Fact-Finding Survey of Defecation Behavior in Young Japanese Adults

Sunday, 30 July 2017

Megumi Katayama, PhD1
Yoko Aso, PhD1
Aki Ibe, PhD2
Osamu Katayama, PhD3
Hiroko Matsuzawa, MSN4
(1)Graduate School of Nursing/School of Nursing, Mukogawa Women's University, Nishinomiya, Japan
(2)Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga, Japan
(3)Department of Nursing, Kobe City College Of Nursing, Kobe, Japan
(4)Department of Nursing, Tohto College of Health Sciences, Fukaya, Japan


 Defecation is an act that is essential to maintaining biological activity and is a basic physiological need in humans. Spending one’s daily life without discomfort or hindrance to defecation is also associated with quality of life. Several past surveys of defecation have focused on constipation and fecal incontinence, and many surveys have focused on the presence or absence and causes of constipation. However, the postures that individuals adopt when independently performing defecation behavior, and behaviors that have been devised to facilitate defecation remain unclear. The purpose of this survey was to clarify the state of defecation behavior and coping behavior for constipation in young adults


  1. Survey subjects

    A total of 300 healthy university students at a nursing faculty.

  2. Survey period

    December 2015

  3. Survey method

    We created a proprietary self-administered questionnaire in which subjects could fill out information on their experience of constipation, posture during defecation, behavior during defecation and other facts. The questionnaires were distributed to subjects at once and recovered using a collection box in which subjects voluntarily submitted their questionnaires. To avoid coercion of subjects during distribution and recovery of the questionnaires, an investigator with no connection to the allocation process of students’ academic credits was assigned to distribution and recovery.

  4. Survey details

    Survey items included age, sex, pattern of defecation frequency, the Constipation Assessment Scale (CAS), use of constipation prophylaxis, methods of coping with constipation, use of laxatives, style of toilet, ease of defecation based on the style of toilet, time required for one defecation, fatigue after one defecation, defecation posture, and means of facilitating defecation.

  5. Analysis method

    1) Percentages were tallied up for age, sex, use of constipation prophylaxis, use of laxatives, defecation style, and ease of defecation based on defecation style.

    2) Subjects were divided into two groups based on the pattern of defecation frequency: a constipation group who “did not defecate for 3 days or more” and a normal group comprising all other subjects. Subjects were also divided into two groups based on the CAS: a constipation group who scored at least 5 points and a normal group who scored less than 5 points. The CAS incorporates a subjective sense of constipation, which was considered in line with the purpose of this survey. To evaluate fatigue after defecation, subjects were asked to indicate on a visual analog scale (VAS) how fatigued they felt. A VAS score of 0 denoted “Almost no change,” a score of 50 denoted “Mild sense of muscle fatigue,” and a score of 100 denoted “Either general muscle fatigue, malaise, shortness of breath or other sensation.” Those who scored below 50 were allocated to a “low fatigue group” while those who scored over 50 were allocated to a “strong fatigue group.” For defecation posture, subjects were divided into three groups: an “upright 90° posture group,” “forward leaning group” and “belly-to-thighs group.” For defecation time, subjects were divided into 5 groups: a “1–2 minutes group,” “3–5 minute group,” “6–9 minute group,” “10–15 minute group” and “15 minutes or more group.” These groups were used to test for statistical differences by using chi-square tests. As “means of facilitating defecation” and “methods of coping with constipation” were open-ended questions, their content was categorized to examine trends.

    A pvalue of less than 0.05 was considered to indicate a significant difference in statistical processing, which was done using the statistical software SPSS Ver. 23.


 Of the 300 questionnaires that were distributed, 258 were recovered (recovery rate: 86%). The subjects were 30 men and 227 women: the ratio of men and women was 12% and 88%, respectively. The mean age of subjects was 20.5 ± 1.42 years.

 The defecation frequency was daily in 51%, every 2 days in 24%, every 3 days in 19% and every 3 days or more in 6% of subjects. CAS scores were 5 points or below in 75% and 6 points or more in 25%. Constipation prophylaxis was used by 47% and not used by 53%. Coping methods were used during constipation by 51% and not used by 49%. Laxatives were used by 10% and not used by 90%. Among those who answered that they used coping methods, 85% described specific methods. Of these methods, laxatives were used by 10%. The style of toilet used was a Japanese-style toilet in 1% and a Western-style toilet in 99%. In response to “ease of defecation based on the style of toilet,” 14% responded with a Japanese-style toilet and 86% responded with a Western-style toilet. Defecation time was “1–2 minutes” in 31%, “3–5 minutes” in 40%, 6–9 minutes” in 15%, “10–15 minutes” in 11%, and “15 minutes or more” in 3%. The fatigue score was 50 or below in 86% and over 50 in 14%. The defecation posture adopted was “90°” in 19%, “forward leaning” in 76% and “belly-to-thighs” in 5%.

 Significant statistical differences were seen between CAS score and coping methods during constipation (p < 0.01), CAS score and use of medication (p < 0.01), CAS score and defecation time (p < 0.05), CAS score and defecation posture (p < 0.01), fatigue and defecation time (p < 0.01), and defecation posture and fatigue (p< 0.05).

 Means of preventing constipation were often described as associated with diet, such as “eating vegetables,” “eating yogurt” and “consuming plenty of fluids.” Subjects also described conscious defecation behavior, such as “immediately going to the toilet upon feeling the urge to defecate” and physical maintenance including “jogging” and “getting a massage.” Methods of coping with constipation were mostly the same, but included methods such as “taking laxatives” and “applying heat.”

 Means of facilitating defecation during constipation included moving the body such as “crossing legs,” “raising heels,” “pressing on the tailbone,” “twisting the stomach” and “making a fist,” but also included physical methods, such as “holding onto handrails,” “placing feet on a low platform,” “stimulating the anus with a washing machine,” and “pushing against the wall with the feet.”


 CAS scores of at least 5 points in 25% of subjects revealed that a quarter of the students surveyed felt that they were constipated. We also found that many students employed some kind of coping method when they felt constipated. Some subjects relieved constipation by taking oral laxatives, which were used by 10% of all subjects. Those with higher CAS scores tended to be more likely to use laxatives. While laxatives were used as a coping method by 10% of subjects, the remaining 90% used other methods. This revealed that the majority of subjects coped with constipation by means other than medication. The fact that the subjects of this survey were young adult students studying nursing who had knowledge of medications and strong awareness of health may have influenced the results.

 As for defecation postures, the majority of subjects adopted a forward leaning posture, which is consistent with a posture considered to morphologically facilitate defecation. This fact-finding survey investigated the postures that people naturally adopt to facilitate defecation and revealed that people adopt a logical posture.

 In this survey of healthy adults, 86% of subjects experienced “mild fatigue from defecation,” indicating that many subjects felt fatigued after defecating. However, results may differ in elderly people with diminished muscle strength required for defecation and in patients undergoing treatment for heart disease or cerebrovascular disease that restrict actions such as straining during defecation. We intend to continue investigating defecation behavior in such subjects.