A cross-sectional study was conducted of a prospectively maintained database of patients seeking assessment at the Colorectal Pelvic Floor Service at the Queen Elizabeth II Jubilee Hospital, Queensland, Australia. This study was approved by the Metro South Human Research Ethics Committee reference: HREC/2020/QMS/62215.
Data was collected on all patients who had been assessed at the functional colorectal pelvic floor unit for defaecatory dysfunction from 2017–2019. All patients were routinely asked to complete validated questionnaires, including being asked about a history of previous sexual abuse. We included all female patients who completed the questionnaire with regards to their symptoms, quality of life, and history of sexual abuse. Patients who were male, transgender, or who did not complete the questionnaire, were excluded. A retrospective review of patient charts was conducted to capture demographic data, medical, surgical, obstetric and social histories. Sexual abuse (SA) is defined as responses to the following questions: 1) Have you ever had sex without agreeing to it? 2) If yes, was this vaginal sex, anal sex, or both?
Symptom And Quality Of Life Assessment
All patient questionnaires were completed at the initial visit to the Colorectal Pelvic Floor unit. Symptom severity and quality of life were assessed on symptoms of faecal incontinence and constipation using validated scoring systems. Patients completed those surveys that correspond to their presenting complaint of either faecal incontinence, constipation, or both. The Wexner Incontinence Scale  and Vaizey Incontinence Score  quantify the severity of incontinence based on different types of bowel contents (gas, mucus, liquid and/or solid stool). Higher values reflect increase in symptom severity. The Faecal Incontinence Quality of Life Score (FIQOL) has demonstrated high reliability in measuring the effect of faecal incontinence on quality of life . It assesses four domains: lifestyle, coping and behaviour, depression and self-perception, and embarrassment, which have been added together for a total score. Lower values indicate a reduced quality of life. The Constipation Scoring System  and Obstructed Defecation Score  are validated systems that assess severity of disease with higher scores reflecting increased severity. The Patient Assessment of Constipation Quality of Life Sore (PACQL) is a validated questionnaire that assesses the burden of constipation on everyday function and well-being . Four categories are evaluated: worries/concerns, physical discomfort, psychosocial discomfort, and satisfaction. The first three categories are summed up to give a dissatisfaction score and the fourth category a satisfaction score.
Clinical examination and anorectal physiology studies were performed on all patients. Relevant clinical examination pertaining to this study evaluated dyssynergia by the presence or absence of paradoxical puborectalis contraction when asked to strain. Anorectal physiology assessments included endoanal manometry for resting and squeeze pressures, endoanal ultrasound to assess for internal or external sphincter defect, rectal sensation with balloon inflation, and pudendal nerve terminal motor latency. Dyssynergia was also evaluated objectively using both manometry and electromyography.
Variables were analysed either with chi-squared (χ2) test for categorical variables, or with Mann-Whitney test for continuous variables comparing the two cohorts of patients with and without a history of SA. A multivariate linear regression model was used to determine the effect of sexual abuse on the results of the different survey scores evaluating symptom severity, quality of life, and anorectal physiology study results. A P value of 0.05 or less was considered statistically significant. All analysis was performed using SPSS Statistics for Windows, version 25 (SPSS Inc., Chicago, Ill., USA).