Prevalence of childhood trauma and its association with lower urinary tract symptoms in women and men in the LURN study

Abstract

Aims: To describe the association between childhood traumas (death of a family member, severe illness, sexual trauma, parental separation) reported by women and men and lower urinary tract symptoms (LUTS). Methods: In this secondary analysis of the Lower Urinary Tract Research Network Observational Cohort Study, participants completed the LUTS tool, childhood trauma events scale (CTES), PROMIS depression and anxiety and perceived stress scale. LUTS tool responses were combined to quantify urinary urgency, frequency, incontinence, and overall LUTS severity. Multivariable linear regression tested associations between trauma and LUTS; mental health scores were tested for potential mediation. Results: In this cohort (n = 1011; 520 women, 491 men), more women reported experiencing at least one trauma (75% vs. 64%, p < .001), greater than three traumas (26% vs. 15%, p < .001), and childhood sexual trauma (23% vs. 7%, p < .001), and reported higher impact from traumatic events compared with men (median [interquartile rnage] CTES score = 10 [5-15] vs. 6 [4-12], p < .001). The number of childhood traumatic events was not associated with severity of overall LUTS (p = .79), urinary frequency (p = .75), urgency (p = .61), or incontinence (p = .21). Childhood sexual trauma was significantly associated with higher incontinence severity (adjusted mean difference 4.5 points, 95% confidence interval= 1.11-7.88, p = .009). Mental health was a mediator between trauma and LUTS among those with at least one childhood trauma.

Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms

“…The other studies were retrospective, cross-sectional in nature (n=3). Fourteen studies were conducted in the US [23][24][25][26][27][28][29][30][31][32][33][34][35][36], 2 in Germany [37,38], 1 in the Netherlands [39] and 1 in Hong Kong [40].…”

“…voiding difficulties (16.1% vs 27%) but not UI (40.4% vs 45.2%) Difficulty with ADLs and IADLs and current emotional abuse by family or friends and by their partner. Women with a history of unwanted first sexual experience had increased odds of reporting difficulty with mobility Geynisman-Tan et al [ 36 ] Secondary analysis of baseline data obtained from the Symptoms of Lower Urinary Tract Research Network Observational Cohort Study (US). n =1,064 (of which 519 men; median age 58.8) SA: CTES includes sexual and other trauma occurring before age 17.…”

“…Table 3 summarises the results of these studies [ 30 – 36 , 38 ]. SA was assessed using different methods and only one study used a validated questionnaire, The Childhood Traumatic Events Scale [ 36 ].…”

“…The wide prevalence of abuse across studies reflects differences in the cohorts Most studies defined SA broadly as forced or unwanted sexual activity, ranging from the broadest, "unwanted sexual touching" [23] to the narrowest, "complete sexual penetration of the vagina, mouth or rectum without a women's consent, involving the use of force or threat of harm" [24]. Furthermore, only four studies used a validated scale to assess SA [23,29,36,40], which limited the extent to which the nature, length and severity of abuse could be assessed. The wide prevalence range of SA reported in the studies, from 1.3% [40] to 49.6% [28] may not accurately reflect the true prevalence of SA in patients reporting with LUTS; however, it is somewhat in keeping with the prevalence reported in other cohorts without LUTS [41,42].…”

“…Table 3 summarises the results of these studies [30][31][32][33][34][35][36]38]. SA was assessed using different methods and only one study used a validated questionnaire, The Childhood Traumatic Events Scale [36]. The prevalence of SA varied greatly between studies, from 9% [33] to 52.5% [38].…”