Using a footstool does not aid simulated defecation in undifferentiated constipation: A randomized trial.
anorectal manometry
balloon expulsion test
constipation
defecation
footstool
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
revised:
08
03
2023
received:
29
08
2022
accepted:
14
03
2023
medline:
14
6
2023
pubmed:
30
3
2023
entrez:
29
3
2023
Statut:
ppublish
Résumé
The use of a footstool has been advocated to optimize posture when sitting on the toilet and thus facilitate bowel evacuation. We aimed to assess the alterations in defecatory posture, and the changes in simulated defecation with use of a footstool in patients with constipation. Forty-one patients (female 93%, mean 52 year, SD 14 year) with constipation referred to a tertiary neurogastroenterology unit were enrolled. A bowel questionnaire, Hospital Anxiety and Depression Scale, and Rome questionnaire were administered prior to anorectal manometry. Each patient underwent three rectal balloon expulsion tests in randomized order with no footstool, a 7-inch, and a 9-inch footstool. Additional assessments included angle between spine and femur, and visual analogue scales assessing ease of evacuation, urge to defecate, and discomfort with expulsion. Defecatory posture was significantly altered by footstool use, with progressive narrowing of the angle between the spine and femur as footstool height increased (p < 0.001 for all comparisons). Compared with no footstool, the use of a footstool was not associated with a change in balloon expulsion time and there was no difference between the two footstool heights. Subjectively, no significant change was identified in any of the three perceptions of balloon expulsion between no footstool and footstool use. Although the use of a footstool led to changes in defecatory posture, it did not improve subjective or objective measures of simulated defecation in patients with undifferentiated constipation. Therefore, the recommendation for its use during evacuation cannot be applied to all patients with constipation.
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14580Informations de copyright
© 2023 John Wiley & Sons Ltd.
Références
Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome foundation global study. Gastroenterology. 2021;160(1):99-114. doi:10.1053/j.gastro.2020.04.014
Belsey J, Greenfield S, Candy D, Geraint M. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther. 2010;31(9):938-949. doi:10.1111/j.1365-2036.2010.04273.x
Hosseinzadeh ST, Poorsaadati S, Radkani B, Forootan M. Psychological disorders in patients with chronic constipation. Gastroenterol Hepatol Bed Bench. 2011;4(3):159-163.
Werth BL, Fisher MJ, Williams KA, Pont LG. Chronic constipation in the community: a National Survey of Australian adults. J Wound Ostomy Continence Nurs. 2020;47(3):259-264. doi:10.1097/won.0000000000000632
Tomita T, Kazumori K, Baba K, Zhao X, Chen Y, Miwa H. Impact of chronic constipation on health-related quality of life and work productivity in Japan. J Gastroenterol Hepatol. 2020;36:1529-1537. doi:10.1111/jgh.15295
Rao SS, Kavlock R, Rao S. Influence of body position and stool characteristics on defecation in humans. Am J Gastroenterol. 2006;101(12):2790-2796.
Altomare DF, Rinaldi M, Veglia A, Guglielmi A, Sallustio PL, Tripoli G. Contribution of posture to the maintenance of anal continence. Clinical trial comparative study. Int J Colorectal Dis. 2001;16(1):51-54.
Sakakibara R, Tsunoyama K, Hosoi H, et al. Influence of Body Position on Defecation in Humans. Lower Urinary Tract Symptoms. 2010;2:16-21. doi:10.1111/j.1757-5672.2009.00057.x
Sikirov D. Comparison of straining during defecation in three positions: results and implications for human health. Dig Dis Sci. 2003;48(7):1201-1205.
Mounsey A, Raleigh M, Wilson A. Management of Constipation in older adults. Am Fam Physician. 2015;92(6):500-504.
Waterham M, Kaufman J, Gibb S. Childhood constipation. Aust Fam Physician. 2017;46(12):908-912.
Australian Centre for Evidence Based Aged Care. Constipation: Standardised Care Process. Australia Department of Health and Human Services; 2018.
Wald A, Bharucha AE, Limketkai B, et al. ACG clinical guidelines: Management of Benign Anorectal Disorders. Off J Am College Gastroenterol. 2021;116(10):1987-2008.
Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. In: Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE, eds. Rome IV: Functional Gastrointestinal Disorders Disorders of Gut-Brain Interaction. 4th ed. The Rome Foundation; 2016.
Chiarioni G, Kim SM, Vantini I, Whitehead WE. Validation of the balloon evacuation test: reproducibility and agreement with findings from anorectal manometry and electromyography. Clin Gastroenterol Hepatol. 2014;12(12):2049-2054. doi:10.1016/j.cgh.2014.03.013
Mazor Y, Prott G, Jones M, Kellow J, Ejova A, Malcolm A. Anorectal physiology in health: a randomized trial to determine the optimum catheter for the balloon expulsion test. Neurogastroenterol Motil. 2019;31(4):e13552. doi:10.1111/nmo.13552
Jutras G, Wahba G, Ayuso E, Neshkova E, Bouin M. Do age and sex influence anorectal manometry parameters? J Canadian Assoc Gastroenterol. 2021;4(5):235-241. doi:10.1093/jcag/gwaa045
Sharma M, Lowry AC, Rao SS, et al. A multicenter study of anorectal pressures and rectal sensation measured with portable manometry in healthy women and men. Neurogastroenterol Motil. 2021;33(6):e14067. doi:10.1111/nmo.14067
Noelting J, Ratuapli SK, Bharucha AE, Harvey DM, Ravi K, Zinsmeister AR. Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol. 2012;107(10):1530-1536. doi:10.1038/ajg.2012.221
Oblizajek NR, Gandhi S, Sharma M, et al. Anorectal pressures measured with high-resolution manometry in healthy people-Normal values and asymptomatic pelvic floor dysfunction. Neurogastroenterol Motil. 2019;31(7):e13597. doi:10.1111/nmo.13597
Lee HJ, Jung KW, Han S, et al. Normal values for high-resolution anorectal manometry/topography in a healthy Korean population and the effects of gender and body mass index. Neurogastroenterol Motil. 2014;26(4):529-537. doi:10.1111/nmo.12297
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370. doi:10.1111/j.1600-0447.1983.tb09716.x
Rome Foundation. ROME IV: Functional Gastrointestinal Disorders. Disorders of Gut-Brain Interaction. 4th ed. The Rome Foundation; 2016.
Carrington EV, Heinrich H, Knowles CH, et al. The international anorectal physiology working group (IAPWG) recommendations: standardized testing protocol and the London classification for disorders of anorectal function. Neurogastroenterol Motil. 2020;32(1):e13679. doi:10.1111/nmo.13679
Tagart REB. The anal canal and rectum. Dis Colon Rectum. 1966;9:449-452. doi:10.1007/BF02617443
Takano S, Midori N, Tsuchino M, Nakao Y, Watanabe A. Influence of foot stool on defecation: a prospective study. Pelviperineology. 2018;37:101-103.
Takano S, Sands DR. Influence of body posture on defecation: a prospective study of "the thinker" position. Tech Coloproctol. 2016;20(2):117-121. doi:10.1007/s10151-015-1402-6
Koo E, Chey WD, Ezell G, Baker JR, Armstrong M, Nojkov B. Can a defecation posture modifying device correct an abnormal balloon expulsion test in chronically constipated patients? Clin Gastroenterol Hepatol. 2023;21(3):847-848. doi:10.1016/j.cgh.2021.12.048