— Assist device was helpful for a particular subgroup of patients
by Zaina Hamza, Staff Writer, MedPage Today October 27, 2021

For women with defecatory dysfunction, those with normal stool consistency, greater rectoanal pressure gradient, lower anal tone, and of younger age (<50 y/o) were most likely to benefit from a squatting assist stool (SAS), a researcher reported.

In a registry analysis of mostly female patients who failed a balloon expulsion test (BET), the highest likelihood of a successful BET after using an SAS was observed among women with a Bristol type 3 or 4 stool consistency (OR 3.86, 95% CI 1.21-12.34), according to Lauren Ulsh, MD, of Stanford University Medical Center in California.

Greater rectoanal pressure gradient, lower anal resting pressure, and age under 50 were also significantly associated with odds of a successful BET, according to her presentation at the American College of Gastroenterology annual meeting.

“Patients with defecatory dysfunction can be a challenging population to treat,” Rebecca Gunter, MD, MS, of the Cleveland Clinic in Ohio, told MedPage Today. “Squatting assist stools have become popularized in the general media and are more commonly being seen in people’s homes.”

“However, they are not well studied and there is very little in the literature to guide their use,” Gunter, who was not involved in this study, added. “This much-needed study offers insight into which patients with defecatory dysfunction would benefit from a squatting assist stool, providing physicians with objective data to aid in decision-making.”

At the presentation, Ulsh said patients with defecatory dysfunction may benefit from SAS, since the device requires a person to straighten the anorectal angle positioning for defecation, which suggests a benefit from SAS by overcoming anorectal dyssynergia.

“Women who benefitted from squatting had certain clinical characteristics and significantly different symptom severity scores for obstructive defecation and fecal incontinence,” noted Ulsh.

For their study, the researchers performed a retrospective analysis of 657 patients with defecatory dysfunction who underwent BET and high-resolution anorectal manometry. An abnormal BET was defined as patients who were unable to expel a rectal balloon containing 50 mL of water within a minute. However, a failed BET was defined as those who could not pass the balloon after more than 2 minutes.

Overall, there were 657 patients in the registry, and nearly 80% (n=524) were women.

“When we actually stratified by gender, we noted that women were the […] drivers of significance,” Ulsh said.

There were 347 patients (55%) with normal BET results and 249 who failed the BET. Of those, 209 still failed after the use of an SAS. Only 40 passed the BET with the use of SAS in less than 2 minutes.

Patients who passed the BET after use of SAS tended to be younger, with a higher BMI, a normal stool consistency, less laxative use, less abdominal pain, and lower Cleveland Clinic Fecal Incontinence Scores.

No differences were observed when examining patients by race, neuropsychiatric disorders, urinary incontinence, bowel frequency, or medical history.

The retrospective analysis had several limitations, including the low number of male participants and the lack of structural data.