History of abuse common in female patients with IC

Atlanta-The idea that abuse plays a role in pelvic pain syndromes in women has been a controversial one. Now, another study is adding to that debate.

The idea is controversial among members of the IC patient community because they have long felt labeled by doctors as having psychological problems and as having pain that is either completely or at least partly psychogenic. Therefore, they feel they are either dismissed entirely without treatment or are inadequately treated medically.

The researchers-Kenneth Peters, MD, nurse practitioner Donna Carrico, and colleagues-drew their conclusions from both surveys and examination of 38 women with IC participating in the Women's Initiative for Sexual Health and Pelvic Pain (WISH) program at William Beaumont. In the surveys, 36.9% of 206 IC patients reported having been abused compared with 22.4% of 823 age-matched control women in the Midwest.

Among 38 IC patients who were examined and treated in the program, 31 (82%) had levator ani pain, which they rated at an average of six on a 10-point pain scale. This rate is similar to the 70% rate of pelvic floor dysfunction reported previously in IC patients. Of the 31 women with levator pain, 17 (55%) reported they had been abused physically, sexually, or emotionally.

Most of the abuse took place in childhood: 59% reported being abused at age 14 years or younger and 12% at ages 14 to 19 years. Twenty-four percent reported that abuse began in childhood continued into adulthood. The mean time between abuse and onset of IC symptoms was 24.4 years.

In 42%, the abuse was sexual, in 45% physical, in 48% emotional, and in 39% there was domestic violence, with combinations of those for many patients. The investigators did not specifically correlate the types of abuse with levator pain.

The findings surprised Dr. Peters. He had been seeing some of these patients for years, not knowing this was part of their history.

"Then they [saw] my nurse practitioner who was asking different questions, and I got these histories back," said Dr. Peters, who is director of clinical research in the department of urology. "It was shocking to me when I read the type of abuses they'd had. It's disheartening to know that this is out there, but at the same time, it's opened my eyes to change my practice and look at the patient as a whole besides their bladder and to use that multimodal approach to make them better."

"The issue also is with pelvic floor dysfunction," Carrico told Urology Times. "That really should be a front-line way of treating IC, as opposed to starting only pharmacologic therapy or a lot of interventions that may actually cause more upregulation of the nerves. So, if therapy can start with physical therapy and relax the pelvic floor muscles, we're finding a lot of the women are having improvement in symptoms."

She included some intravesical therapies among those that can upregulate nerves, noting that many patients have flares after some intravesical therapies, rather than being helped by the procedures. In addition, she noted, many women have symptoms worsen after pelvic procedures meant to diagnose or resolve pelvic pain problems, such as diagnostic or therapeutic laparoscopy or hysterectomy, a finding of another WISH program study.

Further research is needed to determine whether there is a causal relationship between abuse and IC, Dr. Peters said. He speculated that abuse leads to tensioning in the body and pelvic floor, which may lead to voiding dysfunction and pain, particularly when patients become sexually active, leading to even more pain and creating a vicious cycle.