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Association Between Child Maltreatment and Constipation: A School-Based Survey Using Rome III Criteria

Rajindrajith, Shaman*; Devanarayana, Niranga M.; Lakmini, Chamila*; Subasinghe, Vindya*; de Silva, D.G. Harendra*; Benninga, Marc A.

Journal of Pediatric Gastroenterology and Nutrition: April 2014 - Volume 58 - Issue 4 - p 486–490
doi: 10.1097/MPG.0000000000000249
Original Articles: Gastroenterology

Objective: Child abuse leads to multiple physical and psychosomatic sequelae. The aim of the present study was to evaluate the association between child abuse and constipation among schoolchildren.

Methods: Children 13 to 18 years of age were selected from 4 semiurban schools in Gampaha District, Sri Lanka. A self-administered questionnaire was used for data collection. Information regarding sociodemographic factors and gastrointestinal symptoms, child abuse, and somatisation were collected. Constipation was diagnosed using Rome III criteria.

Results: A total of 1792 children were included in the analysis (boys 975 [54.4%], mean age 14.4 years, standard deviation [SD] 1.3 years). One hundred thirty-eight (7.7%) fulfilled Rome III criteria for constipation. The number of children exposed to physical, emotional, and sexual abuse were, respectively, 438 (24.4%), 396 (22.1%), and 51 (2.8%). The prevalence of constipation was significantly higher in those exposed to sexual (5.8% vs 2.6% P = 0.03), emotional (40.9% vs 20.8%, P < 0.0001), and physical abuse (41.6% vs 23.2%, P < 0.0001). Mean somatisation score was higher in the total group of abused children with constipation (mean 18.6, SD 12.5) compared with those without (mean 13.9, SD 12.3; P = 0.027). Children with a history of abuse did not seek health care more often than children without this history. Patient-perceived severity of bowel symptoms was higher in children with physical abuse (23.7 vs 19.7 P = 0.001) and emotional abuse (25.4 vs 19.3 P < 0.0001).

Conclusions: Childhood constipation shows a significant association with physical, sexual, and emotional abuse. Children with constipation complain of more somatic symptoms and bowel symptoms when they are exposed to abuse.

*Faculty of Medicine, Department of Paediatrics

Faculty of Medicine, Department of Physiology, University of Kelaniya, Ragama, Sri Lanka

Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.

Address correspondence and reprint requests to Dr Shaman Rajindrajith, Faculty of Medicine, Department of Paediatrics, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka (e-mail:

Received 12 November, 2013

Accepted 12 November, 2013

The present study was supported by the International Foundation for Functional Gastrointestinal Diseases.

S.R. and N.M.D. contributed equally to the article.

M.A.B. has been a consultant to Shire, Norgine, and Sucampo. The other authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,