Implementation of a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects

Abstract

Introduction: Straining is the aspect of defecation over which individuals have the largest control from an anatomic standpoint. The introduction of defecation postural modification devices (DPMDs) has brought increased awareness of defecation posture to Western populations (Figure 1). There have not been previous studies within the United States addressing this topic. Therefore, we conducted a study to assess the impact of DPMDs in this population.Figure: Improved bowel posture using the defecation postural modification device. Image Copyright: Squatty Potty LLC, (St. George, UT).Methods: A prospective study was conducted where resident physicians were voluntarily recruited to record bowel movements for 4 weeks (2 weeks without DPMD and 2 weeks with DPMD). Exclusion criteria included previous DMPD use, pregnancy, wheelchair bound, presence of ileostomy/colostomy, or history of small bowel resection >12 centimeters. SQUATTY POTTY, LLC (St. George, UT) provided the DMPDs but did not provide financial support nor were they otherwise involved in the trial. Primary outcomes of interest included average bowel movement duration, straining pattern scores, and bowel emptiness scores with and without DPMD usage, which were compared using paired t-test. Results: 52 participants (mean age 29 years and 40.1% female) were recruited for this study. At baseline 15 subjects (28.8%) reported incomplete emptying, 23 subjects (44.2%) had increased straining with defecation, and 29 subjects (55.8%) noticed blood on their toilet paper in the past year (Table 1). A total of 1119 bowel movements were recorded (735 without DPMD and 384 with DPMD), with numerical differences between cohorts due to subjects having limited access to DPMD during work hours. Our findings show reduced duration (4.24 vs. 5.60 min, P<0.001), reduced straining patterns (2.46 vs. 3.10, P<0.001), and increased bowel emptiness (2.19 vs. 1.80, P<0.001) for DMPD versus non-DMPD bowel movements (Table 2). Post-study survey indicated that 35 patients (67.3%) plan to continue to use their DPMD. Of note, incomplete emptying prior to DPMD intervention was a clinical predictor for long-term use of the device (multivariate OR 12.94, P=0.03).Table: Table. Patient CharacteristicsTable: Table. Results of paired t-test for primary outcomes with and without the defecation postural modification devicesConclusion: DMPDs positively influenced bowel movement duration, straining patterns, and complete evacuation of bowels in this study. Moreover, approximately two-thirds of participants plan to continue to utilize their DMPD after study completion. Future studies should focus on use of the device in pertinent clinical processes such as constipation or hemorrhoids.