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PubMed1996

Irritable bowel syndrome: a study to investigate the mechanism(s) of visceral hypersensitivity.

Irritable bowel syndrome (IBS), is characterized by gastrointestinal hyperalgesia. In this study we investigated mucosal application of dyclonine on urge to defecate and pain threshold in volunteers and IBS patients (n = 10). Either saline or dyclonine (40 ml enema) was administered 10 minutes prior to rectosigmoid distension or cutaneous cold water pressor test. In IBS patients and volunteers no differences in cutaneous pain thresholds were noted. However, IBS patients had a lower pain threshold in the rectosigmoid than volunteers. In volunteers there was a significant difference between the threshold for urge to defecate and the threshold for rectosigmoid pain that was not apparent in IBS patients. Dyclonine administered directly into the rectosigmoid did not alter urge to defecate or pain threshold induced by distension in volunteers or IBS patients. These data suggest that the origin of pain perception is localized in deeper structures within the wall of the rectosigmoid colon.

Adult↗
PubMed1997

[Diagnosis with defecography of puborectal muscle syndrome].

The puborectalis syndrome is a defecation disorder supported by the nonrelaxation of puborectalis sling with consequent dyschezia. We report on a series of 98 patients submitted to clinical examination, defecography, anorectal manometry, electromyography and intestinal transit time studies. Puborectalis anatomy and physiology are briefly reviewed. The main symptoms of puborectalis syndrome in our patients were incomplete defecation (89%) and intermittent evacuation (63%); 28% of patients turned to finger defecation. In all patients, defecography showed an abnormal increase in puborectalis impression on the posterior anorectal wall, reduced anorectal angle opening under straining (mean value: 113 degrees) and prolonged expulsion time with barium pooling in the ampulla (mean evacuation time: 38 seconds). Such anorectal abnormalities as rectal mucosal prolapse (47 cases) and anterior rectocele (36 cases) were also associated. In 33 of 98 patients (34% of cases), sling assessment by bidigital palpation at preliminary clinical examination revealed puborectalis hypertonia, which was later confirmed at defecography. Manometry was not specific for the diagnosis of puborectalis syndrome, detecting increased external anal sphincter pressure under straining in 24 of 35 patients (68.8%). Puborectalis activity was increased under straining in 16 subjects submitted to electromyography. Intestinal transit time studies showed a typical expulsion delay and radiopaque marker pooling in the ampulla in 18 of 23 patients (78.2%). In our experience, defecography is a useful, simple and noninvasive method for the accurate diagnosis of the puborectalis syndrome.

Defecation↗
PubMed2004

Efficacy and tolerability of tegaserod in constipation dominant irritable bowel syndrome.

OBJECTIVE: To determine the efficacy and tolerability of tegaserod in the treatment of symptoms of irritable bowel syndrome (IBS) IBS-C patients. DESIGN: An open label (quasi interventional) study. PLACE AND DURATION OF STUDY: Patients were enrolled between October 2000 and August 2001 at 4 centres (AKUH, Karachi; Mayo Hospital, Lahore; PIMS, Islamabad; Hayatabad Teaching Complex, Peshawar). PATIENTS AND METHODS: Tegaserod was administered in a dose of 6 mg (twice-a-day) orally for a period of 6 weeks. Symptoms were assessed before and during treatment using a questionnaire. RESULTS: The mean age of patients was 37.5 years and 81(69.2%) were males. The study enrolled 117 patients and 101 patients completed the study. Number of bowel movements, symptoms of straining at defecation, stool consistency, bloating, urgency and abdominal pain improved significantly following treatment (p<0.05). Analysis of data in both genders separately showed statistically significant improvement in symptoms of urgency, straining at defecation, abdominal pain and number of bowel movements following treatment. Side effects of diarrhoea and vertigo (6 and 1 patients respectively) necessitating discontinuation of treatment were infrequent. CONCLUSION: Tegaserod given in a dose of 6 mg b.d. is effective and well tolerated in IBS-C patients. It is equally effective in males and females in relieving the symptoms of abdominal pain, bloating, straining at defecation as well as increased in the mean number of bowel movements per week.

Adult↗
PubMed1997

Deflation reflex: description and clinical significance.

BACKGROUND: During our study of the defecation mechanism, we found that the external anal sphincter contracted not only upon rectal inflation but also upon deflation. As this reflex relationship was reproducible, it was studied to elucidate its clinical significance in the light of its function. METHODS: A catheter with a condom at its end was introduced into the rectum of 16 healthy volunteers (mean age 45.2 years). The EMG response of the external anal sphincter to rapid rectal inflation and deflation was studied by means of a concentric needle electrode inserted into the muscle. The procedure was repeated in eight subjects after sphincter infiltration with xylocaine or saline. RESULTS: The external sphincter contracted twice on rectal distension: once on inflation and another time on deflation. The amplitude increased and latency decreased with increasing rectal inflation, while neither was affected on deflation. The anesthetized sphincter did not respond, while the saline-infiltrated sphincter responded to rectal distension. CONCLUSIONS: The deflation reflex functions to interrupt or terminate the act of defecation. It may prove of diagnostic significance in defecation disorders.

Action Potentials↗
PubMed2000

Age effects on the social interaction test in early adulthood male rats.

The effects of age on active and passive social interaction were studied in Wistar rats using the social interaction test (S.I.T.). Individual behaviors such as ambulation, rearing, and defecation were also studied. Despite the widespread use of the S.I.T. in anxiety research, the effects of age on the S.I.T. have not been studied thoroughly. Male Wistar rats of 75, 135, and 180 days old were used. Our results showed age effects on active social contact, passive social contact, ambulation, rearing, and defecation. At 135 days old, animals presented the lowest scores on active social behavior and the highest scores on defecation. Moreover, exploratory behavior measured by ambulation and rearing decreased with age. These results suggest that age could be a relevant variable in the social interaction test.

Aging↗
PubMed1980

Gender differences in open-field behavior as a function of age.

Male and female rats were observed in an open field at 30, 45, 60, 90, and 120 days of age. Thirty- and 45-day-old rats of both genders presented similar defecation, ambulation, and rearing scores. From 60 days on the male rats showed higher defecation scores and less ambulation and rearing than did the females. The gender difference observed in the adult rats reflected a decrease of defecation by females and a decrease of ambulation and rearing by males when compared to the earlier ages.

Aging↗
PubMed2005

Mosapride citrate, a novel 5-HT4 agonist and partial 5-HT3 antagonist, ameliorates constipation in parkinsonian patients.

Mosapride citrate is a novel selective 5-HT4 receptor agonist. It facilitates acetylcholine release from the enteric cholinergic neurons. In contrast to cisapride, mosapride does not block K(+) channels or D2 dopaminergic receptors. The objective of this study is to perform an open study of mosapride citrate's effects on constipation, a prominent lower gastrointestinal tract disorder in parkinsonian patients. A total of 14 parkinsonian patients (7 with Parkinson's disease, 7 with multiple system atrophy; 10 men, 4 women; mean age, 67 years) with constipation (10 with bowel movement < 3 times/week; 14 with difficulty in defecation) were treated with 15 mg/day of mosapride citrate for 3 months. Pre- and posttreatment objective parameters in colonic transit time (CTT) and rectoanal videomanometry were obtained. Statistical analysis was made by Student's t test. Mosapride was well tolerated by all patients except for 1, who discontinued use of the drug because of epigastric discomfort. None had a worsening of parkinsonism or other adverse events. Thirteen patients reported subjective improvements in bowel frequency (>3 times/week, 13) and difficult defecation (13). Mosapride shortened CTT of the left colon (P < 0.01) and the total colon (P < 0.05). During rectal filling, mosapride lessened the first sensation (P < 0.05) and augmented the amplitude in phasic rectal contraction. During defecation, mosapride augmented the amplitude in rectal contraction (P < 0.05) and lessened the volume of postdefecation residuals. The present study showed for the first time that mosapride citrate augmented lower gastrointestinal tract motility, as shown in CTT and videomanometry, and thereby ameliorated constipation in parkinsonian patients without serious adverse effects.

Aged↗
PubMed1997

Scent-marking by coyotes, Canis latrans: the influence of social and ecological factors

We observed 49 coyotes, Canis latransfrom five resident packs for 2456 h and five transient coyotes for 51 h from January 1991 to June 1993 in the Lamar River Valley, Yellowstone National Park, Wyoming, U.S.A. During these observations we recorded 3042 urinations, 451 defecations, 446 ground scratches and 743 double-marks. The rate of scent-marking (via urination) was influenced by the social organization (resident versus transient) to which the coyote belonged, the social class (alpha, beta or pup) of the animal and the time of the year. Transient coyotes scent-marked at a lower rate than did members of a resident pack. Within the resident packs, alpha coyotes scent-marked at a higher rate than beta coyotes (adults and yearlings subordinant to alphas, but dominant over pups) and pups. Alpha coyotes increased their rate of marking during the breeding season; beta and pup coyotes performed scent-marks at a relatively constant rate throughout the year. There was no influence of social class or time of year on the rate of defecation. The rate of double-marking was highest among alpha coyotes with a peak during the breeding season. Alpha coyotes ground-scratched at a higher rate than did beta and pup coyotes. Alpha and beta coyotes scent-marked more than expected along the periphery of the territory compared to the interior; pups marked in the interior and edge in proportion to expected frequencies. Double-marking and ground-scratching were higher than expected along the periphery of the territory. The distribution of defecations was not different from expected along the edge versus the interior of the territory. Pack size did not influence the rate of scent-marking performed by individuals in the pack or by the alpha pair. We concluded that alpha coyotes were the primary members of the resident pack involved in scent-marking. The large coyote packs and the high rate of marking by the alpha pairs were parallel to the scent-marking behaviour displayed by wolves, C. lupusto a greater extent than previously reported. Scent-marks appear to provide internal information to the members of the resident pack (internal map of territory, breeding condition, reproductive synchrony) and enhance demarcation of territorial boundaries.Copyright 1997 The Association for the Study of Animal Behaviour1997The Association for the Study of Animal Behaviour

Journal Article↗
PubMed1999

Scent marking in a territorial African antelope: II. The economics of marking with faeces.

Faeces may be ideal substances for scent marking because they have a minimal energetic cost to the signaller. However, marking with faeces is also constrained by the animal's ability to produce faeces. This study examined whether limits on the volume of faeces produced by oribi Ourebia ourebi, in Serengeti National Park, Tanzania, caused territorial males to regulate their output and prioritize the placement of faecal marks. Territorial males marked with faeces more often, and with a smaller volume per defecation, than did juvenile males and females. Territorial males also defecated only on established dung middens along borders shared with other territorial males or on top of a female's urine and faeces. In contrast, juvenile males and females defecated randomly with regard to their location in territories. Territorial males with larger harems marked with faeces at higher rates and less volume than males with few or no females. This difference suggests that when males overmark female excretions they reduce the amount of faeces available for marking other preferred sites, such as along territory borders shared with other males. Dominant males with adult subordinates marked with faeces less often, and with a greater volume per mark, than males that defended territories without the aid of subordinates. Dominant males also reduced the volume of marks less as the number of females on their territory increased than did males without subordinates. Territories occupied by more than one adult male also were marked with faeces at higher rates, and with marks of greater volume, than territories held by single males. These results suggest that the presence of subordinate males reduced the demand on dominant males to regulate the volume and placement of faecal marks. Overall, these results suggest that territorial male oribi regulate their faecal marking behaviour in response to a limited supply of faeces. Copyright 1999 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1975

Screening hallucinogenic drugs: systematic study of three behavioral tests.

The effects of several hallucinogenic and non-hallucinogenic drugs have been studied on three behavioral tests proposed as useful indexes of hallucinogenic activity: "head-twitching" in mice, defecation in an open-field, and suppression of responding on a differential reinforcement of low rates (DRL) schedule of reinforcement. According to the original propositions, after administration of hallucinogenic agents the frequency of head-twitches would increase in mice, the defecation of rats in an open field would decrease without consistent change in ambulation, rearing and grooming, and the responding of rats on a DRL schedule would yield a typical cumulative record pattern. It was found that the head-twitch test was sensitive to mescaline and LSD-25, but not to delta9-THC or to myristicin and elemicin. Besides, the data on interobserver agreement suggested there is a high degree of subjectivity involved in assessing this response. In the open-field test, non-hallucinogenic drugs such as chlorpromazine and apomorphine fell into the hallucinogenic pattern proposed. In addition, the post-injection interval selected seemed to critically affect defecation scores. The DRL "hallucinogenic" pattern occurred nonspecifically after administration of hallucinogenic and non-hallucinogenic drugs. It was concluded that the three tests have limited value for screening purposes.

5-Hydroxytryptophan↗
PubMed1994

Evaluating activity and emotional reactivity in a hexagonal tunnel maze: correlational and factorial analysis from a study with the Roman/Verh rat lines.

Two hundred forty 30-day-old Roman high- and low-avoidance (RHA/Verh and RLA/Verh) rats (divided equally by line and gender) which had received several peri- and/or postnatal treatments, forming two factorial [line x sex x treatment(s)] experimental designs, were tested in a hexagonal tunnel maze including a brightly illuminated central arena. The present study reports the results of correlational and factorial (principal-components) analyses performed on the data from those two experimental constituencies. The purpose of the study was to evaluate the validity of the hexagonal tunnel maze for testing emotionality, and therefore, the following measures were included in the analysis: entries into the central illuminated arena, total activity during testing, defecation during testing, and defecation during handling and weighing after testing. An overall pattern of negative correlations (or opposite loadings in the principal-components analyses) between defecation (especially during maze testing) and entries into the illuminated center and activity was found, thus giving support to the validity of entries into the illuminated center as being indicative of emotional reactivity.

Animals↗
PubMed1995

Simultaneous dynamic proctography and peritoneography for pelvic floor disorders.

PURPOSE: We sought to evaluate a new diagnostic technique for the identification of rectal and pelvic floor pathology in patients with obstructed defecation, pelvic fullness/prolapse, and/or chronic intermittent pelvic floor pain. METHODS: Thirteen symptomatic women with either a nondiagnostic physical examination or nondiagnostic dynamic proctography (DPG) were studied. After placement of intraperitoneal and intrarectal contrast material, resting and straining pelvic x-rays were obtained in all patients, and defecation was videotaped using fluoroscopy. RESULTS: Simultaneous DPG and peritoneography identified clinically suspected and unsuspected enteroceles in 10 of the 13 patients studied. An enterocele or other pelvic floor hernia was ruled out by the technique in three of the women studied. Rectoceles and rectal prolapse that were identified during physical examination were confirmed by DPG with peritoneography. Simultaneous DPG and peritoneography also gave a qualitative assessment of the severity and clinical significance of the identified pelvic floor disorders. Results of simultaneous DPG and peritoneography affected operative treatment planning in 85 percent of patients studied. CONCLUSION: Simultaneous DPG and peritoneography identifies both rectal and pelvic floor pathology and provides a qualitative assessment of pelvic floor pathology severity, which allows for better treatment planning in selected patients with obstructed defecation and pelvic prolapse.

Adult↗
PubMed1995

Prevalence of benign anorectal disease in a randomly selected population.

BACKGROUND: The prevalence of benign anorectal diseases (BAD) in the general population has been difficult to establish, either because the individual diseases themselves were difficult to characterize in surveys or because of bias in the selection of the survey population. Reported herein is a prevalence survey of BAD symptoms and treatment history of a sample of the general population, selected by random digit dialing. METHOD: A survey instrument that inquired into symptoms of BAD, BAD treatment history, and health-seeking behaviors was administered by telephone interview with 102 individuals, between the ages of 21 and 65 of both genders and all races, chosen by random digit dialing in the Joliet, Illinois area. For selected variables (gender, education level, obesity, previous BAD treatment, fiber supplementation, time for defecation and reading during defecation all related to BAD symptoms) odds ratios and 95 percent confidence intervals were calculated. RESULTS: Of the 102 individuals, 9 had been previously treated for hemorrhoids, 4 by surgery, and 5 medically. Twenty individuals currently have BAD symptoms, six of these have multiple symptoms frequently, implying established BAD, and four of these have been previously treated for hemorrhoids. Seven of eight individuals with rectal bleeding in the past year have not sought medical evaluation. Of the associations tested, statistical significance was found only between female gender and BAD symptoms (odds ratio = 4.6; 95 percent confidence interval = 1.3-20.4). CONCLUSIONS: History of hemorrhoidal treatment and current BAD symptomatology are highly prevalent in a randomly selected population, and 80 percent of the subjects with symptoms of BAD have not consulted a physician regarding BAD. Some previously held correlates of hemorrhoidal symptoms, such as obesity and extended time for defecation, showed no apparent association with hemorrhoid treatment history or current BAD symptoms. The best predictors of current BAD symptoms were female gender (odds ratio = 4.6; 95 percent confidence interval = 1.3-20.4) and previous hemorrhoid treatment (odds ratio = 3.9; 95 percent confidence interval = 0.7-20).

Adult↗
PubMed1997

Abdominoperineal resection and perineal colostomy for low rectal cancer. The Lazaro da Silva technique.

PURPOSE: We sought to evaluate a new technique for creation of a continent perineal colostomy following abdominoperineal resection (APR) of the rectum for low rectal cancer. METHODS: Nine selected patients with low rectal cancer (two males; median age, 55.6 years; classified as Dukes A, 6 patients and as Dukes B, 3 patients) underwent APR. Following this, the original Lazaro da Silva technique was used as follows: 1) for performance of three circular myotomies in the distal sigmoid with a distance between each couple of no more than 8 cm; 2) repair of the myotomies, thus creating three circular colonic valves, the most distal of which remained extraperitoneally; 3) for construction of a perineal colostomy lying flush with the perineal skin; 4) after the patient starts consuming a regular diet, enemas through the perineal stoma are done, usually twice per week, to achieve defecation. Functional outcome was assessed by evaluation of bowel movements and neoanal continence. RESULTS: There were no deaths. From January 1994 until October 1995, no tumor recurrence has occurred, and fecal continence has been good. Four of the patients were able to defecate without enemas (2-4 times per week), and in five patients the self-administration of enemas (2-4 times a week) were necessary to accomplish defecation. CONCLUSION: Initial results with the Lazaro da Silva technique have been encouraging.

Abdomen↗
PubMed2000

Randomized, controlled trial to compare the J-pouch and W-pouch configurations for ulcerative colitis in the maturation period.

PURPOSE: Proctocolectomy with ileal pouch-anal anastomosis has become the procedure of choice for the treatment of ulcerative colitis. Functional results may differ with different pouch designs. This randomized study aimed to evaluate the relative effectiveness of two-limb J and four-limb W reservoir designs in the so-called maturation period after ileostomy closure. METHODS: Twenty-four patients underwent ileal pouch-anal anastomosis for ulcerative colitis. Eleven were randomly assigned to the J-pouch group and 13 to the W-pouch group. Frequency of defecation and other functional data were collected at 4, 8, and 12 months after ileostomy closure. Maximum tolerated volume was assessed in the same period by a latex balloon inflated with water. Maximum resting anal pressure, maximum voluntary contraction, and the rectoanal inhibitory reflex were assessed in the preoperative period and at 4, 8, and 12 months after ileostomy closure. RESULTS: Frequency of defecation decreased from 4 to 12 months after ileostomy closure in both groups (P = 0.04), but patients with a W-pouch had significantly lower values than patients with J-pouches (P < 0.01). Night-time defecation (P = 0.04) and use of antidiarrheals (P = 0.04) were significantly lower for patients with a W-pouch. Maximum tolerated volume was greater in the W-pouch group throughout the whole period (P = 0.01). Maximum resting anal pressure, maximum voluntary contraction, and rectoanal inhibitory reflex did not differ between the study arms. CONCLUSION: Patients with W-pouch have better functional results than those with J-pouches in the "maturation period" after ileostomy closure.

Adult↗
PubMed1998

Contribution of behavior therapy and biofeedback to laxative therapy in the treatment of pediatric encopresis.

A model incorporating physiological, behavioral, and psychological parameters are presented to explain the maintenance and consequences of pediatric encopresis. It was hypothesized that the more comprehensive a treatment in addressing these parameters, the more efficacious it would be and the more children it would benefit. Eighty-seven children between the ages of 6 and 15 with the primary complaint of encopresis were randomly assigned to one of three treatments: (a) Intensive Medical Care (IMC), receiving enemas for disimpaction and laxatives to promote frequent bowel movements; (b) Enhanced Toilet Training (ETT), using reinforcement and scheduling to promote response to defecation urges and instruction and modeling to promote appropriate straining, along with laxatives and enemas; or (c) Biofeedback (BF), directed at relaxing the external anal sphincter during attempted defecation, along with toilet training, laxatives, and enemas. Three months following initiation of treatment, ETT and BF produced similar reductions in soiling/child (76% and 65%) that were superior (p's < .04) to IMC (21%). ETT significantly benefited more children than the other two treatments, employing fewer laxatives and fewer treatment sessions at a lower cost. Consistent with the presented model, reduction in soiling was associated with an increase in bowel movements in the toilet, reduction in parental prompting to use the toilet, and defecation pain. These results demonstrate that ETT should be used routinely with laxative therapy in the treatment of chronic encopresis.

Adolescent↗
PubMed1996

Anterior resection: do the patients perceive any clinical benefit?

PURPOSE: Functional results following anterior resection of the rectum have been sparsely reported. Results concerning stool frequency and continence vary widely. These variations may represent several areas of bias, but one of the main concerns is study design. Many studies are focused on physiological results and even when a control population is included in the study design, it is not used to compare the clinical functional outcome. the aims of this prospective study were: (1) to study serially before and 1 year after low anterior resection for carcinoma the changes in clinical function; and (2) to study if these changes could be attributable to the characteristics of the population, comparing the results with sex-matched and age-matched controls. MATERIAL AND METHODS: Sample size was previously established according the prevalence of continence disorders fund in two previous studies carried out in our country, 36% for anterior resection, and 6% among general population in our community. Thirty-eight consecutive patients (mean age 63.9 years, range 41-77 years) with a diagnosis of rectal carcinoma were invited to participate in the study. The lower margin of the tumor was located between 4 and 15 cm from the anal margin (median of level tumor 6.0 cm). A control group of 25 volunteers matched for sex and age with patients who were questioned 1 year after the anterior resection were also studied. Median level of anastomosis was 6.2 +/- 2.7 cm (range 2-11) above the anal margin. In six patients with an anastomosis less than 4 cm from the anal margin, a loop ileostomy was constructed and closed 3 months later. Patients were interviewed by a research assistant before and 1 year after operation or 1 year after closure of the temporary defunctioning loop ileostomy. Patients were questioned about bowel frequency over 24 h, urgency, tenesmus, erratic defecatory patterns, discrimination of bowel content and continence. RESULTS: Clinical function of patients before and after operation. Compared with pre-operative, bowel frequency of 3.9/day (range 0.3-14) did not differ significantly 1 year after operation at 2.3/day (range 0.5-6). Frequency of erratic defecatory patterns (44%), urgency (40%) and obstructed defecation (20%) did not differ between the preoperative and postoperative period. Forty-eight percent of patients suffered tenesmus and 20% were unable to discriminate between flatus and feces before operation, whereas these troublesome symptoms were present in 24% and 16%, respectively, after the operation. Before the operation 32% of patients reported fecal leaks while in the postoperative period 52% patients complained of this alteration. Clinical function of patients compared with controls. Patients had a mean stool frequency per day of 2.3 (range 0.5-6) and controls 1.3 (range 0.3-5). Forty-four percent of patients had erratic defecatory patterns, 24% suffered tenesmus and 40% urgency, whereas these troublesome symptoms were present in 12% in the control population. Moreover, obstructed defecation was present in 20% and 4%, respectively. All controls and 84% of patients maintained discrimination of flatus, liquid and solid feces. Fifty-two percent of patients and 8% of controls suffered from altered continence. CONCLUSIONS: One year after low anterior resection patients had poor bowel function when compared with a control population of the same age and sex. A distinct anterior resection syndrome exists consisting of increased bowel frequency, erratic defecatory patterns, urgency, tenesmus, obstructed defecation, and minor fecal leakage. Furthermore, these disturbances in defecatory function did not differ significantly from symptoms produced by the rectal carcinoma, and patients experienced no major benefit from surgery from a functional point of view.

Adult↗
PubMed2002

Long-term follow-up of women who underwent surgical correction for imperforate hymen.

The aim of this study was to demonstrate the clinical results of postoperative evaluation for a consecutive series of cases of imperforate hymen presenting at a tertiary medical center during an over 14-year period. We retrospectively reviewed the clinical records of 15 patients with imperforate hymen that had undergone hymenectomy between 1987 and 1998. After completing a questionnaire via a telephone interview regarding sexuality, fertility, menstrual problems, micturition and defecation after surgical correction, those patients were persuaded to come back to the hospital for further gynecological surveys during 2002. The mean postoperative follow-up was 8.5 years (range, 4-14 years). The mean age at diagnosis was 13.2 years (range, 11-16). The most common clinical symptom was cryptomenorrhea (15), followed by pelvic pain (11), palpable abdominal mass (9), urinary retention and other voiding problems (8) and problems of defecation (4). None admitted intercourse attempts before. Two patients also had uterine anomalies, but none had urinary tract or bowel anomalies. During the follow-up period, we found that the majority of patients had irregular menstrual cycles and were worried about their future fertility. Six patients suffered from dysmenorrhea; of 11 patients who began having intercourse two later delivered babies, and none complained of sexual dysfunction. After hymenectomy, the women with imperforate hymen were markedly relieved of cryptomenorrhea, and problems of micturition and defecation also greatly improved. Although complaints of irregular menstruation and dysmenorrhea gradually evolved as the center of attention during follow-up, most patients fared well in terms of fertility and sexual function.

Adolescent↗