Defecation posture

Humans can practice defecation in a number of defecation postures, including:
*squatting defecation posture in squat toilets
**the posture used for Japanese toilets is a variation of the squatting posture
*sitting defecation posture in Western toilets
**lean-forward posture
**90-degrees posture

General information

The type of defecation posture chosen by an individual can affect their risk of developing various medical conditions, including defecation syncope and death, and therefore defecation postures are of interest to medical researchers. In general, the posture chosen is largely a culture decision.

For gynaecologists, the posture used while using the toilet is an important consideration when taking care of patients in micturition.A. Rane; A. Corstiaans (2008, Department of Urogynaecology, Townsville Hospital, Townsville, Queensland, Australia): [http://www.informaworld.com/smpp/content~content=a793839402~db=all Does micturition improve in the squatting position?] in Journal of Obstetrics and Gynaecology, Volume 28, Issue 3 of April 2008, pages 317 - 319. Quotes: "Posture on the toilet is an important consideration during micturition", "the ability to squat in our population of volunteers was quite poor" (from the abstract).]

The anorectal angle

The anorectal angle (ARA), the angle formed by the junction of the rectum with the anus, is an important consideration in defecation posture studies. ARA is "one of the most important contributions to anal continence"; its normal value at rest is 90 degrees.ALTOMARE Donato F.; RINALDI Marcella; VEGLIA Antonella; GUGLIELMI Altomarino; SALLUSTIO Pier Luca; TRIPOLI Gaetano (Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, Coloproctology Unit, University School of Medicine, Bari, ITALY) (2001): [http://cat.inist.fr/?aModele=afficheN&cpsidt=926435 Contribution of posture to the maintenance of anal continence] , in International journal of colorectal disease, 2001, vol. 16, number 1, pp. 51-54 (4 ref.). Publisher: Springer.]

According to a 1996 article in the "Townsend Letter for Doctors and Patients",

In a classic paper, Tagart (1966) measured the anorectal angle in various postures, finding that the angle is partially straightened out when squatting. He argued that squatting thereby reduced the pressure required for defaecation and recommended a hips-flexed position for defaecation to help treat constipation and prevent haemorrhoids. [Christine Dimmer, Brian Martin, Noeline Reeves and Frances Sullivan , "Squatting for the Prevention of Hemorrhoids?", Published in Townsend Letter for Doctors & Patients, 1996: 159, 66-70 [http://www.uow.edu.au/arts/sts/bmartin/pubs/96tldp.html link ] ]

The sitting defecation posture

The sitting defecation posture is a defecation posture used by humans, especially when confronted with a flush toilet, but it is also practised on bed pansSikirov, Dov, MD (1990): [http://www.ncbi.nlm.nih.gov/pubmed/2398836 Cardio-vascular events at defecation: are they unavoidable?] in Med Hypotheses, 1990, Jul; 32(3): 231-3.] . The sitting posture is more widepread in the Western world, and less common in the developing world.

Dov Sikirov MD has called the sitting defecation posture "unnatural".. Historically, toilet seats are a recent development, only coming into widespread use in the Nineteenth Century.

Advantages and health benefits

Disadvantages and health risks

A 1989 study claimed that the sitting position causes the defecating human to assume a recto-anal angle of an obstructive nature which causes difficulty in emptying the bowels. It professed that "The only natural defecation posture for a human being is squatting". Sikirov, Dov, MD (1989): [http://www.ncbi.nlm.nih.gov/pubmed/2927355 Primary constipation: an underlying mechanism] in Med Hypotheses, 1989 Feb; 28(2):71-3.]

A 1990 study by Dov Sikirov MD claimed that the sitting position causes the defecating human being to repeat the Valsalva Maneuver many times and with great force, which results in overloading the cardiovascular system and is the causative factor of defecation syncope and death.

A 2004 study by Dov Sikirov MD concluded that the sitting defecation posture requires "excessive expulsive effort compared to the squatting posture." [http://www.springerlink.com/content/rlu7151837n07562/] ]

The squatting defecation posture

[
flush toilets that normally assume that the user will use them in the sitting posture]

The squatting defecation posture is a defecation posture that humans use, especially when confronted with a squat toilet. It is more widespread in the developing world than in the Western world.

People who are not used to squatting may have low squatability, ie a difficulty to squat.

Advantages and health benefits

Dr. Denis Burkitt proposed the theory that the squatting defecating posture is a preventive factor against malignant neoplasm (cancer), especially for colon diseases.Burkitt, Denis, Dr (1979): "Don't Forget Fibre in Your Diet" (best-selling book translated into nine languages), cited in English Wikipedia (2008 October 4) article Diet and cancer.]

A 1989 study claimed that "The only natural defecation posture for a human being is squatting", as the resulting recto-anal angle allows smooth bowel elimination. [ [http://www.ncbi.nlm.nih.gov/pubmed/2927355] ]

A 2004 study concluded that the squatting defecation posture requires less expulsive effort when compared to the sitting defecation posture [http://www.springerlink.com/content/rlu7151837n07562/] ]

Dov Sikirov MD theorised in 1990 that the squatting position could prevent the risk of defecation syncope and death due to cardiovascular complications associated (in Sikirov's research) with the sitting position, as squatting requires less amount of straining on part of the defecating individual.

A 2003 study by eleven researchers found that squatting can be beneficial for patients suffering from the spastic pelvic floor syndrome, thanks to the increased anorectal angle enabled by the posture.Cho YK, Kim CS, Koo ES, Yun JW, Kim JW, Lee JH, Park CY, Sohn CI, Jeon WK, Kim BI, Choi DI (2003): [http://www.koreamed.org/SearchBasic.php?RID=181132&DT=1 Contribution of Posture to Anorectal Angle and Perineal Descent on Defecography] in Korean J Gastroenterol, 2003 Mar; 41(3):190-195 (in Korean). Quote: "In patients with spastic pelvic floor syndrome, squatting position increases the anorectal angle" (from the abstract).]

Disadvantages and health risks

A 2002 study by four scientists published in Acta Neurologica Scandinavica focused on the question of whether the squatting defecation posture could place Indians at risk of stroke, concluding that the squatting posture can place individuals at risk of stroke [http://www3.interscience.wiley.com/journal/118935461/abstract?CRETRY=1&SRETRY=0] ] However, the study did not compare squatting with sitting for defecation, and did not measure the blood pressure of subjects straining on a western toilet.

A 1994 study by four Indian researchers from the Department of Gastroenterology of the King Edward Memorial Hospital in Bombay, India found that 50% of Indian men (who regularly use the squatting posture) have a high pressure zone in the rectosigmoid region, and suggested that future research should be directed at establishing links with the role of diet or defecation posture.Rajkumar P. Wadhwa, Fersosh P. Mistry, Shobna J. Bhatia, and Philip Abraham (1994): [http://www.springerlink.com/content/u6w77756847tq80v/ Existence of a high pressure zone at the rectosigmoid junction in normal Indian men] : "The role of diet or defecation posture in its etiology and its effect on bowel habit need to be studied."]

Defecation postures in space

In 1989 five Auburn University students submitted a proposal for a zero gravity toilet for use in the space station . The students claimed that there is no evidence that posture can have an effect on the ease of urination. Regarding defecation, the authors said that since defecation involves the stomach muscles the body should be in such a position as to support them, and clarified that squatting increases the abdominal pressure, while in normal gravity environments the best posture is one in which the knees are higher than the buttocks.http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/19900003720_1990003720.pdf]

Colonic diverticulosis

A 1988 study by B. A. Sikirov found that Colonic diverticulosis (diverticulosis coli) may be caused by the sitting defecation posture, as in that posture the magnitude of straining is at least three times greater than with the squatting posture, and straining is a a factor that promotes diverticulosis coli.Sikirov, B., A. (1988): [http://grande.nal.usda.gov/ibids/index.php?mode2=detail&origin=ibids_references&therow=615277 Etiology and pathogenesis of diverticulosis coli: a new approach] , in Med-Hypotheses, 1988 May; 26(1): 17-20.]

References

Bibliography

*Balukian, L. (2002): [http://grande.nal.usda.gov/ibids/index.php?mode2=detail&origin=ibids_references&therow=735764 In praise of squatting] in Altern-Ther-Health-Med, 2002 Jan-Feb; 8(1): 26
*http://www3.interscience.wiley.com/journal/68502379/abstract?CRETRY=1&SRETRY=0

ee also

*defecography

=External links=