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Influence of body posture on defecation: a prospective study of “The Thinker” position



We hypothesized that bending the upper body into what we have termed “The Thinker” position facilitates defecation. This study aimed to assess the influence of “The Thinker” position on defecation.


This is the prospective single-group study. Patients who could not evacuate the paste in normal sitting position on cinedefecography between January and June 2013 were enrolled in this study. Cinedefecography was first performed in the sitting position; if the patient was unable to evacuate the paste, images were obtained in “The Thinker” position. Patients who were able to evacuate the paste were excluded from the study. Anorectal angle (ARA), perineal plane distance (PPD), and puborectalis length (PRL) during straining in both positions were measured from the radiographs.


Twenty-two patients unable to evacuate the barium paste underwent cinedefecography in “The Thinker” position. Seventeen patients were female, average age of 56 (range 22–76) years. “The Thinker” position had significantly wider ARA than the sitting position (113° vs. 134°, respectively; p = 0.03), larger PPD (7.1 vs. 9.3 cm, respectively; p = 0.02), and longer PRL (12.9 vs. 15.2 cm, respectively; p = 0.005) during straining. Eleven patients could evacuate completely in “The Thinker” position.


“The Thinker” position seems to be a more efficient method for defecation than the sitting position. This technique may be helpful when retraining patients with constipation.

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Correspondence to S. Takano.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Takano, S., Sands, D.R. Influence of body posture on defecation: a prospective study of “The Thinker” position. Tech Coloproctol 20, 117–121 (2016).

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  • Defecation posture
  • Defecography
  • Anorectal angle
  • Constipation
  • Fecal outlet obstruction