Physiological Optimization of Digital Self-Disimpaction Using a Step Stool: A Case Report

Digital disimpaction, which is often required for cases of severe fecal impaction, carries significant risks of mucosal injury and vasovagal reflex. Evidence-based guidance for safe home-care disimpaction is limited. Moreover, detailed physiological self-assessments of medically trained individuals during such events have seldom been reported. Herein, we report a rare case of self-disimpaction performed by a gastroenterological surgeon, providing a detailed clinical analysis of the physiological mechanisms involved. A 49-year-old male gastroenterologist presented with recurrent distal fecal impaction associated with occupational constipation. Previous evacuation attempts in a sitting posture required excessive strain and triggered severe presyncopal symptoms (bradycardia and diaphoresis). In the current episode, initial sitting attempts reproduced these vagal prodromes. Deep hip flexion was achieved using a toddler's step stool (height: approximately 20 cm) to simulate a squatting posture. This positional change immediately relieved mechanical obstruction and autonomic symptoms. By maintaining rigorous surgical nail hygiene, the patient successfully fragmented and evacuated the stool without hemorrhage or mucosal trauma. Footstool-assisted squatting induces puborectalis muscle relaxation and straightens the anorectal angle. This biomechanical realignment reduces outlet resistance and minimizes the requirement for forceful straining, thereby preventing hemodynamic collapse secondary to vagal stimulation. Simulating physiological squatting posture and ensuring strict nail hygiene may be practical strategies for mitigating hemodynamic instability and mechanical injury during digital disimpaction. Importantly, these findings were derived from a single healthy adult. Thus, this technique cannot be generalized to high-risk populations (e.g., the elderly or those with cardiac disease) without professional medical supervision.