Rethinking the effectiveness of defecation postures and practices: it’s not what you do it’s the way that you do it!
This paper reports on a piece of research to investigate the effectiveness of defecation postures and anal cleansing method. The research compared how long each bowel movement took on a pedestal toilet with and without a footstool. Volunteers were asked to compare the two positions for speed as well as stress/strain on the body. The effectiveness of the method of anal cleansing was also rated by a subset of the volunteers. Although the study was conducted using volunteers in the UK, the findings have international relevance for sanitation marketing and hygiene promotion programmes.Ahmed, I., Shabbir, M.N., Iqbal, M.A. and Najam, M.S. (2013) ‘Role of defecation postures on the outcome of chronic anal fissure’, Pakistan Journal of Surgery 29(4): 269–71.
BBC News (2010) ‘Squat toilets in Rochdale shopping centre’ [online], BBC News <www.bbc.co.uk/news/uk-england-manchester-10644118> [accessed 10 August 2017].
Chambers, R. and Myers, J. (2016) ‘Norms, knowledge and usage’, Frontiers of CLTS: Innovations and Insights Issue 7 [pdf], Brighton: IDS <https://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/8960/Issue7_Norms_knowledge_and_usage_2ndEdition.pdf?sequence=3> [accessed 10 August 2017].
Coffey, D., Gupta, A., Hathi, P., Khurana, N., Spears, D., Srivastav, N. and Vyas, S. (2014) Revealed Preference for Open Defecation: Evidence from a New Survey in Rural North India, SQUAT Working Paper 1 [pdf], Rice Institute <http://riceinstitute.org/research/revealed-preference-for-open-defecation-evidence-from-a-new-survey-in-rural-north-india-longer-working-paper/>.
Dumpert, J. and Perez, E. (2015) ‘Going beyond mason training: enabling, facilitating and engaging rural sanitation markets for the base of the pyramid’, Waterlines 34(3): 210–26 <https://doi.org/10.3362/1756-3488.2015.021>.
Edgar, C. (2016) Squatting vs Sitting, Washing vs Wiping: are United Kingdom citizens correct in the way in which they use a toilet, BSc dissertation, Loughborough University.
Han, Aung Myo., Khin New Do, Tin Aye, Thein Hlaing (1986) ‘Personal toilet after defaecation and the degree of hand contamination according to different methods used’, Journal of Tropical Medicine and Hygiene 89(5): 237–41.
Jones, H. and Reed, R. (2005) Water and Sanitation for Disabled People and Other Vulnerable Groups: Designing Services to Improve Accessibility, Loughborough, UK: WEDC <https://wedc-knowledge.lboro.ac.uk/details.html?id=16357> [accessed 10 August 2017].
Jones, H. and Wilbur, J. (2014) Compendium of Accessible WASH Technologies, WEDC, WaterAid, SHARE.
Kira, A. (1976) The Bathroom Book, Penguin.
McMahon, S., Caruso, B.A., Obure, A., Okumu, F. and Rheingans, R.D. (2011) ‘Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya’, Tropical Medicine & International Health 16: 1536–40 <http://dx.doi.org/10.1111/j.1365-3156.2011.02879.x>.
Phifer, M. (2014) ‘What goes in must come out!’ [online] Natural Health and Wellness <http://nhwdenver.com/straining-to-defecate/> [accessed 10 August 2017].
Pitt, B. (2010) ‘PCC upholds complaint against Daily Star over “Muslim-only public loos” story’, 26 September [online], Islamophobia Watch <www.islamophobiawatch.co.uk/2010/?w=38> [accessed 10 August 2017].
Rad, S. (2002) ‘Impact of ethnic habits on defecographic measurements’, Archives of Iranian Medicine 5(2): 115–7.
Sakakibara, R., Tsunoyama, K., Hosoi, H., Takahashi, O., Sugiyama, M., Kishi, M., Ogawa, E., Terada, H., Uchiyama, T. and Yamanishi, T. (2010) ‘Influence of body position on defecation in humans’, Lower Urinary Tract Symptoms LUTS 2: 16–21 <http://dx.doi.org/10.1111/j.1757-5672.2009.00057.x>.
Sidibe, M. and Curtis, V. (2007) Can Hygiene be Cool and Fun? Insights from School Children in Senegal [pdf], Washington, DC: World Bank <http://documents.worldbank.org/curated/en/765011468307739863/Can-hygiene-be-cool-and-fun-Insights-from-school-children-in-Senegal> [accessed 10 August 2017].
Sikiov, D. (2003) ‘Comparison of straining during defecation in three positions results and implications for human health’, Digestive Diseases and Sciences 48(7): 1201–5.
Sugden, S. (2014) ‘Latrine design: Go in peace’, Waterlines 33(3): 220–39 <http://dx.doi.org/10.3362/1756-3488.2014.023>.
Taggart, R.E.B. (1966) ‘The anal canal and rectum: their varying relationship and its effect on anal continence’, Diseases of the Colon & Rectum 9(6): 449–52.
UN (2015) ‘Clean water and sanitation’ [online], Global Goals for Sustainable Development <www.globalgoals.org/global-goals/clean-water-sanitation/> [accessed 10 August 2017].
von Münch, E. and Milosevic, D. (2015) Qualitative survey on squatting toilets and anal cleansing with water with a special emphasis on Muslim and Buddhist countries by using the SuSanA discussion forum, Schwalbach, Germany: Ostella Consulting.
Williams, J.F. and Wetherill, G.G. (1950) Personal and Community Hygiene Applied, Philadelphia, PA: Saunders.
WSP (2005) ‘Anal cleansing’ [online], Hygiene, Sanitation & Water Toolkit, Washington, DC: World Bank <https://www.wsp.org/Hygiene-Sanitation-Water-Toolkit/BasicPrinciples/AnalCleansing.html> [accessed 10 August 2017].
Ahmed, I., Shabbir, M.N., Iqbal, M.A. and Najam, M.S. (2013) ‘Role of defecation postures on the outcome of chronic anal fissure’, Pakistan Journal of Surgery 29(4): 269–71.
BBC News (2010) ‘Squat toilets in Rochdale shopping centre’ [online], BBC News <www.bbc.co.uk/news/uk-england-manchester-10644118> [accessed 10 August 2017].
Chambers, R. and Myers, J. (2016) ‘Norms, knowledge and usage’, Frontiers of CLTS: Innovations and Insights Issue 7 [pdf], Brighton: IDS <https://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/8960/Issue7_Norms_knowledge_and_usage_2ndEdition.pdf?sequence=3> [accessed 10 August 2017].
Coffey, D., Gupta, A., Hathi, P., Khurana, N., Spears, D., Srivastav, N. and Vyas, S. (2014) Revealed Preference for Open Defecation: Evidence from a New Survey in Rural North India, SQUAT Working Paper 1 [pdf], Rice Institute <http://riceinstitute.org/research/revealed-preference-for-open-defecation-evidence-from-a-new-survey-in-rural-north-india-longer-working-paper/>.
Dumpert, J. and Perez, E. (2015) ‘Going beyond mason training: enabling, facilitating and engaging rural sanitation markets for the base of the pyramid’, Waterlines 34(3): 210–26 <https://doi.org/10.3362/1756-3488.2015.021>.
Edgar, C. (2016) Squatting vs Sitting, Washing vs Wiping: are United Kingdom citizens correct in the way in which they use a toilet, BSc dissertation, Loughborough University.
Han, Aung Myo., Khin New Do, Tin Aye, Thein Hlaing (1986) ‘Personal toilet after defaecation and the degree of hand contamination according to different methods used’, Journal of Tropical Medicine and Hygiene 89(5): 237–41.
Jones, H. and Reed, R. (2005) Water and Sanitation for Disabled People and Other Vulnerable Groups: Designing Services to Improve Accessibility, Loughborough, UK: WEDC <https://wedc-knowledge.lboro.ac.uk/details.html?id=16357> [accessed 10 August 2017].
Jones, H. and Wilbur, J. (2014) Compendium of Accessible WASH Technologies, WEDC, WaterAid, SHARE.
Kira, A. (1976) The Bathroom Book, Penguin.
McMahon, S., Caruso, B.A., Obure, A., Okumu, F. and Rheingans, R.D. (2011) ‘Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya’, Tropical Medicine & International Health 16: 1536–40 <http://dx.doi.org/10.1111/j.1365-3156.2011.02879.x>.
Phifer, M. (2014) ‘What goes in must come out!’ [online] Natural Health and Wellness <http://nhwdenver.com/straining-to-defecate/> [accessed 10 August 2017].
Pitt, B. (2010) ‘PCC upholds complaint against Daily Star over “Muslim-only public loos” story’, 26 September [online], Islamophobia Watch <www.islamophobiawatch.co.uk/2010/?w=38> [accessed 10 August 2017].
Rad, S. (2002) ‘Impact of ethnic habits on defecographic measurements’, Archives of Iranian Medicine 5(2): 115–7.
Sakakibara, R., Tsunoyama, K., Hosoi, H., Takahashi, O., Sugiyama, M., Kishi, M., Ogawa, E., Terada, H., Uchiyama, T. and Yamanishi, T. (2010) ‘Influence of body position on defecation in humans’, Lower Urinary Tract Symptoms LUTS 2: 16–21 <http://dx.doi.org/10.1111/j.1757-5672.2009.00057.x>.
Sidibe, M. and Curtis, V. (2007) Can Hygiene be Cool and Fun? Insights from School Children in Senegal [pdf], Washington, DC: World Bank <http://documents.worldbank.org/curated/en/765011468307739863/Can-hygiene-be-cool-and-fun-Insights-from-school-children-in-Senegal> [accessed 10 August 2017].
Sikiov, D. (2003) ‘Comparison of straining during defecation in three positions results and implications for human health’, Digestive Diseases and Sciences 48(7): 1201–5.
Sugden, S. (2014) ‘Latrine design: Go in peace’, Waterlines 33(3): 220–39 <http://dx.doi.org/10.3362/1756-3488.2014.023>.
Taggart, R.E.B. (1966) ‘The anal canal and rectum: their varying relationship and its effect on anal continence’, Diseases of the Colon & Rectum 9(6): 449–52.
UN (2015) ‘Clean water and sanitation’ [online], Global Goals for Sustainable Development <www.globalgoals.org/global-goals/clean-water-sanitation/> [accessed 10 August 2017].
von Münch, E. and Milosevic, D. (2015) Qualitative survey on squatting toilets and anal cleansing with water with a special emphasis on Muslim and Buddhist countries by using the SuSanA discussion forum, Schwalbach, Germany: Ostella Consulting.
Williams, J.F. and Wetherill, G.G. (1950) Personal and Community Hygiene Applied, Philadelphia, PA: Saunders.
WSP (2005) ‘Anal cleansing’ [online], Hygiene, Sanitation & Water Toolkit, Washington, DC: World Bank <https://www.wsp.org/Hygiene-Sanitation-Water-Toolkit/BasicPrinciples/AnalCleansing.html> [accessed 10 August 2017].
Ahmed, I., Shabbir, M.N., Iqbal, M.A. and Najam, M.S. (2013) ‘Role of defecation postures on the outcome of chronic anal fissure’, Pakistan Journal of Surgery 29(4): 269–71.
BBC News (2010) ‘Squat toilets in Rochdale shopping centre’ [online], BBC News <www.bbc.co.uk/news/uk-england-manchester-10644118> [accessed 10 August 2017].
Chambers, R. and Myers, J. (2016) ‘Norms, knowledge and usage’, Frontiers of CLTS: Innovations and Insights Issue 7 [pdf], Brighton: IDS <https://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/8960/Issue7_Norms_knowledge_and_usage_2ndEdition.pdf?sequence=3> [accessed 10 August 2017].
Coffey, D., Gupta, A., Hathi, P., Khurana, N., Spears, D., Srivastav, N. and Vyas, S. (2014) Revealed Preference for Open Defecation: Evidence from a New Survey in Rural North India, SQUAT Working Paper 1 [pdf], Rice Institute <http://riceinstitute.org/research/revealed-preference-for-open-defecation-evidence-from-a-new-survey-in-rural-north-india-longer-working-paper/>.
Dumpert, J. and Perez, E. (2015) ‘Going beyond mason training: enabling, facilitating and engaging rural sanitation markets for the base of the pyramid’, Waterlines 34(3): 210–26 <https://doi.org/10.3362/1756-3488.2015.021>.
Edgar, C. (2016) Squatting vs Sitting, Washing vs Wiping: are United Kingdom citizens correct in the way in which they use a toilet, BSc dissertation, Loughborough University.
Han, Aung Myo., Khin New Do, Tin Aye, Thein Hlaing (1986) ‘Personal toilet after defaecation and the degree of hand contamination according to different methods used’, Journal of Tropical Medicine and Hygiene 89(5): 237–41.
Jones, H. and Reed, R. (2005) Water and Sanitation for Disabled People and Other Vulnerable Groups: Designing Services to Improve Accessibility, Loughborough, UK: WEDC <https://wedc-knowledge.lboro.ac.uk/details.html?id=16357> [accessed 10 August 2017].
Jones, H. and Wilbur, J. (2014) Compendium of Accessible WASH Technologies, WEDC, WaterAid, SHARE.
Kira, A. (1976) The Bathroom Book, Penguin.
McMahon, S., Caruso, B.A., Obure, A., Okumu, F. and Rheingans, R.D. (2011) ‘Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya’, Tropical Medicine & International Health 16: 1536–40 <http://dx.doi.org/10.1111/j.1365-3156.2011.02879.x>.
Phifer, M. (2014) ‘What goes in must come out!’ [online] Natural Health and Wellness <http://nhwdenver.com/straining-to-defecate/> [accessed 10 August 2017].
Pitt, B. (2010) ‘PCC upholds complaint against Daily Star over “Muslim-only public loos” story’, 26 September [online], Islamophobia Watch <www.islamophobiawatch.co.uk/2010/?w=38> [accessed 10 August 2017].
Rad, S. (2002) ‘Impact of ethnic habits on defecographic measurements’, Archives of Iranian Medicine 5(2): 115–7.
Sakakibara, R., Tsunoyama, K., Hosoi, H., Takahashi, O., Sugiyama, M., Kishi, M., Ogawa, E., Terada, H., Uchiyama, T. and Yamanishi, T. (2010) ‘Influence of body position on defecation in humans’, Lower Urinary Tract Symptoms LUTS 2: 16–21 <http://dx.doi.org/10.1111/j.1757-5672.2009.00057.x>.
Sidibe, M. and Curtis, V. (2007) Can Hygiene be Cool and Fun? Insights from School Children in Senegal [pdf], Washington, DC: World Bank <http://documents.worldbank.org/curated/en/765011468307739863/Can-hygiene-be-cool-and-fun-Insights-from-school-children-in-Senegal> [accessed 10 August 2017].
Sikiov, D. (2003) ‘Comparison of straining during defecation in three positions results and implications for human health’, Digestive Diseases and Sciences 48(7): 1201–5.
Sugden, S. (2014) ‘Latrine design: Go in peace’, Waterlines 33(3): 220–39 <http://dx.doi.org/10.3362/1756-3488.2014.023>.
Taggart, R.E.B. (1966) ‘The anal canal and rectum: their varying relationship and its effect on anal continence’, Diseases of the Colon & Rectum 9(6): 449–52.
UN (2015) ‘Clean water and sanitation’ [online], Global Goals for Sustainable Development <www.globalgoals.org/global-goals/clean-water-sanitation/> [accessed 10 August 2017].
von Münch, E. and Milosevic, D. (2015) Qualitative survey on squatting toilets and anal cleansing with water with a special emphasis on Muslim and Buddhist countries by using the SuSanA discussion forum, Schwalbach, Germany: Ostella Consulting.
Williams, J.F. and Wetherill, G.G. (1950) Personal and Community Hygiene Applied, Philadelphia, PA: Saunders.
WSP (2005) ‘Anal cleansing’ [online], Hygiene, Sanitation & Water Toolkit, Washington, DC: World Bank <https://www.wsp.org/Hygiene-Sanitation-Water-Toolkit/BasicPrinciples/AnalCleansing.html> [accessed 10 August 2017].
Ahmed, I., Shabbir, M.N., Iqbal, M.A. and Najam, M.S. (2013) ‘Role of defecation postures on the outcome of chronic anal fissure’, Pakistan Journal of Surgery 29(4): 269–71.
BBC News (2010) ‘Squat toilets in Rochdale shopping centre’ [online], BBC News <www.bbc.co.uk/news/uk-england-manchester-10644118> [accessed 10 August 2017].
Chambers, R. and Myers, J. (2016) ‘Norms, knowledge and usage’, Frontiers of CLTS: Innovations and Insights Issue 7 [pdf], Brighton: IDS <https://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/8960/Issue7_Norms_knowledge_and_usage_2ndEdition.pdf?sequence=3> [accessed 10 August 2017].
Coffey, D., Gupta, A., Hathi, P., Khurana, N., Spears, D., Srivastav, N. and Vyas, S. (2014) Revealed Preference for Open Defecation: Evidence from a New Survey in Rural North India, SQUAT Working Paper 1 [pdf], Rice Institute <http://riceinstitute.org/research/revealed-preference-for-open-defecation-evidence-from-a-new-survey-in-rural-north-india-longer-working-paper/>.
Dumpert, J. and Perez, E. (2015) ‘Going beyond mason training: enabling, facilitating and engaging rural sanitation markets for the base of the pyramid’, Waterlines 34(3): 210–26 <https://doi.org/10.3362/1756-3488.2015.021>.
Edgar, C. (2016) Squatting vs Sitting, Washing vs Wiping: are United Kingdom citizens correct in the way in which they use a toilet, BSc dissertation, Loughborough University.
Han, Aung Myo., Khin New Do, Tin Aye, Thein Hlaing (1986) ‘Personal toilet after defaecation and the degree of hand contamination according to different methods used’, Journal of Tropical Medicine and Hygiene 89(5): 237–41.
Jones, H. and Reed, R. (2005) Water and Sanitation for Disabled People and Other Vulnerable Groups: Designing Services to Improve Accessibility, Loughborough, UK: WEDC <https://wedc-knowledge.lboro.ac.uk/details.html?id=16357> [accessed 10 August 2017].
Jones, H. and Wilbur, J. (2014) Compendium of Accessible WASH Technologies, WEDC, WaterAid, SHARE.
Kira, A. (1976) The Bathroom Book, Penguin.
McMahon, S., Caruso, B.A., Obure, A., Okumu, F. and Rheingans, R.D. (2011) ‘Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya’, Tropical Medicine & International Health 16: 1536–40 <http://dx.doi.org/10.1111/j.1365-3156.2011.02879.x>.
Phifer, M. (2014) ‘What goes in must come out!’ [online] Natural Health and Wellness <http://nhwdenver.com/straining-to-defecate/> [accessed 10 August 2017].
Pitt, B. (2010) ‘PCC upholds complaint against Daily Star over “Muslim-only public loos” story’, 26 September [online], Islamophobia Watch <www.islamophobiawatch.co.uk/2010/?w=38> [accessed 10 August 2017].
Rad, S. (2002) ‘Impact of ethnic habits on defecographic measurements’, Archives of Iranian Medicine 5(2): 115–7.
Sakakibara, R., Tsunoyama, K., Hosoi, H., Takahashi, O., Sugiyama, M., Kishi, M., Ogawa, E., Terada, H., Uchiyama, T. and Yamanishi, T. (2010) ‘Influence of body position on defecation in humans’, Lower Urinary Tract Symptoms LUTS 2: 16–21 <http://dx.doi.org/10.1111/j.1757-5672.2009.00057.x>.
Sidibe, M. and Curtis, V. (2007) Can Hygiene be Cool and Fun? Insights from School Children in Senegal [pdf], Washington, DC: World Bank <http://documents.worldbank.org/curated/en/765011468307739863/Can-hygiene-be-cool-and-fun-Insights-from-school-children-in-Senegal> [accessed 10 August 2017].
Sikiov, D. (2003) ‘Comparison of straining during defecation in three positions results and implications for human health’, Digestive Diseases and Sciences 48(7): 1201–5.
Sugden, S. (2014) ‘Latrine design: Go in peace’, Waterlines 33(3): 220–39 <http://dx.doi.org/10.3362/1756-3488.2014.023>.
Taggart, R.E.B. (1966) ‘The anal canal and rectum: their varying relationship and its effect on anal continence’, Diseases of the Colon & Rectum 9(6): 449–52.
UN (2015) ‘Clean water and sanitation’ [online], Global Goals for Sustainable Development <www.globalgoals.org/global-goals/clean-water-sanitation/> [accessed 10 August 2017].
von Münch, E. and Milosevic, D. (2015) Qualitative survey on squatting toilets and anal cleansing with water with a special emphasis on Muslim and Buddhist countries by using the SuSanA discussion forum, Schwalbach, Germany: Ostella Consulting.
Williams, J.F. and Wetherill, G.G. (1950) Personal and Community Hygiene Applied, Philadelphia, PA: Saunders.
WSP (2005) ‘Anal cleansing’ [online], Hygiene, Sanitation & Water Toolkit, Washington, DC: World Bank <https://www.wsp.org/Hygiene-Sanitation-Water-Toolkit/BasicPrinciples/AnalCleansing.html> [accessed 10 August 2017].
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