Constipation in Sri Lankan children: association with physical, sexual, emotional abuse

Abstract

BACKGROUND/AIMS: Child abuse in any form leads to multiple psychosomatic sequel. It is commonly associated with gastrointestinal manifestations. The main aim of this study was to evaluate the association between child abuse and constipation among school children. METHODS: Children aged 13–18 years were randomly selected from three semi-urban schools in Gampaha district, Sri Lanka. A previously validated, questionnaire was administered in an examination setting. Information regarding sociodemographic factors and gastrointestinal symptoms, child abuse and somatisation were collected. Constipation was diagnosed using Rome III criteria for paediatric functional gastrointestinal diseases. RESULTS AND DISCUSSION: A total of 1365 children were recruited [males 749 (54.9%), mean age 14.2 years, SD 1.22 years]. Hundred and ten (8.1%) fulfilled Rome III criteria for constipation. The number of children exposed to physical, emotional and sexual abuse, were respectively 1001 (73.3%), 299 (21.9%) and 34 (2.4%). Prevalence of functional constipation was significantly higher in those exposed to sexual (17.6% vs. 7.8%, p =0.038), emotional (14.7% vs. 6.2%, p = 0.0001) abuse, and physical abuse (9.1% vs. 5.2%, p = 0.02). Mean somatization score in children with constipation and controls were 15.9 and 8.3, respectively (p < 0.0001). Among children with constipation, somatisation index was higher in those who have experienced emotional abuse (20.1 vs. 13.1 p = 0.003). CONCLUSIONS: Childhood constipation shows a significant association with physical, sexual and emotional abuse. Children with constipation complain of more somatic symptoms, especially those exposed to emotional abuse.