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Posture During Defecation is a Risk factor for Colonic Diverticular Disease
Omer Ozturk1, Seyfettin Koklu*1, Erdem Akbal2, Evrim Kahramanoglu Aksoy1, Hayretdin Koklu1, Ege Altan1, Osman Yuksel1, Omer Basar1, Tugrul Purnak1
1Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey; 2Canakkale Onsekiz Mart University, Canakkale, Turkey
Background: Although several factors are suspected, the etiology of colonic-diverticulosis (CD) is not known. Excessive straining may predispose to CD development. Inadequate anorectal angle during defecation in a sitting posture causes excessive straining.
Aim: The aim of this study was to determine the prevalence, location, associated factors and clinical features of CD. We especially aimed to detect whether there is an association between CD and postures (sitting or squatting) during defecation.
Methods: The present prospective study enrolled 1018 patients from 1 March 2015 to 30 September
2015. Demographic data and information on each patient were recorded using a standardized questionnaire before undergoing colonoscopy. Patient colonoscopy results, including presence of one or more diverticula and their localization in the colon, presence of hemorrhoids, polyps or other findings were recorded. The subjects were divided into two groups as a diverticulosis group (D group, n: 95) and non-diverticulosis group (non-D group, n: 662).
Results: Two hundred sixty-one patients were excluded from the study. The median age of the 757 included subjects was 54.9 +-13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was 56.8% (n:54) in the left, 24.2% (n:23) in the right and 19% (n:18) in both sides of the colon. Patients in the D-group were older (p<0.001) and had female predominance (p:0.04). Other characteristics were comparable among the groups. Frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). Use-time of Western-type toilet was longer in the D-group compared to the non-D group (p: 0.04). In multivariable logistic regression analysis, irritable bowel syndrome, toilet type and presence of hemorrhoids were independent risk factor for diverticulosis.
Conclusion: Sitting during defecation (Western type toilet) seems to increase the risk of CD. To optimize the anorectal angle, placing a footstool during defecation may have a protective role against diverticula formation.
Key words: diverticula, colonic diverticulosis, defecation, sitting, squatting, irritable bowel syndrome, constipation
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