This explains why defecation is frequently accompanied by urination and why urination is frequently accompanied by flatulence Defecation may be involuntary or under voluntary control Young children learn voluntary control through the process of toilet training Once this has been achieved loss of control causing fecal incontinence may be caused by physical injury such as damage to the anal sphincter that may result from an episiotomy intense fright excessive pressure placed upon the abdomen inflammatory bowel disease impaired water absorption in the colon see diarrhea and psychological or neurological factors The loss of voluntary control of defecation is experienced frequently by those undergoing a terminal illness Joanne Lynn MD Merck October 2007 Symptoms During a Fatal Illness Uploaded 3 1 09 Posture aspects The positions and modalities of defecation are culture dependent The natural and instinctive method used by all primates including humans for defecation is the squatting position Squat toilets sometimes referred to as natural position toilets are still used by the vast majority of the world including most of Africa Asia and the Middle East Kira A The Bathroom Harmondsworth Penguin 1976 revised edition pp 115 116 The widespread use of seated position toilets in the Western World is a recent development beginning in the 19th century with the advent of indoor plumbing A History of Technology Vol IV The Industrial Revolution 1750 1850 C Singer E Holmyard A Hall T Williams eds Oxford Clarendon Press pps 507 508 1958 Bockus Gastroenterology the standard textbook on the subject states The ideal posture for defecation is the squatting position with the thighs flexed upon the abdomen In this way the capacity of the abdominal cavity is greatly diminished and intra abdominal pressure increased thus encouraging expulsion Bockus Gastroenterology p 754 2nd ed Saunders Philadelphia and London 1964 Other considerations The anus and buttocks may be cleansed with toilet paper similar paper products or other absorbent material In some cultures water is used e g as with a bidet or Lota vessel either in addition or exclusively In Japan and South Korea some toilets known as washlets are designed to wash and dry the anus of the user after defecation see anal cleansing References Deeb Benjamin 2004 Healthy to the Core How to Measure Effective Defecation Greenwood Press Widmaier Raff Strang 2006 Vanders Human Physiology the mechanisms of body function Chapter 15 McGraw Hill Category Digestive system Category Medical signs Category Proctology bs Defekacija br Kac hat bg cs Vyprazd ov n stolice de Stuhlgang es Defecaci n fa fr D f cation gl Defecaci n i d Buang air besar it Defecazione lt Tu tinimasis nl Defecatie ja no Defekasjon pl Defekacja medycyna pt Defeca o ru simple Defecation sk Defek cia ta vi i ti n zh