Hemorrhoids are the consequence of the sitting defecation posture.
The defecation in the natural for a human being squatting posture will resolve this problem.
Try! It is not esthetic, but don't use the toilet bowl as a squatting device; it is dangerous (can break down) and may be not effective as doesn't permit natural squatting (see the instructions).

VARIATION OF DURATION OF DEFECATION ACCORDINGLY TO DEFECATION POSTURE

 Hemorrhoids and the evolution of the human being.

Berko Dov Sikirov, M.D                                                

   Abstract
The variation of duration of defecation of times of six consecutive defecations in squatting posture was minimal comparatively to any sitting posture (p<0.0001); the intrasabject variation of times needed for bowel emptying in squatting posture was the smallest comparatively to any sitting posture(p< 0.0001); there was no difference of intrasabject variation of times of six consecutive defecations in sitting postures on bowels of two different heights (p=0.295) with minimal difference of variation of duration of defecation of the two sitting postures(p=0.053). These important findings explain the underlying anatomo-physiological mechanism of minimal expulsive defecation effort in squatting versus sitting posture.

   Introduction
In a recent study (1) the time needed for rectal emptying was recorded by 28 volunteers in the squatting and the two sitting defecation postures of different height (toilet bowls of 42 and 32cm). Six consecutive bowel movements were recorded in each position with the goal to compare the time needed for rectal emptying in sitting versus squatting postures. Presently the time of six defecation postures were statistically analyzed in order to study the variability of time of six defecations in sitting versus squatting defecation postures.                                              

Statistics
The comparison of variation of duration of defecation of three defecation postures has done in two ways:   
1 The comparison between postures regarding the variations of mean of six measurements of duration of defecation in either posture has estimated by Pitman Test. Initially for every volunteer has calculated mean of six measurements in either defecation posture then calculated the variations of the means, finally the defecation postures have compared for variation of means (Table 1).

Table 1         The variability of mean time of 6 defecations according to postures

         (Variations) Standard Deviations

             Position

               (0.449)   0.67

             Squatting

               (2.341)   1.53

             Sitting at a height of 31-32cm

               (3.349)   1.83

             Sitting at a height of 41-42

Summary:
The three defecation postures differ one from another regarding the variation of duration of defecation with minimal variation in squatting defecation posture; squatting  versus sitting on bowel 42cm height (P<0.0001), squatting versus sitting on bowel 32cm height (P<0.0001), sitting on bowel 42cm height versus sitting on bowel 32cm height (P=0.053).                                  

 2 Comparison between postures concerning the intrasubject variation of defecation times has estimated by Friedman Test to compare the three defecation postures and Wilcoxon tests has used to compare pairs of defecation postures. For every volunteer has calculated the standard deviation of six measurements in either posture, the three groups of defecation  postures have compared for standard deviations, after statistical significance between all three postures have established the pairs of defecation postures have compared by Wilcoxon Test (Table 2).

Table 2      The intrasubject variability of time of 6 defecations according to postures

Median Standard Deviations (upper and low quartiles)

             Position

(0.356, 0.07)   0.148

            Squatting

(1.15, 0.214)   0.529

            Sitting at a height of 31-32cm

(1.517,0.197)  0.468

            Sitting at a height of 41-42cm

Summary:
The intrasubject variation of times needed for bowel emptying in squatting posture was the smallest comparatively to sitting postures (Table 2, Fig 1). It was not found the difference of the intrasabject variation between sitting postures (Friedman Test: P<0.0001 concerning the difference between all postures; Wilcoxon test: P<0.0001 concerning difference between squatting versus any sitting posture; P=0.295 concerning difference between sitting postures).

 Results     sd_chart_variant_fig_400

The two sitting and squatting postures differ one from another regarding the variation of duration of defecation with minimal variation in squatting : squatting versus sitting (p<0.0001); sitting on bowel 42cm height versus sitting on bowel 32cm height(p=0.053).

The intrasabject variation of times needed for bowel emptying in squatting posture was the smallest comparatively to any sitting posture (p<0.0001). It was not found the difference of intrasubject variation between sitting postures (p=0.295).

 Discussion

As during the study(1) no parameters was changed the only explanation for variation of times spent on defecation in the same person and in the same defecation posture may be the variation in food. Any person has its specific diet preference nevertheless some daily variation in food is a usual practice. Such variation in diet causes very significant fluctuation in expulsive effort in any sitting defecation posture, however only insignificant variation in expulsive effort in squatting posture. In this aspect the difference between postures may be explained in the following way: in the squatting posture the recto anal angle straitens (2) in the same person to the same degree forming the similar anatomical configuration of the recto anal outlet. Thus feces in different defecation acts are pushing out through the closely similar anatomical structure obligating minimal (1) and closely similar expulsive defecation effort. In such situation the variation in food and accordingly in consistency of feces affect the defecation effort only to a small extent.

Defecation in sitting posture associated with closed recto anal outlet and its opening dependent exclusively on intensity of expulsive defecation effort. In such situation the variation in consistency of feces (i.e. variation in food) obligate different expulsive defecation effort, more densely the feces more straining is necessary to empty the rectum. On the early history of human existence the food was rough and varied very much.    If the expulsive defecation effort had dependent on the kind of food the surviving of the human being would have been doubtful. The people would have suffered from hemorrhoids accompanied by bleeding, causing anemia disrupting the health of men.  The birth of child is a trigger for hemorrhoids which cured spontaneously when the squatting defecation posture is a practice. If the humanity had used on his early history the sitting defecation posture the hemorrhoids in woman after child birth would have continued infinitely, causing bleeding, anemia, prolapsing hemorrhoids questioning the possibility of the following pregnancy. And hemorrhoids are only the tip of the iceberg (see the articles on this site)

The squatting defecation posture is the only natural defecation posture which allowed the humanity to pass through a long history, accompanied by great variation of food, without affecting so important physiological act as ridding from faces and not affect the human health. 

References:

1 Sikirov D.: Comparison of Straining During Defecation in Three Positions. Results and Implications for Human Health. Digestive Diseases and Sciences 48: 1201-1205, 2003

 2 Tagart R.E The anal canal and rectum: their varying relationship and its effect on anal continence. Dis Colon Rectum 9: 449-452, 1966

3.also published  on springer.com

 

Acknowledgements

The author thanks Esther Shabtai and Doron Comaneshter, Tel Aviv Sourasky Medical Center for statistical analysis and assistance

All correspondence : Berko Dov Sikirov 15 Neufeld street Bnei Brak-51242 Israel

 E-mail: cikir@zahav.net.il