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In the middle of the 20th century, a group of physicians working in the rural Africa were surprised by the near absence of the hemorrhoids, constipation, hiatus hernia, and diverticulosis coli in the rural black population (1).They further found that the rarity of these problems is also characteristic for the other Third world countries. Those authors attributed this finding to a high fiber diet and studies were embarked upon to confirm this hypothesis especially with regard to diverticulosis coli. Following this publications the Western world have taken steps to enrich their diets with an edible fibers, but the prevalence of the mentioned diseases have not changed. Moreover several later studies on the role of low fiber diet in the etiology of diverticulosis coli could not confirm such associations (2-3). The bulk- forming agents were also tested in the treatment of hemorrhoids and were found to relieve the symptoms only slightly better then placebo after six weeks in one study (4) and not better than placebo after three months of treatment in another study (5) Merely on the basis of the statistical chance it is quite impossible that the quantity of the diet fiber in the Third world countries such as China, Africa, Iran, Korea and others are similar high, thus preventing the above mentioned medical problems, more real that the quantity of diet fiber varied from country to country. Recently, the two groups of volunteers with normal bowel function on their usual diet compared the time needed for bowel emptying in the sitting comparatively to the squatting posture (6, 7). In both studies it was found that the time needed for bowel emptying in the sitting posture at least twice more than in the squatting posture and so were the subjective fillings of the volunteers. Basing on these studies it can be said with certainty that the common relevant factor for countries of the Third world is not the high fiber diet but the squatting toilet, while for the Western world is not the low fiber diet but the sitting toilet. The diminished excessive expulsive effort in the squatting posture is the only factor that explains the low prevalence rate of the above mentioned problems in the Third world countries comparatively to the Western world. At least regarding hemorrhoids this was conformed directly in the control trial in which hemorrhoids were cured after the patients had switched from the sitting to the squatting defecation posture (article published on this site). And now it is not simply an advice to switch to the squatting defecation posture, a new squatting device was designed and tailored for the sewage system of the Western world (see on the page: video-film of a new squatting device)
History of hemorrhoid research it is a history of great mistakes. History of treatment of hemorrhoids is a history of needless and invasive treatment. |