{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T21:35:40Z","timestamp":1776893740217,"version":"3.51.2"},"reference-count":28,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:00:00Z","timestamp":1680048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The use of a footstool has been advocated to optimize posture when sitting on the toilet and thus facilitate bowel evacuation. We aimed to assess the alterations in defecatory posture, and the changes in simulated defecation with use of a footstool in patients with constipation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty\u2010one patients (female 93%, mean 52\u2009year, SD 14\u2009year) with constipation referred to a tertiary neurogastroenterology unit were enrolled. A bowel questionnaire, Hospital Anxiety and Depression Scale, and Rome questionnaire were administered prior to anorectal manometry. Each patient underwent three rectal balloon expulsion tests in randomized order with no footstool, a 7\u2010inch, and a 9\u2010inch footstool. Additional assessments included angle between spine and femur, and visual analogue scales assessing ease of evacuation, urge to defecate, and discomfort with expulsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Defecatory posture was significantly altered by footstool use, with progressive narrowing of the angle between the spine and femur as footstool height increased (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 for all comparisons). Compared with no footstool, the use of a footstool was not associated with a change in balloon expulsion time and there was no difference between the two footstool heights. Subjectively, no significant change was identified in any of the three perceptions of balloon expulsion between no footstool and footstool use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>Although the use of a footstool led to changes in defecatory posture, it did not improve subjective or objective measures of simulated defecation in patients with undifferentiated constipation. Therefore, the recommendation for its use during evacuation cannot be applied to all patients with constipation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14580","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T18:46:38Z","timestamp":1680115598000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Using a footstool does not aid simulated defecation in undifferentiated constipation: A randomized trial"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5775-2498","authenticated-orcid":false,"given":"Rose Qizhengyan","family":"Trieu","sequence":"first","affiliation":[{"name":"Neurogastroenterology Unit and Department of Gastroenterology Royal North Shore Hospital  St Leonards New South Wales Australia"},{"name":"The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gillian","family":"Prott","sequence":"additional","affiliation":[{"name":"Neurogastroenterology Unit and Department of Gastroenterology Royal North Shore Hospital  St Leonards New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol","family":"Sequeira","sequence":"additional","affiliation":[{"name":"Neurogastroenterology Unit and Department of Gastroenterology Royal North Shore Hospital  St Leonards New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0565-4938","authenticated-orcid":false,"given":"Michael","family":"Jones","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Health and Human Sciences Macquarie University  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8590-6271","authenticated-orcid":false,"given":"Yoav","family":"Mazor","sequence":"additional","affiliation":[{"name":"Neurogastroenterology Unit and Department of Gastroenterology Rambam Health Care Campus  Haifa Israel"},{"name":"Department of Medical Neurobiology The Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Schnitzler","sequence":"additional","affiliation":[{"name":"The University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Colorectal Surgery Royal North Shore Hospital  St Leonards New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-3788","authenticated-orcid":false,"given":"Allison","family":"Malcolm","sequence":"additional","affiliation":[{"name":"Neurogastroenterology Unit and Department of Gastroenterology Royal North Shore Hospital  St Leonards New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,3,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.04.014"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2010.04273.x"},{"issue":"3","key":"e_1_2_11_4_1","first-page":"159","article-title":"Psychological disorders in patients with chronic constipation","volume":"4","author":"Hosseinzadeh ST","year":"2011","journal-title":"Gastroenterol Hepatol Bed 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