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Sexual and physical abuse are not associated with rectal hypersensitivity in patients with irritable bowel syndrome
  1. Y Ringel1,
  2. W E Whitehead1,
  3. B B Toner2,
  4. N E Diamant3,
  5. Y Hu1,
  6. H Jia1,
  7. S I Bangdiwala1,
  8. D A Drossman1
  1. 1Department of Medicine, Division of Digestive Diseases and Nutrition, and the UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, North Carolina, USA
  2. 2Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Ontario, Canada
  3. 3Division of Gastroenterology, University of Toronto, Ontario, Canada
  1. Correspondence to:
    Dr Y Ringel
    Division of Gastroenterology and Hepatology, 1140 BioInformatics Bldg, CB#7080, 130 Mason Farm Rd, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080, USA;


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.

  • irritable bowel syndrome
  • rectal sensation
  • history of abuse
  • IBS, irritable bowel syndrome
  • AML, ascending method of limit
  • TT, tracking technique
  • VAS, visual analogue scale

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