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FISIOLOGI PENCERNAAN
Oleh : Adelia Handoko
Pembimbing : dr. Harlina Soetjipto, MS
Original Article
Influence of body posture on defecation: a prospective study
of The Thinker position
S. Takano, D. R. Sands
INTRODUCTION
Fecal outlet obstruction lowers quality of life (QOL) of patient with
functional constipation
Outlet obstruction may be attributed multiple causes, like nonrelaxation of
puborectalis muscle, anismus, rectal prolapse, rectocele and rectal
hyposensitivity.
Tsuchino et al. assessed rectal and anal pressure during defecation with the
patient in a bending position rather than a normal sitting position
The authors reported that this position resulted in higher rectal and lower
anal pressures. This position, described by Tsuchino, is reminiscent of Rodins
sculpture, Le Penseur
This study was to assess the influence of The Thinker position on
defecation during cinedefecography.
Inclusion criteria:
The criteria for enrollment in this study were patients with constipation, who were
scheduledto undergo cinedefecography, and who could not evacuate the paste in
the sitting position.
Diagnosis of constipation and outlet obstruction were made using the criteria for
functional defecation disorders of ROME III
Exclusion criteria
pregnancy,
and prior rectal surgery and patients who could evacuate the paste in the vertical
position on cinedefecography
Cinedefecography
The barium paste was mixed with oatmeal to create a stool consistency in
Bristol type 4.
The patient was then asked to sit on a commode. Lateral films of the pelvis
are taken during the pushing phase in a sitting position.
If the patient could not evacuate the paste, the patient was asked to assume
The Thinker position and additional films were taken. If patient could
evacuate the paste, the patient was excluded from the study. The Thinker
position involves bending the upper body forward and placing the elbow on
the knee
PPD
was considered as the vertical distance between the ARA position and a line
drawn between the pubic symphysis to the tip of the coccyx.
PRL
was measured as the distance between the ARA and the pubic symphysis.
Discussion
Tsuchino et al. showed higher rectal pressure and lower anal pressure in this
position. Furthermore, they suggested this position creates higher
intraabdominal Individual values for ARA, PPD, and PRL during attempted
defecation in the vertical position and The Thinker position.
ARA anorectal angle, PPD perineal plane distance, PRL puborectalis length
pressure and the combination of increased rectal pressure and ARA helps to
facilitate evacuation. The findings suggest that The Thinker position helps the
levator ani relax which then allows for an increase in the pushing effort caused
from higher intraabdominal pressure.
In this study, The Thinker position showed wider ARA. This means the position
makes more relaxation of puborectalis muscle than vertical position. It was
suggested that The Thinker position makes easier evacuation forpatients with
fecal outlet obstruction.
Conclusion
TERIMA KASIH