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

Abstract

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.

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“…There is little evidence that increasing physical activity improves constipation. Physical activity can decrease colonic transit time and reduce symptoms of constipation in the elderly, but has not been shown to have any positive effect on constipation in young adults [31,32]. The minor influence of physical activity on bowel function is highlighted by a recent North American survey [33].…”

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“…This position should be reached on the toilet by placing a support under the feet. This avoids pushing and, thus, increases pressure in the intra-abdominal cavity, lowering the PFM and weakening them [ 74 ]. The toilet should be used at the same time, as the nervous system is then accustomed to regularity.…”

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“…Modulation of the defecation posture may be another option for constipation. During defecation, the squatting position facilitates rectal emptying by anorectal angle straightening, resulting in higher rectal pressure and lower anal pressure with relaxation of the levator ani [98]. Sikirov reported that the squatting position led to quicker evacuation and a more complete sense of bowel emptying than the sitting position [99].…”

“…This custom may induce suboptimal bowel habits, particularly in older individuals with reduced straining and pelvic floor weakness. Modi et al reported that the use of a footstool (defecation posture modification device) provided similar benefits to squatting [98].…”