Abuse Plays Small Role, at Best, in IC
Nickel JC, Tripp DA, Pontari M, Moldwin R, Mayer R, Carr LK, Doggweiler R, Yang CC, Mishra N, Nordling J. Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome: a case control study. Can Urol Assoc J. 2011 Dec;5(6):410-5. doi: 10.5489/cuaj.11110.
Studies that pegged the rates of abuse to be higher in women with IC than others fueled controversy and old prejudices about a psychologic cause and the futility of medical therapy. But the effect of early trauma isn’t significant, shows this new study with a fairly large number of patients at a number of centers in North America and Europe and careful statistical analysis. We reported on this study in the ICA eNews and the ICA Update after some results were presented at the 2010 Society for Infection and Inflammation in Urology meeting. Now, the detailed analysis has been published showing a modest effect, at best. The study included 207 IC patients and 117 controls matched for their age, partner status, and education. Participants answered questionnaires related to their disease, mental state, quality of life, and childhood traumatic events. Among the IC patients, 24 percent reported having been “raped or molested” before age 17, whereas 14.7 percent of controls did so, a difference that didn’t rise to the level of statistical significance. The IC patients who reported early sexual abuse reported greater sensory pain, depression, and poorer physical quality of life than IC patients who had not been abused. The controls who reported sexual abuse reported more depression, anxiety, stress, social maladjustment, and poorer mental quality of life than those who had not been abused. But when the analysis was corrected for potential error, these differences weren’t significant.
Interestingly, just as this article was published, a large study from the Centers for Disease Control and Prevention (CDC) on rape, sexual violence, and stalking. Estimates of rape during a woman’s lifetime were high—ranging from about 11 to nearly 30 percent in different states, with the lifetime rate nationwide estimated at 18.3 percent. About 42 percent of women who had been raped experience the first rape before age 18 and about 80 percent before at 25. The study also reported higher rates of asthma, irritable bowel syndrome, and diabetes in women who had been raped, stalked, or experienced physical violence from an intimate partner than in those who had not experienced any of these forms of violence. Although this report implies some physical consequences of sexual violence, IC was not reported among them, and although the difference for the other conditions were significant between victims and nonvictims, the proportion of victims experiencing these physical problems was by no means a majority.
These two studies certainly highlight that the rates of rape and sexual violence are too high, possibly higher than we thought, and stopping this violence may ease some physical suffering, but that won’t be a cure or even helpful to the majority of patients with IC or the other conditions mentioned in the CDC report. Doctors who see men, the large majority of perpetrators, could help in prevention while concentrating on medical therapy as part of the multidisciplinary approach to IC treatment.
IC Saps Sleep
Panzera AK, Reishtein J, Shewokis P. Sleep disruption and interstitial cystitis symptoms in women. Urol Nurs. 2011 May-Jun;31(3):159-65, 172.
Thanks to the 407 women with IC who responded to Alis Panzera, PhD’s sleep survey posted through the ICA website, we now know that all the patients had poor sleep because of pain, urinary urgency, and the need to urinate frequently during the night. Not surprisingly, the lack of quality sleep translated to daytime fatigue, lost productivity, depression and an overall drop in quality of life.