Bowel dysfunction is highly correlated with pelvic organ prolapse (POP) and urinary incontinence (UI). While racial/ethnic minority women have higher prevalence of POP and UI, rates of bowel dysfunction in this population have shown mixed results. As such, the factors associated with bowel dysfunction among racial/ethnic minority women is understudied. We evaluated the role of psychosocial stress, specifically perceived social stress and discrimination among Latina women in a clinical setting.

We analyzed data from a cross-sectional study of Spanish- and English-speaking Latina women with pelvic floor disorders (PFDs) recruited from urology and urogynecology clinics in Los Angeles.  Demographic data was obtained and study participants completed validated questionnaires for psychosocial measures: Perceived Stress Scale (PSS), PSS subscores representing protective and negative domains, and Everyday Discrimination Scale (EDS), including a chronicity-weighted EDS (CEDS). PFDs were assessed via the Pelvic Floor Disorders Inventory (PFDI-20). The primary outcome was bowel dysfunction as determined by response to the Colorectal-Anal Distress Inventory (CRAD-8) portion of the PFDI-20. We conducted multivariable logistic regression to test the association between demographic data, psychosocial and PFD-related questionnaires for those with and without bowel dysfunction with statistical significance at a p-value <0.05.

Of the 153 women recruited from clinics, 99 (64.7%) self-reported bowel symptoms, of which 36 (23.5%) had fecal incontinence. Compared to women without bowel symptoms, women with symptoms were more likely to be older (56.6 vs 49.4, p < 0.001), had higher mean total PSS (18.5 vs 15.1, p = 0.008), higher PSS subscores, higher EDS (0,82 vs 0.59, p = 0.06), more severe prolapse (p < 0.001) and urinary symptoms (p < 0.001). They also had a non-statistically significant increase in CEDS scores (95.6 vs 65.1, p = 0.38). On multivariable logistic regression analysis (Table 1), the protective subscale of the PSS (OR = 1.35, 95% CI = 1.06 -1.72, p = 0.01), being a homemaker (OR = 0.06, 95% CI = 0.01 - 0.57, p = 0.01), and severe prolapse symptoms (OR = 9.55, 95% CI = 1.43 - 63.71, p = 0.02) had statistically significant associations with the presence of bowel symptoms.

Among Latina women who seek care for PFDs and have bowel dysfunction, a relationship exists between bowel symptoms, self-reported psychosocial stress, and sociocultural factors.

Further studies are warranted to understand the role these factors may have in the etiology of bowel dysfunction, and whether stress might be a determinant or consequence of these disorders.