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

Authors:

Abstract

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.
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Objectives: To compare three positions for defecation by measuring abdominal pressure and the anorectal angle simultaneously. Methods: We recruited six healthy volunteers. The videomanometric measures included simultaneous fluoroscopic images, abdominal pressures, subtracted rectal pressures and anal sphincter pressures. Three positions were used: sitting, sitting with the hip flexing at 60 ° with respect to the rest of the body, and squatting with the hip flexing at 22.5 ° with respect to the rest of the body. Results: Basal abdominal pressure before defecation on hip-flex sitting was lower than that with normal sitting, although the difference did not reach statistical significance. Basal abdominal pressure before defecation on squatting (26 cmH2 O) was lower than that with normal sitting (P < 0.01). Abdominal pressure increase (strain) on hip-flex sitting was lower than that with normal sitting, although this difference did not reach statistical significance. Similarly, the abdominal pressure increase on squatting was smaller than that with normal sitting, and yet the difference did not reach statistical significance. The rectoanal angle on defecation on hip-flex sitting did not differ from that with normal sitting. The rectoanal angle on defecation on squatting (126 °) was larger than that with normal sitting (100 °) (P < 0.05), and was also larger than that with hip-flex sitting (99 °) (P < 0.01). Conclusion: The results of the present study suggest that the greater the hip flexion achieved by squatting, the straighter the rectoanal canal will be, and accordingly, less strain will be required for defecation.
Article
Despite economic growth, government latrine construction, and increasing recognition among policymakers that open defecation constitutes a health and human capital crisis, it remains stubbornly widespread in rural India. We present evidence from new survey data collected in Bihar, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh. Many survey respondents' behaviour reveals a preference for open defecation: over 40% of households with a working latrine have at least one member who defecates in the open. Our data predict that if the government were to build a latrine for every rural household that lacks one, without changing sanitation preferences, most people in our sample in these states would nevertheless defecate in the open. Policymakers in India must lead a large-scale campaign to promote latrine use.
Article
This paper summarizes the findings from a meta-analysis of 22 rural sanitation supply studies commissioned by the Water and Sanitation Program (WSP) of the World Bank over the past seven years in South America, sub-Saharan Africa, East Asia, and South Asia. By building a comprehensive analytical framework for the sanitation market, the article identifies globally relevant weaknesses in the sanitation market, gives examples of positive interventions, and identifies key areas of activities that could lead to a strengthening of a relevant sanitation market for the base of the pyramid (BoP). The study also identified global knowledge gaps on how to enable, facilitate, and engage rural sanitation markets for the BoP. The full report is expected to be published by WSP later in 2015.
Article
Background- Defecography, along with other radiologic modalities, can be used to evaluate rectal abnormalities such as functional disorders of the rectum. It appears that ethnic habits can influence the evacuative function of the rectum. The main goal of this study was to compare Iranian and European habits of bowel evacuation on defecographic measurements. Methods- Thirty Iranian patients (21 male, 9 female) referred for barium enema were enrolled in the study. The patients were instructed to defecate using two types of toilet: an unraised, ground-level style (common in Iran), and a bowl with attached tank style (common in Western countries). Radiographs were taken of each patient while defecating into both types of toilet, during which the anorectal angle and other defecographic indices were measured. Results- Use of the Iranian-style toilet yielded a much wider anorectal angle, and a larger distance between the perineum and the horizontal plane of the pelvic floor than the European style. Bowel evacuation was also more complete using the Iranian-style toilet. Conclusion- Use of the Iranian-style toilet seems to be more a more comfortable and efficient method of bowel evacuation than the European style. Further studies are needed to ascertain the optimal approximation of the measurements to standard height of toilets for ordinary use.
Article
Objective: To learn how children in rural schools in Nyando District, Kenya clean themselves after defecation. Methods: Six focus group discussions were held with boys and girls ages 12-15 in three rural schools in mid-2009. Parents were interviewed in one setting. In early 2010, a survey of head teachers was conducted in 114 schools in Nyanza Province, Kenya, to assess the provision of anal cleansing materials and handwashing water and soap in schools. Results: Anal cleansing behaviour is linked with access to materials, age, social pressure, perceived personal risk of illness and emotional factors. Materials used for anal cleansing include schoolbook paper, leaves, grasses, stones, corncobs and one's own hands. Students have knowledge gaps in terms of personal hygiene. They were forthcoming with information on their anal cleansing practices. Almost no schools budgeted for or provided anal cleansing materials regularly. Conclusion: Anal cleansing is a necessary human activity. However, because of social taboos, there are few articles on the topic. School health plans overlook it as well. Researchers need to determine if and how current practices could harm child health to inform policy.
Article
The aim of the study was to compare the straining forces applied when sitting or squatting during defecation. Twenty-eight apparently healthy volunteers (ages 17-66 years) with normal bowel function were asked to use a digital timer to record the net time needed for sensation of satisfactory emptying while defecating in three alternative positions: sitting on a standard-sized toilet seat (41-42 cm high), sitting on a lower toilet seat (31-32 cm high), and squatting. They were also asked to note their subjective impression of the intensity of the defecation effort. Six consecutive bowel movements were recorded in each position. Both the time needed for sensation of satisfactory bowel emptying and the degree of subjectively assessed straining in the squatting position were reduced sharply in all volunteers compared with both sitting positions (P < 0.0001). In conclusion, the present study confirmed that sensation of satisfactory bowel emptying in sitting defecation posture necessitates excessive expulsive effort compared to the squatting posture.
Role of defecation postures on the outcome of chronic anal fissure
  • Imtiaz Ahmed
  • Muhammad Najmuddin
Ahmed, Imtiaz., Muhammad Najmuddin Shabbir, Mohammad Ali Iqbal, Muhammad Shahzeb Najam (2013) Role of defecation postures on the outcome of chronic anal fissure Pak J Surg 2013; 29(4):269-271. http://www.pjs.com.pk/journal_pdfs/oct-dec13/269.pdf [Accessed 10 th August, 2017]
Norms, Knowledge and Usage
  • R Chambers
  • J Myers
Chambers, R. and Myers, J. (2016) 'Norms, Knowledge and Usage', Frontiers of CLTS: Innovations and Insights Issue 7, Brighton: IDS: https://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/8960/Issue7_Norms_knowledge _and_usage_2ndEdition.pdf?sequence=3 [Accessed 10 th August, 2017]