J Neurogastroenterol Motil  https://doi.org/10.5056/jnm22177
Consistency of Feces Affects Defecatory Function
Daming Sun,1 Kar Man Lo,2 Ssu-Chi Chen,3 Wing Wa Leung,3 Cherry Wong,3 Tony Mak,3 Simon Ng,3 Kaori Futaba,3 and Hans Gregersen2
1Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China; 2California Medical Innovations Institute, San Diego, CA, USA; and 3Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
Correspondence to: Hans Gregersen, MD
California Medical Innovations Institute, San Diego, CA, USA
Tel: +1-8582497400, E-mail: hag@giome.org

Daming Sun and Kar Man Lo equally contributed to this study.
Received: October 21, 2022; Revised: May 6, 2023; Accepted: September 27, 2023; Published online: March 27, 2024
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
It is a common belief that constipated patients have hard feces that contributes to the difficulties defecating. To the best of our knowledge, no studies had been published on controlled evacuation of simulated feces with different consistencies.
Methods
Twelve normal subjects were recruited for studies with the simulated feces device “Fecobionics” of different consistency (silicone shore 0A-40A corresponding to Bristol Stool Form Scale types 2-4). The subjects filled out questionnaires and had the balloon expulsion test (BET) and anorectal manometry (ARM) done for reference. The Fecobionics probes were inserted in rectum in random order with +20 minutes between insertions. The bag was filled to urge-to-defecate and evacuations took place in privacy. Non-parametric statistics with median and quartiles are provided.
Results
One subject was excluded due to technical issues, and another had abnormal ARM-BET. The 4 females/6 males subjects were 23yrs (range 20-48). Most differences were observed between the 0A and 10A probe (duration, maximum bag pressure, duration x maximum bag pressure, and relaxation of the front pressure and the bend angle during evacuation), eg, the duration was 9 (8-12) seconds at 0A and 18 (12-21) seconds at 10A (P < 0.05), and maximum bag pressure was 107 (96-116) at 0A and 140 (117-162) cmH2O at 10A (P < 0.05). The bend angle before evacuation differed between the probes whereas only the 10A differed from 40A during defecation. The 10A was harder to evacuate than the 0A probe. Except for the bend angles, no further significant change was observed from 10A to 40A.
Conclusion
Fecal consistency affects defecatory parameters.
Keywords: Anorectal physiology; Consistency; Defecatory function; Fecobionics; Stiffness


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