more likely to complain of constipation (P < 0.03) and diarrhoea (P < 0.04). Anismus was more frequent in patients who had been sexually abused (P < 0.02). The prevalence of abuse was four times greater in patients with lower than with upper functional motor disorders of the gastrointestinal tract (P < 0.002). This study confirms the large prevalence of a past history of sexual abuse among patients consulting for gastrointestinal tract functional disorder, and this whatever the kind of recruitment may be. It shows the association to be much stronger in patients who have a lower rather than an upper gastrointestinal dysfunction, the major complaint of abused patients being constipation and diarrhoea.

The purpose of this study was to determine some relationships between colonic myoelectric spiking activity and intraluminal propulsion when colonic peristalsis was stimulated by bisacodyl. Myoelectric recordings were obtained in 12 subjects by means of a 50 cm long Silastic tube equipped with four bipolar electrodes fixed at 10-cm intervals. The tube was introduced into the left colon by flexible sigmoidoscopy and the electrodes were located at 50, 40, 30, and 20 cm from the anal verge. A small polyethylene catheter opening at the proximal end of the Silastic tube was used for introducing the laxative into the colon. One hour recording sessions were obtained before and after bisacodyl administration (5 mL of 0.4% solution). The control tracings showed that colonic spiking activity was made of rhythmic stationary bursts that occurred at only one electrode site and of sporadic bursts that were either propagating over the whole colonic segment or nonpropagating. Administration of bisacodyl was followed by complete suppression of the rhythmic stationary activity; a considerable increase in the sporadic spiking activity, propagating as well as nonpropagating; the occurrence of abdominal cramps and urgency to defecate, both associated with the propagating sporadic spike bursts. It is concluded that colonic propulsion induced by bisacodyl may be dependent upon the production of the sporadic bursts, particularly the propagating ones, while the rhythmic stationary bursts do not seem to play a significant role in colonic transit.

No abstract

The great variability which is known to affect colonic motility may partly be the result of changes in physiological conditions. In order to test this hypothesis, 40 subjects were sequentially put in conditions of vigilance, rest, stress, and feeding while colonic motility was monitored. The myoelectric spiking activity of the left colon was recorded with a 50-cm-long silastic tube equipped with four bipolar ring electrodes (located 10 cm apart) introduced into the left colon by flexible sigmoidoscopy. Tracings were performed while the subjects were kept awake (by conversation) for 1 hr, put at rest (quiet) for another 1 hr, submitted to a stress (by alternatively immersing and removing one hand from 2-4 degrees C cold water) for 20 min, and finally recorded for 2 hr after a 800-kcal meal. In 18 other subjects, the sequences of vigilance and rest were randomized. The results showed that colonic spiking activity was made of sporadic bursts that are known to be associated with intraluminal propulsion and of stationary bursts that probably play no role in colonic peristalsis. The duration of sporadic spiking activity was respectively 13.6 +/- 1.2 min/hr (mean +/- SEM) during the period of vigilance, 5.4 +/- 0.6 min/hr during the period of rest (P less than 0.001), 14.3 +/- 1.0 min/hr during the period of stress (NS), and 16.8 +/- 1.2 min/hr after a meal (P less than 0.05). The duration of stationary spiking activity did not change significantly throughout the four periods, respectively, 6.6 +/- 4.9, 4.4 +/- 3.7 (NS), 5.2 +/- 3.9 (NS), and 3.3 +/- 2.8 min/hr (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Anorectal manometry was performed in 40 women, who consulted for functional disorders of the lower gastrointestinal tract and had been sexually abused. Anismus, defined as a rise in anal pressure during straining, was observed in 39 of 40 abused women, but in only six of 20 healthy control women (P < 0.0001). Other parameters of anorectal manometry were compared with those observed in another control group composed of 31 nonabused women but with anismus, as well as the group of healthy controls. A decreased amplitude of anal voluntary contraction and an increased threshold volume in perception of rectal distension were observed in both abused and nonabused patients. A decreased amplitude of rectoanal inhibitory reflex, little rise in rectal pressure upon straining, frequent absence of initial contraction during rectal distension, and increased resting pressure at the lower part of the anal canal were observed in abused but not in nonabused patients, suggesting that these abnormalities, in association with anismus, suggest a pattern of motor activity in the anal canal that could be indicative of sexual abuse.