Is Defecation Posture and Diet Associated with Functional Constipation in Indian Children?

Abstract

ORIGINAL RESEARCHthe posture during defecation. This angle is straighter in a squatting position, which helps in easing the defecation process. It leads to decreased requirements for the pressure needed for complete evacuation and therefore prevents constipation and as an extension, hemorrhoids. Some studies have been able to demonstrate a reduction in the overall time required for defecation and the number of straining episodes in subjects using a squatting posture. 10 The Indian toilet is designed to void by squatting. Whereas, in comparison, Western toilets are designed for sitting, where this mechanism of anorectal angle straightening does not occur sufficiently or fails entirely, thus leading to a theoretically incomplete evacuation. However, it needs to be studied whether the type of toilet does in fact have any impact on the prevalence of constipation.Dietary fiber is known to help improve defecation by improving the fecal bulk and water retention. 11 It is well established in the literature that it reduces rates of constipation. However, it is not yet IntroductIonConstipation is a common condition affecting the gastrointestinal (GI) system and it impacts populations of all ages. Primarily, there are two types of constipation-functional and organic. Functional constipation refers to persistently difficult, infrequent, or incomplete defecation, in the absence of any evidence of a primary anatomic, pathological, or biochemical cause. 1 This definition is further supported by the "Rome IV" diagnostic criteria, which requires the presence of at least two of six symptoms describing the various presentations of constipation in terms of stool frequency, hardness, size, fecal incontinence, or voluntary stool retention, with the prerequisite that all organic causes of constipation are ruled out by a detailed evaluation. 2,3 Functional constipation accounts for nearly 95% of all cases of constipation in healthy children above the age of 1. 4 A delay in identification or inadequate untimely management may result in voluntary stool-withholding behavior which can further worsen constipation and have grave psychosocial consequences. In some cases, the cause may be organic, in which case the role of the clinician is vital in prompt identification and offering early and appropriate treatment.In a majority of cases, organic causes of constipation can be excluded on the basis of a detailed history and physical examination. Judicious laboratory and radiographic testing should be performed for children with atypical features (warning signs of possible organic constipation), or for those who do not respond to a well-structured and timely administered intervention program for at least 6 months.Previous studies have found that factors such as age, gender, socioeconomic status, education level, anxiety, dietary habits, posture, and psychological factors such as depression likely contribute toward functional constipation. [5][6][7][8][9] A hot topic of discussion amongst functional GI disorder specialists is posture. The anorectal...