Hemorrhoids-cardiovascular Events at Defecation

Probably every physician practicing emergency medicine has encountered tragic cases of cardio and cerebro- vascular events or even of sudden death in the toilet. room.

The defecation act is a consequence of the voluntary straining, which raises the intra-abdominal and intro-thoracic pressures, chain of events known as the Valsalva maneuver. The Valsalva maneuver induces a sharp rise of intravenous, intra-arterial pressures and reduction of coronary flow velocity and cerebral blood flow (1, 2, 3).Different kinds of cardiac rhythm disturbances were found in the persons performing Valsalva maneuver. There is common agreement that the Valsalva maneuver adversely affects the cardio-vascular system and is the causative factor in the patients with the compromised cardio-vascular system of the defecation syncope and death. Therefore it is a routine practice in coronary care units to administer the laxatives and stool softeners hopefully to reduce the straining at defecation.
Two recent studies which compare the length of straining in the sitting comparatively to the squatting defecation posture found that sitting defecation posture obligate at least twice more straining than the squatting posture (4, 5). Accordingly the reduction of the intensity and length of the Valsalva maneuver during defecation in the natural for the human being squatting posture may prevent many cardio-and-cerebro-vascular events (6).
And now it is not merely theoretic advice, a new squatting device was designed and tailored for the sewage system of the Western world (see on the page: video-film of the new squatting device)

in order to conclud here is the study
To evaluate the influence of the less expulsive defecation effort involved in a squatting defecation posture on the course of hemorrhoids.
Method. Sixty-eight consecutive patients presenting to family physicians with symptoms indicative of hemorrhoids were asked to assess the severity of their symptoms (on a scale of 0-4) before and after changing from a sitting to squatting defecation posture (trial) or before and after standard medical treatment (control). The treated patients whose symptoms were not relieved switched to a squatting posture during defecation thus serving as their own controls.
Results. Changing from a sitting to squatting defecation posture (trial group) caused a significant reduction in the intensity of all symptoms, while medical treatment (control group) led only to a reduction in bleeding and pain. A comparison of the two groups revealed a significant decrease in the bleeding and pain in the trial group compared to the control, but no significant difference in the extent of prolapse. The patients in the control group who switched to a squatting defecation posture reported significant reduction in the bleeding, prolapse and pain .The percentage of patients with complete cessation of bleeding and pain was significantly greater in the trial group and in patients who reverted to a squatting defecation posture after being treated medically.