*EMBARGOED All research presented at the World Congress of Gastroenterology at ACG2017 is strictly embargoed until Monday, October 16, 2017, at 8:00 am EDT.

Rohan M. Modi, MD

Poster 83 Implementation of a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects

Author Insight from Rohan M. Modi, MD, The Ohio State University Wexner Medical Center

What’s new here and important for clinicians?

I have come to appreciate that patients of different backgrounds often feel uncomfortable discussing concerns regarding bowel movements. Similar to many of you, I frequently find myself prescribing medications including senna, docusate and polyethylene glycol 3350 for a variety of indications. The objective of this study was to evaluate how bowel habits can be modified through an easily accessible intervention. We have coined the term “defecation postural modification device” (DPMDs) to describe newly available products that assist with the defecation posture (Figure 1 in Abstract).

While squatting during bowel movements is commonly practiced in the Middle East, Africa and Asia, Western populations have transitioned to using the toilet. The introduction of DPMDs has resulted in increased awareness in anatomical differences based on anorectal angle when squatting versus sitting. I found this concept intriguing and found limited literature to support this idea, with previous studies limited by sample size. More importantly, this is the first study in the United States to address the impact of DPMDs and their potential clinical utility.

Our results were surprising on a number of levels. First, we recruited “healthy” internal medicine residents and their spouses to find that 29/52 (55.8%) of subjects had blood on their toilet paper in the past year with significant amount of straining (44.2%) and incomplete emptying (28.8%). Secondly, the study findings demonstrate that when using DPMDs, participants have reduced time, reduced straining, and increased bowel emptiness. This was intentionally designed for “healthy” individuals, but future studies will need to focus the use of the device in clinically pertinent situations including constipation or hemorrhoids.

What do patients need to know?

The biggest motivator to perform this study was my clinic patients! It can take a tremendous amount of courage to share concerns about your bowel habits with your physician. My advice to any patient is to bring up any issues you may have because regular bowel patterns can improve your overall health.

In terms of this study, I think it is important to note that DPMDs offer a non-pharmacologic option for healthier bowel movements. That being said, always discuss any intervention—including DPMDs—with your provider, as they know you best. Stay tuned as we hope to continue our research on DPMDs and to eventually be able to address important issues such as constipation or hemorrhoids.

Read the Abstract

Table 1

Table 2

Figure 1

Author Contact
Rohan M. Modi, MD, The Ohio State University Wexner Medical Center


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