title: Influence of body posture on defecation: a prospective study of "The Thinker" position.
abstract: OBJECTIVE
  We hypothesized that bending the upper body into what we have termed "The Thinker" position facilitates defecation. This study aimed to assess the influence of "The Thinker" position on defecation.
  
  
  METHODS
  This is the prospective single-group study. Patients who could not evacuate the paste in normal sitting position on cinedefecography between January and June 2013 were enrolled in this study. Cinedefecography was first performed in the sitting position; if the patient was unable to evacuate the paste, images were obtained in "The Thinker" position. Patients who were able to evacuate the paste were excluded from the study. Anorectal angle (ARA), perineal plane distance (PPD), and puborectalis length (PRL) during straining in both positions were measured from the radiographs.
  
  
  RESULTS
  Twenty-two patients unable to evacuate the barium paste underwent cinedefecography in "The Thinker" position. Seventeen patients were female, average age of 56 (range 22-76) years. "The Thinker" position had significantly wider ARA than the sitting position (113° vs. 134°, respectively; p = 0.03), larger PPD (7.1 vs. 9.3 cm, respectively; p = 0.02), and longer PRL (12.9 vs. 15.2 cm, respectively; p = 0.005) during straining. Eleven patients could evacuate completely in "The Thinker" position.
  
  
  CONCLUSIONS
  "The Thinker" position seems to be a more efficient method for defecation than the sitting position. This technique may be helpful when retraining patients with constipation.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA. micg@takano-hospital.jp.
authors.forename: S
authors.initials: S
authors.lastname: Takano
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Sands
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000502:physiology; D003672:Defecation / Q000502:physiology*; D019841:Defecography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D055815:Young Adult
keywords: Anorectal angle; Constipation; Defecation posture; Defecography; Fecal outlet obstruction