Defecation Posture Research Articles

Potty Stools, a Pilot Study to Step Up the Management of Functional Constipation in Children.

Functional constipation (FC) comprises 30% of pediatric gastroenterology clinic visits. FC results from withholding behaviors that can be worsened by poor toileting posture. The use of a defecation posture modification device (DPMD)-a potty stool-has demonstrated benefit in adults. The aim of this study was to assess the risks and benefits of incorporating a DPMD as an adjunct to the FC treatment plan for children. Toilet-trained children aged ≥4 years meeting the Rome IV criteria for FC were enrolled and offered a DPMD at no cost and were followed for 4 months. There were no injuries or treatment-related adverse events reported by the 43 subjects who completed the study. Notably, 98% (n = 42) of respondents would recommend the DPMD to assist other children with FC. DPMD users showed a 33% reduction in fecal incontinence compared with 60% non-users. The DPMD represents a safe adjunct to incorporate into the FC management plan of children.

Nerve transfer for restoration of lower motor neuron-lesioned bladder, urethral and anal sphincter function. Part 4: Effectiveness of the motor reinnervation.

In pilot work, we showed that somatic nerve transfers can restore motor function in long-term decentralized dogs. We continue to explore the effectiveness of motor reinnervation in 30 female dogs. After anesthesia, 12 underwent bilateral transection of coccygeal and sacral (S) spinal roots, dorsal roots of lumbar (L)7, and hypogastric nerves. Twelve months postdecentralization, eight underwent transfer of obturator nerve branches to pelvic nerve vesical branches, and sciatic nerve branches to pudendal nerves, followed by 10 mo recovery (ObNT-ScNT Reinn). The remaining four were euthanized 18 mo postdecentralization (Decentralized). Results were compared with 18 Controls. Squat-and-void postures were tracked during awake cystometry. None showed squat-and-void postures during the decentralization phase. Seven of eight ObNT-ScNT Reinn began showing such postures by 6 mo postreinnervation; one showed a return of defecation postures. Retrograde dyes were injected into the bladder and urethra 3 wk before euthanasia, at which point, roots and transferred nerves were electrically stimulated to evaluate motor function. Upon L2-L6 root stimulation, five of eight ObNT-ScNT Reinn showed elevated detrusor pressure and four showed elevated urethral pressure, compared with L7-S3 root stimulation. After stimulation of sciatic-to-pudendal transferred nerves, three of eight ObNT-ScNT Reinn showed elevated urethral pressure; all showed elevated anal sphincter pressure. Retrogradely labeled neurons were observed in L2-L6 ventral horns (in laminae VI, VIII, and IX) of ObNT-ScNT Reinn versus Controls in which labeled neurons were observed in L7-S3 ventral horns (in lamina VII). This data supports the use of nerve transfer techniques for the restoration of bladder function.NEW & NOTEWORTHY This data supports the use of nerve transfer techniques for the restoration of bladder function.

Multidisciplinary co-development of a chronic constipation management education programme for older people with dementia and the establishment of a model facility

Chronic constipation (CC) is prevalent among the elderly population and particularly those with dementia. Associate Professor Tomoyoshi Naito, School of Nursing, Seirei Christopher University, Japan, is exploring supportive care of elderly patients with dementia. He is working with collaborators to develop a multidisciplinary CC management education programme for healthcare professionals involved with elderly patients suffering from dementia. The researchers will also build a model facility to implement and verify the impact of the programme. Part of this research concerns gaining a more in-depth understanding of management and care techniques, based on the Japanese Chronic Constipation Treatment Guidelines from 2017, especially in relation to the diet and differentiation of chronic functional constipation. The goal is to reduce the number of painful medical procedures by enhancing therapy, exercise therapy, lifestyle guidance and making it possible to select step-by-step drug therapy. The programme will be executed at two facilities in Japan, targeting specialist caregivers who work with elderly patients with dementia, including doctors, nurses, pharmacists and other healthcare professionals. They will receive basic education on chronic constipation in elderly people with dementia, as well as practical training on the management of CC in addition to self-training and evaluations based on case studies. In a randomised controlled trial, Naito sought to verify the impact of bowel training as a treatment for CC and found that, together with the training, encouraging patients to use appropriate defecation posture significantly improved the condition. This was associated with a corresponding improvement in the mental health and wellbeing of patients and caregivers.

Is Defecation Posture and Diet Associated with Functional Constipation in Indian Children?

Is Defecation Posture and Diet Associated with Functional Constipation in Indian Children?

Research in Brief

Bowel training and improving defecation posture can benefit patients with dementia who are suffering from chronic constipation, improving their mental health and reducing the burden on care givers, new research suggests. Tomoyoshi Naito and colleagues randomly assigned patients to receive either bowel training and a defecation posture intervention (n=14) or general care (n=16). At 8 weeks, the mean number of complete spontaneous bowel movements per week increased from 0·53 to 1·58 movements in the intervention group whilst decreasing from 0·56 to 0·43 movements in the general care group (pinteraction<0·001).

Comparing bioaerosol emission after flushing in squat and bidet toilets: Quantitative microbial risk assessment for defecation and hand washing postures

Indoor bathroom is an essential place in daily human life, and the toilet in it releases bioaerosols with varying emission characteristics, having a noticeable influence on human health. Especially after flushing, the next user of the shared toilet faces a significant health risk. Therefore, this research sampled and compared Staphylococcus aureus bioaerosol emission characteristics in squat and bidet toilets with different exposure heights for defecation and hand washing postures under two different ventilation scenarios. Then, a quantitative health risk model concerning the annual probability of infection and disease burden (DB) was performed for different exposed populations during their use of the shared toilet after flushing with time. The highest bioaerosol concentration was in bathroom with the squat toilet. The infection risk of adult male was 7.59%–26.72% higher than that of the other exposure populations. For defecation posture, 8.43%–59.11% higher health infection risks were observed for squat toilet than for bidet toilet. The infection risks in hand washing posture were 2.12–3.10 times lower than those in defecation posture. The assessment results of DB approximately matched those of infection risk for all exposure scenarios. For defecation posture under turned-off, air-exhaust ventilation scenario, the DB was 1.28–1.95 times higher than that under turned-on, air-exhaust ventilation scenario in both toilets. After flushing at 0–35 min, DB in hand washing posture were acceptable for all exposed populations. The present study provides for the first time innovative information of guidelines for controlling health risks of two types of shared toilet.

Can a Defecation Posture Modifying Device Correct an Abnormal Balloon Expulsion Test in Chronically Constipated Patients?

Evacuation disorders are common among chronically constipated (CC) patients who fail to respond to laxatives and are typically diagnosed by anorectal manometry (ARM) and/or balloon expulsion testing (BET).1,2 Recently, there has been emerging interest in the use of defecation posture-modifying devices (DPMDs) to improve constipation symptoms, presumably by replicating the physiologic benefits of squatting on stool evacuation, such as straightening of the anorectal angle and relaxing the pelvic floor. However, the ability of DPMDs to normalize anorectal function in adult patients with CC has not been studied.

Respiratory function and comfort levels in three different defecatory simulation postures in the elderly

Elderly people experience a heavy physical burden due to deteriorated respiratory function owing to prolonged sitting defecation posture due to constipation. In recent years, to reduce the physical burden of defecation, arm support handrails, which support the arms in a forward-leaning posture, have become more widely available; however, their impact on breathing comfort has not yet been verified. This study’s purpose was to compare the respiratory function of elderly people in traditional defecation postures and the arm-supported, forward-leaning position using the handrail, and thus verify whether the supported position has a positive effect. The trunk leaning angle, respiratory function, thoracic range of motion, and subjective comfort of 57 healthy elderly people were measured and compared in each of the three sitting defecation postures: upright, forward-leaning, and arm-supported forward-leaning. The arm-supported, forward-leaning position involves a trunk leaning angle of 61.84° ± 7.47°, and vital capacity of the respiratory function, thoracic range of motion (axillary region), and subjective comfort in this position are all shown to be significantly higher than those in the other postures. The arm-supported, forward-leaning defecation posture provides a high degree of freedom in the abdomen due to proper forward-leaning, while the upper limb support improves the mobility of the upper thorax, thus ensuring high lung volume. In addition, the increased stability provides a comfortable feeling. Therefore, we conclude that the arm-supported, forward-leaning position is more effective for defecation than the general defecation position.

The effects of a defecation posture, supported by the upper limbs, on respiratory function.

[Purpose] In this study, we aimed to determine which typical postures or an arm-supported posture were more comfortable and conducive to respiratory function, during seated defecation. [Participants and Methods] In 73 healthy adults, we measured and compared respiratory function and subjective contentment associated with 3 sitting defecation postures: upright, forward-leaning, and arm-supported forward-leaning. [Results] Vital capacity (VC), forced vital capacity (FVC), maximal expiratory pressure (MEP), and subjective comfort were significantly greater in the arm-supported forward-leaning position than in the other 2 positions. [Conclusion] The arm-supported forward-leaning position for defection increased the VC and was subjectively comfortable. Moreover, the high MEP in this position, compared with the other 2 positions, may have facilitated strain. A detailed examination of the cause for the observed increase in comfort was beyond the scope of this study; therefore, this effect requires further investigation.

Sa1658 – Influence of a Defecation Posture Modification Device (Squatty Potty®) in Healthy Volunteers and Dyssynergic Patients

Sa1658 – Influence of a Defecation Posture Modification Device (Squatty Potty®) in Healthy Volunteers and Dyssynergic Patients

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

Goals:The goal of this study was to evaluate the influence of defecation postural modification devices (DPMDs) on normal bowel patterns.Background:The introduction of DPMDs has brought increased awareness to bowel habits in western populations.Materials and Methods:A prospective crossover study of volunteers was performed that included real-time collection of data regarding bowel movements (BMs) for 4 weeks (first 2 wk without DPMD and subsequent 2 wk with DPMD). Primary outcomes of interest included BM duration, straining, and bowel emptiness with and without DPMD use.Results:In total, 52 participants (mean age, 29 y 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, and 29 subjects (55.8%) noticed blood on their toilet paper in the past year. A total of 1119 BMs were recorded (735 without DPMD and 384 with DPMD). Utilizing the DPMD resulted in increased bowel emptiness (odds ratio, 3.64; 95% confidence interval (CI), 2.78-4.77) and reduced straining patterns (odds ratio, 0.23; 95% CI, 0.18-0.30). Moreover, without the DPMD, participants had an increase in BM duration (fold increase, 1.25; 95% CI, 1.17-1.33).Conclusions:DPMDs positively influenced BM duration, straining patterns, and complete evacuation of bowels in this study.

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

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.

Rethinking the effectiveness of defecation postures and practices: it’s not what you do it’s the way that you do it!

This paper reports on a piece of research to investigate the effectiveness of defecation postures and anal cleansing method. The research compared how long each bowel movement took on a pedestal toilet with and without a footstool. Volunteers were asked to compare the two positions for speed as well as stress/strain on the body. The effectiveness of the method of anal cleansing was also rated by a subset of the volunteers. Although the study was conducted using volunteers in the UK, the findings have international relevance for sanitation marketing and hygiene promotion programmes.

AB299. SPR-26 Micturition and defecation behavior following pelvic decentralization in a canine model

ObjectiveWe demonstrated motor reinnervation of the decentralized canine urinary bladder by increased detrusor pressure induced by electrical stimulation of the transferred genitofemoral or femoral nerves in 21 of 28 animals. We previously reported evidence of bladder and bowel fullness sensation in these new neuronal pathways based on observation of micturition and defecation postures in the reinnervated animals. Our focus here was to determine whether these postures are eliminated in decentralized animals.MethodsThe pelvis was decentralized by bilateral transection of the hypogastric nerves and all spinal nerve roots caudal to L7 in 6 female canines. A separate group of 6 female canines was decentralized identically with the additional bilateral transection of L7 dorsal roots. Video surveillance of the housing cages allowed measurement of the frequency and duration of urination and defecation postures at monthly intervals post operatively (PO) by observers blinded to the surgical interventions.ResultsIn the 6 animals with intact L7 dorsal roots, 3 displayed micturition postures 1 month, 6/6 at 2 and 3 months and 5/6 at 4 months PO. In the 6 animals with the additional L7 dorsal root transections, micturition postures were observed in 2/6 at 1 and 2 months and 3/6 at 3 and 4 months PO. In the L7 dorsal root intact animals, defecation postures were observed in 0/6 at 1 month and 2/6 at 2, 3 and 4 months PO. In the L7 dorsal root transected group, 1/6 showed defecation postures at 1 and 2 months but not at 4 months, and 1/6 showed these postures at 3 and 4 months PO.ConclusionsIn the L7 dorsal root intact animals, although half were unable to sense bladder fullness and 0/6 could not sense bowel fullness at 1 month PO, all were able to sense bladder fullness at 2 and 3 months and all but 1 at 4 months PO, suggesting sprouting of sensory bladder innervation likely from the remaining lower lumbar dorsal root fibers. Fewer dogs with L7 dorsal root transected were able to detect bladder fullness. The ability of 3/6 animals in the L7 dorsal root transected group to sense bladder fullness at 2–4 months PO may be from sensory nerve sprouting or variations in the bladder sensory innervation, as we described previously. Bowel fullness sensation appears to be primarily mediated by sacral sensory innervation.Funding Source(s)NIH 1R01NS070267

Analysis of correlation between defecation posture and risk of urinary tract infections among adolescent populations

Objective: To assess the correlation between defecation posture and risk of urinary tract infection (UTI) rates among a representative adolescent sample in Malaysia Methods: The study was conducted between February 2015 and September 2015 using Google forms. A total of 568 enrolled and 551 participated in the study. The online questionnaire was divided into three sections viz., informed consent info; demographic details; knowledge and attitude analysis. The form was circulated online to obtain the responses. Results: The mean age of study participants was 23.99 ΁ 6.04 years. Majority of the study population used western type of toilet and felt comfortable with it. In the public context (movie halls, shopping malls etc.), most of the study participants preferred to use Indian/squatting type of toilet to avoid bodily contact with the toilet bowl. The study population was Malaysian. The respondents normally defecated at least once a day and normally took Conclusion: Defecation is an important physiological event and many of the study participants required more education on normal physiological methods of defecation postures. Appropriate education is required to improve the personal health and reducing the risk of acquiring UTIs.

Existence of a high pressure zone at the rectosigmoid junction in normal Indian men.

A hypertonic, electrically hyperactive segment has been described in the rectosigmoid region mainly in constipated persons. Anatomic or manometric evidence to satisfy the criteria for a sphincter here is, however, inconclusive. We evaluated the pressure profile of the rectosigmoid region in normal Indian men. Fifteen male volunteers with regular bowel habits were studied. Rectosigmoid manometry (1 cm station pull-through) was done in the fasting state using a water-perfused system and three-lumen catheter with radially oriented recording ports 5 cm apart. Eight volunteers had a zone of high pressure. Proximal extent of this zone was identified as the station with a rise in basal pressure of at least 10 mmHg over the previous station. A further rise of at least 10 mmHg in subsequent distal stations was considered essential for defining the existence of the zone. This zone had a median length of 3 cm, with midpoint at median 18 cm from the anal verge and median highest pressure of 36 mmHg. There was no antegrade pressure gradient across the zone; rectal pressures were higher than those in the sigmoid in 12 of 15 volunteers. Approximately one-half of normal Indian men with regular bowel habits have a high pressure zone in the rectosigmoid region. The role of diet or defecation posture in its etiology and its effect on bowel habit need to be studied.

Cardio-vascular events at defecation: Are they unavoidable?

Cardio-vascular events at defecation are to a considerable degree the consequence of an unnatural (for a human being) seating defecation posture on a common toilet bowl or bed pan. The excessive straining expressed in intensively repeated Valsalva Maneuvers is needed for emptying the bowels in sitting position. The Valsalva Maneuver adversely affecting the cardio-vascular system is the causative factor of defecation syncope and death. The cardio-vascular system of a healthy man withstands the intensive and repeated straining at defecation, while the compromised cardio-vascular system may fail resulting in syncope or even death. The squatting defecation posture is associated with reduced amounts of straining and may prevent many of these tragic cases.

Primary constipation: An underlying mechanism

Primary (simple) constipation is a consequence of habitual bowel elimination on common toilet seats. A considerable proportion of the population with normal bowel movement frequency has difficulty emptying their bowels, the principal cause of which is the obstructive nature of the recto-anal angle and its association with the sitting posture normally used in defecation. The only natural defecation posture for a human being is squatting. The alingment of the recto-anal angle associated with squatting permits smooth bowel elimination. This prevents excessive straining with the potential for resultant damage to the recto-anal region and, possibly, to the colon and other organs. There is no evidence that habitual bowel elimination at a given time each day contributes considerably to the final act of rectal emptying. The natural behavior to empty the bowels in response to a strong defecation reflex alleviates bowel emptying by means of the recto anal inhibitory reflex.

Etiology and pathogenesis of diverticulosis coli: a new approach

The paper describes a hypothesis as to the etiology and pathogenesis of diverticulosis coli. Colonic diverticulosis develops as a result of excessive straining at defecation due to habitual bowel emptying in a sitting posture, which is typical of Western man. The magnitude of straining during habitual bowel emptying in a sitting posture is at least three-fold more than in a squatting posture and upon urge. The latter defecation posture is typical of latrine pit users in underdeveloped nations. The bowels of Western man are subjected to lifelong excessive pressures which result in protrusions of mucosa through the bowel wall at points of least resistance. This hypothesis is consistent with recent findings of elastosis of the bowel wall muscles, the distribution of diverticula along the colon, as well as with epidemiological data on the emergence of diverticulosis coli as a medical problem and its geographic prevalence.

Elimination patterns in the laboratory beagle.

Abstract Twelve distinct elimination postures were recorded during the present study. Females employed a wider variety of urination postures, eight compared to four in the males. On the other hand, more males urinated during more tests and did so more frequently than the females. Too, the males showed a considerably lower urination latency than the bitches. Females tended to evacuate the bladder all at once while the males would deposit a small amount of urine many times and continue to pseudo-urinate even though no urine was expelled. In the males, urination appeared to be oriented toward the scent of other males or toward conspicuous vertical objects while female urinations tended to be distributed at random. Although most elimination by the females was aimed at the ground, a substantial number of their urinations were directed toward vertical targets as well. The defecation rate was low in both sexes, being slightly higher in the males. Five defecation postures were used by the males as opposed to two by the females. Of the postures observed, two were formerly thought to be used for urination only. Both sexes showed some defecation on vertical targets. Almost one-fourth of male defecations were placed on the fence. A small amount of ground scratching was done, most of it by the males, who scratched only after urination. Scratching appears to function as part of the marking behavior of the dog. It may help to disperse an animal's odor over a wide area as well as making a conspicuous mark on some surfaces.