Psychological stress has a known relationship to symptom prevalence and severity for bowel dysfunction including constipation and the symptom complex of irritable bowel syndrome, as well as, its associated symptoms of fecal urgency and fecal incontinence. The presence of pelvic floor disorders (PFDs) has also been independently associated with presence of bowel symptoms and are relatively understudied in racial/ethnic minority women.  Psychosocial stress as related to discrimination has been implicated as a contributor to poor health outcomes among racial/ethnic minorities and is of particular importance given the higher exposure to environmental and discrimination-based stressors among racial/ethnic minorities. The role of discrimination-related stress in moderating relationship between PFDs and bowel symptoms warrants further study given higher rates of psychosocial stress among marginalized populations. We will evaluate the relationship between bowel symptoms, psychosocial stressors and prevalence of PFDs among Latina women in the community.

We used data collected through a population-based cross-sectional study of Spanish- and English-speaking Latina women recruited throughout northeast Los Angeles through 2019.  We obtained demographic data and psychosocial measures, specifically the Perceived Stress Scale (PSS), PSS subscores representing protective and negative domains, the Everyday Discrimination Scale (EDS), as well as a chronicity-weighted EDS (CEDS). Symptoms of PFDs were identified by the Pelvic Organ Prolapse Distress Inventory (POPDI-6), Urinary Distress Inventory (UDI-6) and Colorectal-Anal Distress Inventory (CRAD-8) portions of the Pelvic Floor Disorders Inventory (PFDI-20) questionnaire. We considered both presence of PFDs as well as severity. We conducted multivariable logistic regression to test the association between bowel symptoms and the above variables with statistical significance at a p-value <0.05.

We identified a total of 76 women (39.7%) with bowel symptoms. Of those, 25 (13.1%) had FI. Women with bowel symptoms were younger (47.8 vs 5.04, p = 0.27), reported higher levels of perceived stress (16.8 vs 14.3, p = 0.003), specifically in the negative subscore (10.9 vs 8.4, p < 0.001), and had more severe PFDs (p < 0.001). There were non-statistically significant increases in discrimination scores among those with bowel symptoms for both EDS (1.33 vs 1.06, p = 0.12) and CEDS (245.4 vs 196.1, p = 0.39). On multivariable logistic regression analysis (Table 1), PSS negative subscore (OR = 1.1, 1.0 to 1.2, p = 0.02), POPDI-6 severity (OR = 4.2, 1.5 to 11.6, p = 0.005), and UDI-6 severity (OR = 12.6, 4.2 to 33.7, p < 0.001) remained statistically significant.

Bowel symptoms among Latina women recruited in the community were associated with both the severity of PFDs as well as perceived stress and chronic discrimination. These results suggest the role of psychosocial stress as a risk factor, or consequence of bowel symptoms.

Further research is needed to understand the complex interaction between psychosocial mediators and PFDs, especially in the setting of severe PFD symptoms.