Etiology and pathogenesis of diverticulosis coli: a new approach

Sit or Squat? Toilet Type Is a Determinant of Diverticulosis Development

“… 14 Squatting during defecation leads to a more relaxed puborectalis muscle and a wider ARA, thus leading to a decrease in the need of straining and a smoother and more complete feces excretion compared to sitting. 5 , 15 , 16 The culmination of all the aforementioned data is a more physiologic defecation posture in the squatting position.…”

From Primitive Accumulation to Modernized Poverty: Examining Flush toilets through the Four Invaluation Processes

“…In the 1970s, colonic and intestinal diverticulosis, was originally thought to result from fiber deficiency in an individual's diet as studies (Painter, 1971) have shown colonic diverticulosis to appear in "up to 45% in developed countries as compared with an exceptionally low prevalence among rural Africans" (Sikirov, 1988, p. 17). Fiber as a cause of colonic diverticulosis was misplaced as peoples acculturated into Western society with different ethnicities began to suffer from diverticulosis coli, resulting in herniation and colonic atrophy (Sikirov, 1988(Sikirov, , 1989. The primary and "only realistic source" of colonic diverticulosis came from "excessive straining at defecation" (Sikirov, 1988, p. 18).…”

“…Subsequently, doctors have attributed his death and bloating to an enlarged colon and constipation with a colon five to six inches in diameter (two-three inches is normal), placing flush-toilets as a contributing factor or "the straw that broke the horse's back," and making Elvis's bathroom his place of death (McKay, 2010). Diet and lifestyle are undoubtedly contributing factors, however, dramatic increase of diverticular diseases began in England around 1910 and has been attributed to the introduction of roller milled wheat flour around the 1880s and the instillation of toilet seats in the second half of the 1800s with sewer system developments (Sikirov, 1988). Flush-toilets associated with industrial urbanization have spawned an industrial manufactured interface that has structurally negative effects on bodily health as they contribute to cardiovascular disorders, death, colonic muscular distortions, and atrophy within the human body.…”

“…Diverticulosis, a disease of Western societies, is the herniation of the small intestines and the colon that create points of weakness within the small intestines, commonly the sigmoid section of the colon (Sikirov, 1988). In the 1970s, colonic and intestinal diverticulosis, was originally thought to result from fiber deficiency in an individual's diet as studies (Painter, 1971) have shown colonic diverticulosis to appear in "up to 45% in developed countries as compared with an exceptionally low prevalence among rural Africans" (Sikirov, 1988, p. 17).…”

Dietary Fiber: Fact and Fiction

“…It has been hypothe sized that a low-fiber diet produces a vicious cycle of hard stools, increased straining dur ing defecation, higher intraluminal colonic pressure and subsequent herniation of colonic mucosa through the muscle wall. The effect of low-fiber diets on intraluminal colonic pres sure may be compounded by higher colonic pressures generated in the sitting position as opposed to the squatting position used in underdeveloped countries utilizing latrine pits [25], The paucity of animal and clinical Dig D is 1996; 14:43-58studies on diverticular disease supports this pathogenesis of diverticular disease [26], In fact, there is no prospective clinical trial of dietary fiber and the development of diverti cular disease in humans. Due to the difficulty in performing such a study, animal studies have provided most of the current data.…”