Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
The University of Sydney, Sydney, New South Wales, Australia.
Neurogastroenterol Motil. 2023 Jul;35(7):e14580. doi: 10.1111/nmo.14580. Epub 2023 Mar 29.
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.
使用脚凳可以优化坐姿，从而促进排便。本研究旨在评估便秘患者使用脚凳对排便姿势的影响，以及对模拟排便的影响。
41 名便秘患者（女性占 93%，平均年龄 52 岁，标准差 14 岁）入组，在进行肛门直肠测压前进行了排便问卷、医院焦虑抑郁量表和罗马问卷评估。每位患者在无脚凳、7 英寸和 9 英寸脚凳三种情况下随机进行了 3 次直肠球囊排出试验。其他评估包括脊柱与股骨之间的角度，以及评估排便难易程度、排便紧迫感和排出不适的视觉模拟量表。
使用脚凳会显著改变排便姿势，随着脚凳高度的增加，脊柱与股骨之间的角度逐渐变窄（所有比较均 p<0.001）。与无脚凳相比，使用脚凳与球囊排出时间的变化无关，且两种脚凳高度之间没有差异。与无脚凳相比，使用脚凳时，在主观上球囊排出的三种感知均无明显变化。
尽管使用脚凳改变了排便姿势，但对未分化便秘患者的模拟排便的主观和客观指标没有改善。因此，不能将其在排便过程中的推荐应用于所有便秘患者。
