Formation of proper toilet skills as a key element of prevention and therapy of functional constipation: from the physiology of bowel movements to practical solutions: A review

The article is devoted to a comprehensive approach to the analysis of functional constipation through the prism of the formation of physiologically correct toilet skills, a factor that is often underestimated by clinicians, but largely determines both the occurrence of the problem and the long-term result of its treatment. The first part of the review describes in detail the anatomical and physiological foundations of the act of defecation, including neuro-reflex mechanisms, pelvic floor muscle coordination, and the role of intra-abdominal pressure. Next, the pathogenesis of chronic functional constipation and dyssynergic defecation is considered, and their connection with behavioral disorders is emphasized: omission of urges, "postponement" of emptying, inadequate posture and psychological discomfort. The central place is given to the strategy of purposeful education of proper toilet skills in children and adults: choosing a fixed time, using a physiological position (footrest), limiting distracting elements and creating a calm atmosphere. Thus, a rational combination of knowledge about the anatomy and physiology of the act of defecation, early recognition of functional disorders, timely application of a set of preventive and therapeutic measures aimed at the formation of proper toilet skills can achieve positive results in solving this issue and improve the quality of life of patients.