Cultural bowel patterns and sex difference in sigmoid volvulus morbidity in an Ethiopian hospital

A qualitative anthropological study in Gondar region, northwestern Ethiopia, revealed a very striking difference in cultural patterns of defecation in the two sexes which coincided with a high male/female ratio (16.5:1) of sigmoid volvulus morbidity in the regional hospital. Adult males show very irregular bowel behaviour, with bowel motions varying from zero to four per day. Irregular bowel behaviour in males, combined with the population's consumption of high fibre diets producing flatus and bulky stools, appears to overload the sigmoid colon, which elongates and dilates gradually, and subsequently undergoes volvulus occasionally. In women, on the other hand, the custom of limiting defecation to dawn and dusk is strictly adhered to and this regularity of bowel movements seems to protect them from overloading of the sigmoid colon and its consequences, despite their consumption of similar diets. In conclusion, it is believed that the high male/female ratio in sigmoid volvulus morbidity in Gondar region appears to be connected to gender specific patterns of defecation.