Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome: a case control study

Abstract

Background: The impact of early lifetime trauma on symptom severity and quality of life of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) has not been fully elucidated. We wanted to determine and compare the prevalence and impact of childhood traumatic events, with an emphasis on childhood sexual abuse, on patient symptoms, quality of life and other biopsychosocial parameters. Methods: Subjects (female patients with IC/BPS and controls without IC/BPS) completed psychosocial phenotyping questionnaires, including a demographics/history form, and validated questionnaires focused on presenting symptoms (IC symptom indices, pain), psychosocial parameters (depression, anxiety, pain catastrophizing, sexual functioning, social support) and quality of life. Participants also completed the Childhood Traumatic Events Scale. Results: Questionnaires were completed by 207 IC/BPS patients and 117 controls matched for age, partner status and education. It was found that before 17 years of age, the IC/BPS cases reported higher prevalence of "raped or molested" compared to controls (24.0% vs. 14.7%; p = 0.047). Within the IC/BPS group, cases reporting previous sexual abuse endorsed greater sensory pain, depression and poorer physical quality of life at the present time compared to IC cases without a sexual abuse history. In the controls only, those reporting previous sexual abuse endorsed more depression, anxiety, stress, social maladjustment poorer mental quality of life in the present time. When the analysis was corrected for potential multiple comparison error, none of the findings remained significant in either the IC/BPS or control groups. Interpretation: Childhood traumatic events, in particular sexual abuse and extreme illness, are reported as more common in IC/ BPS patients than controls. Early trauma, such as the occurrence of sexual abuse, is associated with some differences in patient adjustment (e.g., pain, quality of life, depression) but this impact appears to be, at most, very modest.

Psychosocial co‐morbidities in Interstitial Cystitis/Bladder Pain syndrome (IC/BPS): A systematic review

“…Six studies measured abuse prevalence via validated self‐report, non‐validated questionnaires, and clinical interview of trauma exposure . One study measured dissociative tendencies .…”

“…When asked directly via clinical interview, this number increased significantly in one study, while decreasing in another study when asked directly “were you abused as an adult/child,” without a definition of “abuse.” Abuse in childhood and adulthood is more common in female patients . The presence of sexual abuse has been associated with altered symptom presentation, where patients experiencing greater sensory pain, less daytime frequency and nocturia, larger voided volumes, and worsened sexual functioning—although one study notes this relationship is at most very modest …”

Linaclotide inhibits colonic and urinary bladder hypersensitivity in adult female rats following unpredictable neonatal stress

“…Childhood trauma is reported to be more common in patients diagnosed with BPS compared to healthy controls . However, despite the high clinical relevance, the mechanisms by which ELS affect the urinary bladder remains to be fully explored.…”

“…Despite the prevalence of both disorders, their etiologies remain unclear, though evidence suggests that stress contributes to both IBS and BPS. Early life stress (ELS) in particular has been implicated as a risk factor for both disorders, with many patients reporting instances of childhood trauma or abuse . In support, studies have shown that exposure to neonatal ELS induces visceral hypersensitivity and abnormalities in bladder smooth muscle contractility .…”

Voluntary exercise improves voiding function and bladder hyperalgesia in an animal model of stress‐induced visceral hypersensitivity: A multidisciplinary approach to the study of urologic chronic pelvic pain syndrome research network study

“…Numerous studies have documented a complex interplay between IC/BPS and stress. IC/BPS patients have increased incidences of childhood trauma and current life stress compared with healthy controls, both of which correlate with worse urinary symptoms, increased pain, and worse quality of life . Patients additionally report that acute stress exacerbates their symptoms in a dose‐dependent fashion .…”