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Evaluation of psychotropic drugs with a modified open field test.

The open field test used to study behavioral alterations induced by psychotropic drugs is based mainly in the defecation, ambulation, rearing and grooming presented by animals subjected to the test. Because of the criticisms raised against the defecation score as a measure of the central effects of drugs, in the present experiment a modification of the test is proposed for the rat. The main points that characterize the new procedure are: (1) defecation scores are not considered; (2) besides ambulation, rearing and grooming, immobility was also recorded; (3) the total time of observation was increased, and (4) the stimuli, usually presented simultaneously in the open field (light and noise), were presented separately. The results obtained suggest that it is possible to differentiate classes of psychotropic drugs, without taking the defecation and grooming scores into consideration. Besides stimulants that evoked a characteristic pattern of behavior, neuroleptics could be differentiated from anxiolytics. Similarities, according to the dose, between barbiturates and anxiolytics were detected. Under LSD a peculiar pattern of behavior characterized by a large reactivity to light was observed.

Animals↗

Detection of predefecatory rectosigmoid wave activity for prevention of fecal soiling in infants.

Identification of an electrophysiologic sign before defecation can prevent fecal soiling in infants. To identify such a sign, the contractile activity of sigmoid colon was recorded percutaneously in 48 healthy infants. The recorder was equipped with a digital clock synchronized to the recorder so as to set off an alarm upon significantly increased electromyographic activity of sigmoid colon. Examination of the recordings at high speed revealed three types of basal, signaling and predefecatory waves of activities. The 'basal' component was comprised of as negatively deflected slow waves. The signaling waves exhibited an increase in amplitudes, cycle rate and conduction velocity, were repeated 8.2+/-1.2 times and lasted for 14.6+/-2.1 minutes prior to defecation, The 'predefecatory' waves preceded defecation by 40.3+/-7.3 seconds, showed a significant increase in wave parameters and sounded the alarm. The findings show a method for early detection of defecation that can be used clinically to prevent fecal soiling in infants.

Colon, Sigmoid↗

Effects of TAK-637, a novel neurokinin-1 receptor antagonist, on colonic function in vivo.

Substance P (SP) is an important neurotransmitter that mediates various gut functions; however, its precise pathophysiological role remains unclear. In this study, we investigated the effect of SP on colonic function and the effect of TAK-637 [(aR,9R)-7-[3,5-bis(trifluoromethyl)benzyl]-8,9,10,11-tetrahydro-9-methyl-5-(4-methylphenyl)-7H-[1,4]diazocino[2,1-g][1,7]naphthyridine-6,13-dione] a new neurokinin-1 (NK1) receptor antagonist, on colonic responses to SP or stress in Mongolian gerbils. SP and the selective NK1 agonist [pGlu6]SP6-11 significantly increased fecal pellet output. TAK-637 reduced [pGlu6]SP6-11-induced defecation, but did not significantly affect neurokinin A-, 5-hydroxytryptamine- or carbachol-stimulated defecation. Oral TAK-637 decreased restraint stress-stimulated fecal pellet output with an ID50 value of 0.33 mg/kg. Ondansetron and atropine, but not the peripheral kappa-receptor agonist trimebutine, also reduced restraint stress-stimulated defecation. TAK-637 inhibited the increase in fecal pellet output stimulated by intracerebroventricular injection of corticotropin-releasing factor, but did not affect the stress-induced increase in plasma adrenocorticotropic hormone levels. Denervation of the sensory neurons with capsaicin did not affect stress-stimulated defecation. These results suggest that NK1 receptors in the enteric plexus play an important role in stress-induced changes in colonic function, and that TAK-637 may be useful in the treatment of functional bowel diseases such as irritable bowel syndrome.

Adrenocorticotropic Hormone↗

[Surgical creation of a reservoir-colostomy with reflex evacuation].

The authors consider that the problem of social rehabilitation of "colostomized" patients consists in an involuntary and sudden character of evacuation from the ostomy due to the absence of normal imperative urge to defecation. For this purpose a method of reservoir-retaining colostomy modulating the appearance of urge to defecation was worked out in experiments and used in clinic in 17 patients. Preconditions for the appearance of the urge were regular sensations due to mediated distention of the parietal peritoneum after filling the reservoir-retaining volume. The subjective sensations preceding the evacuation from the colostomy appeared 10-20 minutes before defecation and were felt as discomfort and abdominal cramping towards of the external end of the colostomy in 15 (88.2%) and as elements of intestinal colic in 2 (11.8%) patients. So, 9 (53%) patients managed to sufficiently control the evacuation from the ostomy and not to use the pouch. Five patients (29.4%) demonstrated the ability to restrain defecation for 10-15 minutes by straining the anterior abdominal wall muscles when the urge appeared. Evacuation from the ostomy was reiterative (2-4 times), once or twice a day, rarely 3-4 times a day and lasted from 15 till 60 minutes.

Colostomy↗

Impact of anal manipulation and pouch design on ileal pouch function.

The frequency of defecation, leakage, maximum resting pressure, and maximum squeeze pressure of the anal canal, maximum tolerated volume, and pouch compliance were evaluated in 116 consecutive patients following total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) and after temporary ileostomy closure. Sixty-nine patients had a double ileal loop pouch ("J") and 47 a triple ("S") design. Seventy patients had mucosal proctectomy and hand-sewn IPAA (mucosectomy) and 46 a stapled IPAA without mucosal proctectomy (stapled). Fifty percent of the S and 30% of the J pouch patients did not have nocturnal defecations. The avoidance of anal manipulation in the stapled group resulted in higher anal canal resting pressures and a lower incidence of leakage. The maximum tolerated volume and compliance was greater in the S pouch group than in the J group. Although the median frequency of defecation was equal in both pouch groups, fewer S pouch patients had nocturnal defecations. Anal canal resting tone may be the primary factor affecting continence following TPC and IPAA, but a compliant pouch may prevent leakage if sphincter function is compromised.

Anal Canal↗

Knowledge, attitudes and behaviour in relation to diarrhoea in a rural community in Burma.

A study was conducted in a rural community in Burma, to determine how people perceive the importance of food, water and defecation in the causation of diarrhoea and to determine whether people wash hands or use soap after defecation or before preparing and eating food. 90% of mothers with under-five children in the community were interviewed. 53 to 86% of people were aware of the importance of food, water and defecation in the causation of diarrhoea. Although 34 to 88% practised hand washing before eating/food handling or after defecation, only 5 to 12% regularly used soap. Furthermore, drinking water for under-five children was obtained by dipping the drinking mug or cup into the drinking water pot (83%) which could result in contamination of drinking water.

Adult↗

Diarrheal diseases of infancy in Cali, Colombia: study design and summary report on isolated disease agents.

For public health reasons, it is important that the etiologic agents of early childhood diarrhea be isolated and identified, and that their routes of transmission be defined. This is especially true in tropical and subtropical developing countries, where childhood patterns of exposure to diarrheal disease agents usually differ from those in developed countries, and where diarrheal illness is a frequent harbinger of death among children under five years of age. This artical describes a study designed to identify diarrheal disease agents and transmission patterns in Cali, a large city of western Colombia's fertile Cauca River Valley. The study area, composed of five working-class districts with a total population of some 40,000, appeared to provide an environment fairly similar to those of many other "average" working-class communities in Latin America. Beginning in July 1962, a cohort of 296 children being born in these districts was studied, the period of investigation starting with the date of birth and continuing until each child's second birthday or its premature withdrawal from the study. Weekly home visits were made to establish defecation patterns, feeding practices, and anthropometry. The resulting data were then analyzed in terms of defecation frequencies, occurrence of liquid stools, and the presence of blood, mucus, or pus in the stools. Differences were noted in male and female defecation patterns and in the defecation frequencies of different age groups. Stool specimens for bacteriologic, virologic, and parasitologic examination were collected monthly on a regular basis and weekly when diarrhea occurred. Numerically, viruses were isolated and identified more often than other agents. The most commonly isolated parasite species and viral and bacterial serotypes were G. lamblia (from 222 subjects), echovirus 11 (from 166 subjects), and enteropathogenic Escherichia coli 026:B6 (from 138 subjects). Compared with the findings of several studies in other countries, isolations of shigellae were relatively rare.

Age Factors↗

Physiology and pathophysiology of colonic motor activity (2).

The basic motor function of the colon is to mix and knead its contents, propel them slowly in the caudad direction, hold them in the distal colon until defecation, and provide a strong propulsive force during defecation. Infrequently, it also produces mass movements in the proximal colon. These motor functions are achieved in most species by three different types of contractions: the individual phasic contractions that include the short- and long-duration contractions, organized groups of contractions that include the migrating and nonmigrating motor complexes, and special propulsive contractions (giant migrating contractions). The spatial and temporal patterns of all of these contractions are controlled by myogenic, neural, and chemical control mechanisms. The individual phasic contractions are highly disorganized in time and space in the colon. For this reason, they are effective in mixing and kneading and slow distal propulsion. The underlying cause of the disorganization of short duration contractions is the irregularity in the frequency and waveshape of colonic electrical control activity and its phase unlocking throughout the colon. The individual contractions in many species occur in cyclic bursts called contractile states. At least in some species, these contractile states exhibit mostly caudad and sometimes orad migration. However, there are also nonmigrating or randomly migrating contractile states in the colon. These two patterns of contractile states are called colonic migrating motor complexes and colonic nonmigrating motor complexes, respectively. The giant migrating contractions provide the strong propulsive force for defecation and mass movements. The neural control of colonic contractions is organized at three levels--enteric, autonomic, and central. The enteric nervous system contains cholinergic and peptidergic neurons and plays a major role in the control of colonic contractions. The autonomic nerves, the vagi, pelvic, lumbar colonic, hypogastric, and splanchnic nerves, seem to continuously monitor the state of the colon and provide a modulatory input when necessary. These nerves play a major role in the reflexive control of colonic motor function. The voluntary input from the central nervous system coordinates the motor activity of the colon, rectum, anal canal and sphincters for orderly evacuation of feces during defecation. The role of acetylcholine, nonadrenaline, and the yet to be completely identified nonadrenergic, noncholinergic neurotransmitter, possibly VIP, in the control of contractions is fairly well established. Besides these, there are several other peptides and chemicals that are localized in the colonic wall; their physiological roles remain unknown. Colonic motor activity has been studied in several disease states. The findings have not always been consistent.(ABSTRACT TRUNCATED AT 400 WORDS)

Aging↗

Viscous fluid retention: a new method for evaluating anorectal function.

The ability to retain viscous fluid in the standing position was tested in 22 patients with fecal incontinence, 11 patients with constipation, and 26 control subjects. Viscous fluid was introduced into the rectum in increments of 50 ml. The examination was stopped when the patient complained of discomfort or the viscous fluid leaked. Eighteen of 22 patients with fecal incontinence leaked fluid, while none of the control subjects and only four of the constipated patients did so. Patients with fecal incontinence retained significantly less viscous fluid than did control subjects, whereas no difference was found between patients with constipation and control subjects. Rectal sensation from distention with air was tested in the patients as well as in the control group. The following volumes and pressures at each sensation were measured: 1) earliest defecation urge (EDU), 2) constant defecation urge (CDU), and 3) maximum tolerable volume (MTV). Patients with fecal incontinence had lower volumes than control subjects at all sensations, while patients with constipation had higher volumes at earliest defecation urge and at constant defecation urge. Rectal compliance was higher in patients with fecal incontinence than in control subjects, whereas patients with constipation did not differ from control subjects. Regression analysis showed a linear relationship between viscous fluid retention and the maximum tolerable volume and also between viscous fluid retention and rectal compliance. No difference in the ability to retain viscous fluid between male and female control subjects was found; regression analysis of viscous fluid retention in relation to age revealed decreasing volumes with increasing age. Day-to-day variation of the ability to retain viscous fluid was tested in eight persons, and reproducibility was found to be good.

Adult↗

Anismus: the cause of constipation? Results of investigation and treatment.

Anismus, or failure of the somatic sphincter apparatus to relax at defecation, has been implicated as a major contributor to the problem of obstructed defecation. Current diagnostic methods depend on laboratory measurements of attempted defecation and the most complex, dynamic proctography has been the mainstay of diagnosis. Using a new computerized ambulatory method of recording sphincter function in these patients at home, we report an 80% reduction in our diagnostic rate suggesting that conventional tests fail to accurately diagnose this condition, probably because they poorly represent the natural physiology of defecation. Treatment of this distressing condition is more complex and a variety of surgical and pharmacological measures have failed. Biofeedback retraining of anorectal function of these patients has been very successful and represents the management of choice.

Anus Diseases↗

Early and late (ten years) experience with circular stapler hemorrhoidectomy.

PURPOSE: We present a retrospective clinical study concerning the preliminary experience with the circular stapler in the treatment of hemorrhoids. Early results, complications, and long-term follow-up are revisited. METHODS: Fifty-six consecutive patients with second-, third-, and fourth-degree hemorrhoids were included in the study. Data about operation, early postoperative results, and follow-up at one, two, and four weeks were collected. Patients were also contacted by phone after a long-term follow-up (mean, 33 (range, 5-120) months). RESULTS: Every operation attempted was successfully terminated. The length of the operation was less than 15 minutes. No major bleeding or anastomotic disruption occurred. Six patients (13 percent) who underwent spinal or epidural anesthesia had urinary retention. One patient (1.7 percent) had minor bleeding, and four patients (7.1 percent) experienced transient edema of the anastomotic ring after the operation. None needed further treatments. The mean analgesic requirement was 1.4 (range, zero to eight) ketorolac 30-mg injections; 23 patients (41 percent) received no analgesics, and seven patients (12 percent) required a single extra dose of opiates (10 mg morphine cloridrate). Length of hospital stay was between 0 and 11 (mean, 2.7) days, but 20 patients (35 percent) received an additional operation for coexisting surgical disease. At one week, almost all patients experienced little pain at digital inspection and little bleeding after defecations. No anastomotic leakage, wound infection, or healing delay was found. Three patients (5.3 percent) experienced wound edema and pain during defecation. Two weeks later, one patient (1.7 percent) suffered from painful defecation and ten patients (17 percent) reported minor bleeding, but all returned to normal activities. No pain during defecation, bleeding, stenosis, soiling, incontinence, or other anal symptoms were found at one month after the operation, and all patients were well. All patients were contacted by phone 5 to 120 (mean, 33) months later, and all were pleased with the results of this procedure. There were no symptomatic recurrences. DISCUSSION: Our study confirms the feasibility of circular stapler hemorrhoidectomy in the treatment of hemorrhoids. Complications and postoperative pain were minimal. There were no recurrences during long-term follow-up. CONCLUSION: Mechanical hemorrhoidectomy is a promising new option in the treatment of all patients eligible for a surgical approach.

Adult↗

[Results of transperineal levator-plasty in treatment of symptomatic rectocele].

A rectocele is a herniation of the anterior rectal wall through the rectovaginal septum into the vagina. The most important risk factors are a previous hysterectomy, obstetic injuries and the descending perineum syndrome. In some patients the rectocele becomes symptomatical because of defecation disorders. The patients have to give manual vaginal or perineal help during defecation. Radiological parameters like the size of the rectocele or retention of barium only have limited value for the clinical evaluation. In a high percentage we find simultaneous symptoms of fecal incontinence. Transperineal anterior levatorplasty makes it possible to close the rectocele. This procedure has a positive influence on defecation and continence. In a prospective study we performed anterior levatorplasty in 35 female patients having a rectocele in combination with rectal outlet obstruction. Subjective improvement of the defecation disorder was found in 74%. Only 1 patient complained of deterioration. No patient needed manual vaginal help postoperatively. Patients who needed perineal help preoperatively had worse results. Patients who did not need any manual help preoperatively nevertheless reported an improvement postoperatively. Fifteen of 20 patients, who suffered from fecal incontinence preoperatively, reported a better continence postoperatively (75%). Even in patients with incontinence the anterior levatorplasty is a good method for rectocele repair, as it improves rectal emptying and simultaneously provides therapy for fecal incontinence.

Aged↗

Acute effects of clomipramine and fluoxetine on dorsal periaqueductal grey-evoked unconditioned defensive behaviours of the rat.

RATIONALE: Several antidepressants attenuate conditioned escape behaviours reinforced by the terminus of an electrical stimulus applied to the dorsal periaqueductal grey (DPAG). OBJECTIVE: The present study examined whether the antidepressant and antipanic drugs clomipramine (CLM) and fluoxetine (FLX) also attenuate the DPAG-evoked unconditioned defensive behaviours. METHODS: Rats with electrodes in the DPAG were electrically stimulated in the absence of any treatment or 30 min after injections of CLM, FLX or saline. Threshold functions of cumulative response frequencies were fitted through the logistic model and compared using likelihood ratio coincidence tests. RESULTS: CLM produced non-linear effects on galloping, for which median thresholds (I50) were significantly increased (19 +/- 2%) or decreased (22+/-2%) with 5 mg/kg and 10 mg/kg, respectively, or did not change with 20 mg/kg. The latter dose further increased the I(50) of micturition (38 +/- 1%) and decreased the defecation output (-33 +/- 15%). FLX significantly increased the I50 of immobility (22 +/- 2%) and galloping (25 +/- 3%) with 1 mg/kg and 5 mg/kg, respectively. Moreover, corresponding doses either decreased the maximum output (-25 +/- 13%) or increased the I50 (56 +/- 11%) of defecation. Saline was ineffective. CONCLUSIONS: While the attenuation of defecation and micturition by 20 mg/kg CLM suggests a peripheral antimuscarinic action, CLM non-linear effects on galloping were most likely due to its differential action on monoaminergic and cholinergic central mechanisms. In contrast, the attenuation of immobility, galloping and defecation by low doses of FLX suggests a serotonin-mediated antiaversive action. Finally, CLM and FLX acute effects on DPAG-evoked unconditioned galloping response were strikingly similar to those reported for DPAG-evoked shuttle-box conditioned escape.

Animals↗

Stapled and open hemorrhoidectomy: randomized controlled trial of early results.

The aim of the study was to compare the early results in 52 patients randomly allocated to undergo either stapled or open hemorrhoidectomy. Seventy-four patients with grade III and IV hemorrhoids were randomly allocated to undergo either stapled (37 patients) or open (37 patients) hemorrhoidectomy. Stapled hemorrhoidectomy was performed with the use of a circular stapling device. Open hemorrhoidectomy was accomplished according to the Milligan-Morgan technique. Postoperative pain was assessed by means of a visual analogue scale (V.A.S.). Recovery evaluation included return to pain-free defecation and normal activities. A 6-month clinical follow-up and a 17.5 (10 to 27)-month median telephone follow-up was obtained in all patients. Operation time for stapled hemorrhoidectomy was shorter (median 25 [range 15 to 49] minutes versus 30 [range 20 to 44] minutes, p = 0.041). Median (range) V.A.S. scores in the stapled group were significantly lower (V.A.S. score after 4 hours: 4 [2 to 6] versus 5 [2 to 8], p = 0.001; V.A.S. score after 24 hours: 3 [1 to 6] versus 5 [3 to 7], p = 0.000; V.A.S. score after first defecation: 5 [3 to 8] versus 7 [3 to 9], p = 0.000). Resumption of pain-free defecation was significantly faster in the stapled group (10 [6 to 14] days vs 12 [9 to 19] days, p = 0.001). At follow-up 4 weeks and 6 months postoperatively the median (range) symptom severity score was similar in both groups (1 [0 to 2] versus 0 [0 to 3], p = 0.150 and 0 [0 to 2] versus 0 [0 to 2], p = 0.731). At long-term follow-up occasional pain was present in 6/37 (16.2) patients in the stapled group and 7/37 (18.9%) in the Milligan-Morgan group (p = 1.000); episodes of bleeding were reported by 8/37 (21.6%) patients in the stapled group and 5/37 (13.5%) patients in the Milligan-Morgan group (p = 0.542). No problems related to continence and defecation were reported in either group. Patients were satisfied with the operation in 33/37 (89.2%) cases in the stapled group and 31/37 (83.8%) cases in the Milligan-Morgan group (p = 0.735). Hemorrhoidectomy with a circular staple device is easy to perform and achieves better results than the Milligan-Morgan technique in terms of postoperative pain and recovery. Comparable results are obtained at long-term follow-up.

Adult↗

Effect of electrical stimulation in constipated patients with impaired rectal sensation.

BACKGROUND AND AIMS: A subgroup of constipated patients complain of absent or diminished sense of wanting to defecate, suggesting that one of the causes of constipation is impaired rectal sensation. Electrical stimulation therapy (EST) has recently been used to treat patients with urinary and/or fecal incontinence. This study evaluated the efficacy of EST in constipated patients, especially those with impaired rectal sensation. PATIENTS AND METHODS: Of the 130 patients with functional constipation as defined by Rome II criteria, 22 patients who had impaired rectal sensation (rectal desire threshold volume > or =90 ml) on an anorectal manometry were selected. We treated 12 with EST and 10 with biofeedback therapy (BFT) according to a randomized order. RESULTS: Overall symptoms of patients significantly improved after each therapy in both groups. Interestingly, frequency of sense of wanting to defecate improved only after EST. On objective findings there was significant improvement in anal residual pressures on attempted defecation only after BFT solely. On the other hand, rectal sensory threshold volumes for desire and urge to defecate and maximal tolerated volume improved significantly only in the EST group. CONCLUSION: Our findings show that the efficacy of EST can be comparable to BFT in a subgroup of constipated patients, especially those with impaired rectal sensation. EST might be considered as an adjunctive therapeutic modality for the management of functional constipation with impaired rectal sensation.

Adolescent↗

Role of pelvicography and colpocystodefecography in diagnosis of outlet obstructive constipation.

AIMS: The aim was to research the changes in pelvic floor morphology and corresponding visceras in patients with outlet obstructive constipation (OOC). PATIENTS AND METHODS: Thirty-eight patients with OOC and 12 healthy volunteers were enrolled in this study. With simultaneous pelvicography and colpocystodefecography (PCCD), including pelvicography, vaginal opacification, voiding cystography and defecography, pelvic floor morphology was observed and the anorectal angle, the level of the perineum, peritoneum and bladder were measured. RESULTS: Thirty-seven cases of internal rectal prolapse (IRP), 5 cases of rectocele (RC) and 5 cases of spastic pelvic floor syndrome SPFS were diagnosed by PCCD. 12 IRP, 4 RC and 1 SPFS were detected by common physical examination. All of these were confirmed by PCCD. Moreover, PCCD found 9 pelvic floor hernia or peritoneoceles, 6 cystoceles, 3 descending perineum syndromes and 10 uterine prolapses. Compared with controls, OOC patients had a significantly large anorectal angle during defecation, abnormal descending of the perineum at rest and during defecation, and a deep pouch of Douglas during defecation. Some patients with urinary system symptoms may have had an abnormal descent of the bladder during rest and defecation. CONCLUSION: Simultaneous PCCD has a higher positive ratio than the common physical examination in diagnosing IRP and RC, and provides information for the diagnosis of pelvic floor hernia or peritoneocele, cystocele or uterine prolapse. PCCD is helpful in the selection of a proper surgical procedure.

Adult↗

Transanal rectocele repair using EndoGIA: short-term results of a prospective study.

BACKGROUND: The surgical treatment of symptomatic rectocele may be carried out by means of endorectal techniques. Results depend on a correct etiologic evaluation of associated diseases. We report the preliminary results of an original endorectal technique applied to selected patients. METHODS: Fifteen women (median age, 57 years; range, 38-73 years) underwent transanal rectocele resection by a 60 mm endo-GIA and subsequent plication of the anterior rectal wall. All patients had a primary isolated anterior medium sublevator rectocele with obstructed defecation symptoms. They were prospectively evaluated by questionnaire, defecation diary, clinical examination, defecography and anal manometry were performed preoperatively. All patients had less than three weekly bowel motions. Postoperative follow-up included clinical examination and symptoms questionnaire with defecation diary at one week, one month and three months; defecography was performed at three months. RESULTS: The time required to repair the rectocele was approximately 20 min. The mean time spent in hospital after the operation was 37 h. Postoperative pain was low or moderate in all cases, one patient had acute urinary retention, 11 had minor rectal bleeding, and 5 had temporary urgency. Abolition of excessive straining, feeling of incomplete evacuation, enemas and self-digitations was achieved in all patients; stool frequency at three months was 7 per week in 10 patients, 5-6 per week in 3 patients and 4-6 in 2 patients (p<0.001). Defecography at three months did not show any rectocele recurrence. CONCLUSIONS: Transanal rectocele repair with linear stapler applied in selected patients is safe and easy to perform. Short-term results are safisfactory. Complete investigations of impaired defecation and selection of patients are needed to achieve satisfactory results.

Adult↗

Epidemiology of colonic symptoms and the irritable bowel syndrome.

Functional gastrointestinal disease is believed to be very common, but reports of its prevalence have not usually evaluated random community samples, and validated questionnaires have not been used to elicit symptoms. The prevalence of specific colonic symptoms and the irritable bowel syndrome among representative middle-aged whites was determined from a defined population, and the impact of these symptoms on presentation for medical care was measured. An age- and sex-stratified random sample of 1021 residents of Olmsted County, Minnesota, aged 30-64 years, was obtained. All subjects were mailed a valid self-report questionnaire that identified gastrointestinal symptoms and functional gastrointestinal disorders. The response rate was 82% (n = 835). The age- and sex-adjusted prevalence of abdominal pain (more than six times in the prior year) was 26.2 per 100 (95% confidence interval, 23.1-29.2). The prevalence of chronic constipation (hard stools and straining and/or less than 3 stools per week greater than 25% of the time) was 17.4 (95% confidence interval, 14.8-20.0), whereas the prevalence of chronic diarrhea (loose watery stools, and/or greater than 3 stools per day greater than 25% of the time) was 17.9 (95% confidence interval, 15.3-20.5). The prevalence of abdominal pain and disturbed defecation was similar in women and men, except that infrequent defecation and straining at stool were more common in women. Using the Manning symptom criteria to identify irritable bowel syndrome (greater than or equal to 2 of 6 symptoms in those with abdominal pain more than six times in the prior year), the prevalence of irritable bowel syndrome was 17.0 per 100 (95% confidence interval, 14.4-19.6). Overall, 71 persons (9%) reported visiting a physician for abdominal pain or disturbed defecation in the prior year; a subset of variables related to pain severity were the best predictors of health care seeking after adjustment for age and gender. However, these accounted for only 22% of the log likelihood. In conclusion, more than one third of an unselected middle-aged population reported chronic abdominal pain or disturbed defecation, and more than one in six had symptoms compatible with the irritable bowel syndrome. Only a minority had presented for medical evaluation; moreover, the characteristics of the abdominal complaints did not explain the seeking of health care in most cases.

Abdominal Pain↗