impact of ethnic habits on defecographic measurements

Background- Defecography, along with other radiologic modalities, can be used to evaluate rectal abnormalities such as functional disorders of the rectum. It appears that ethnic habits can influence the evacuative function of the rectum. The main goal of this study was to compare Iranian and European habits of bowel evacuation on defecographic measurements.Methods- Thirty Iranian patients (21 male, 9 female) referred for barium enema were enrolled in the study. The patients were instructed to defecate using two types of toilet: an unraised, ground-level style (common in Iran), and a bowl with attached tank style (common in Western countries). Radiographs were taken of each patient while defecating into both types of toilet, during which the anorectal angle and other defecographic indices were measured.Results- Use of the Iranian-style toilet yielded a much wider anorectal angle, and a larger distance between the perineum and the horizontal plane of the pelvic floor than the European style. Bowel evacuation was also more complete using the Iranian-style toilet.Conclusion- Use of the Iranian-style toilet seems to be more a more comfortable and efficient method of bowel evacuation than the European style. Further studies are needed to ascertain the optimal approximation of the measurements to standard height of toilets for ordinary use.