Seat toilets are considered the norm in Western nations but it has now become apparent that the sitting position to pass stool may not be ideal. In contrast the squatting toilets predominantly seen in Eastern nations may offer an advantage for position of the lower parts of the bowels that allows for stool to pass out more easily. While this may not be a problem or concern for every person, it can be a helpful lifestyle change for people who are constipated.
Passage of Stool
Stool fills up in the rectum from the lower portions of colon (descending and sigmoid colon). The rectum is just a temporary holding area for stool. As it fills up the rectal walls stretch and this sends nerve signals that we experience as the urge to defecate. These signals also relax one of the two anal sphincters known as the internal anal sphincter which is under involuntary control. However, stool will not pass out immediately.
In order to defecate a person has to voluntarily relax the external anal sphincter. We usually do this once we find an appropriate setting, like a toilet, where we can pass stool comfortably. Upon sitting and relaxing the external sphincter, stool will pass out of the rectum, down the anal canal and out through the anus into the environment. Some degree of ‘pushing’ is needed and people who are constipated may have to strain significantly.
Sitting or Squatting for Bowel Movement
The question about whether it is better to sit or squat to pass stool has been ongoing for a long period of time. While sitting offers a degree of convenience and is now accepted as the norm in the West, it has been found that it is not the best position for defecating. It is now accepted that squatting is a better option for a number of physiologic and anatomic reasons. However, changing over to squatting may not be necessary for every person.
Why is squatting better?
In order or to understand why squatting is better it is important to understand some of the anatomy behind defecating. For stool to pass out easily, it is logical that the passage through which stool moves needs to be as ‘straight’ as possible in order to be expelled with ease. This curvature is known as the anorectal angle and refers to the ‘bend’ formed between the rectum and anal canal.
When sitting this passage becomes kinked primarily by the muscles that support the rectum. The kinking of the rectum makes it more curved or folded and stool cannot pass through as easily. With squatting the angle changes thereby making the passage more straight. Stool can move through with less difficulty. Squatting can thefeore be highly beneficial for people with constipation and other stool or lower bowel problems.
Is squatting the natural position?
There is still some debate as to what is the normal or abnormal position for defecating. Without the ease of a seat toilet, a person would squat to pass stool. It is a natural or instictive position that we all assume without the convenience of a toilet. Apart from being more comfortable when there is no seat available, we are also instinctually aware that the squatting position will facilitate easier bowel movements.
It is therefore understandable why the squat toilet is also referred to as a natural position toilet. However, most of us are not accustomed to this position after a lifetime of having defecated while seated. Therefore there may be some initial difficulty in adapting to a squatting position. This uncertainty and anxiety over changing positions can sometimes hinder a good bowel movement. With time and practice most people can adapt back to this natural position and experience the benefits of squatting to pass stool.
Tips for Poop Positions
Squatting without any seat may be ideal but most Westerners do not have a squatting toilet and passing stool outdoors may not always be appropriate. Fortunately a typical seat toilet can still be used. There are now commercially available platforms (steps or stools) that allows for a person to squat over a seat toilet. These platforms changes the posture and can elevate a person above the toilet seat. It allows a person to assume the squatting position while having a bowel movement discreetly within familiar surroundings.
It is important to note that these squatting platforms raise the thighs close to the abdomen and do not require the buttocks to be suspended in the air. The squatting position for a bowel movement is not a ‘cure all’ for constipation. While it is beneficial, it should not be the only measure that is taken to facilitate easier bowel movements. A combination of dietary and lifestyle measures is equally important. High fiber intake, increased water consumption and regular exercise should be the cornerstone of constipation management alongside squatting to pass stool.
The following tips are equally important when considering the squatting position for bowel movements:
- Always purchase a good quality squatting platform that can bear your body weight. Should the step break while being used, it can lead to falls and injuries.
- Install hand rails near the toilet to provide support and stability while squatting. This is very important for seniors in particular.
- Practice squatting daily to help build up the necessary muscles to hold the squatting position comfortably during a bowel movement. It can also help to prevent cramps.
- Ensure the toilet floor is dry and not slippery before positioning the step. While good quality devices will have anti-slip bases, a very slippery floor can lead to accidents while squatting.
- Do not try to keep the buttocks suspended high in the air when squatting if you do not have the physical dexterity. This can lead to instability and increase the risk of falls.
Always speak to a medical professional before using a squatting platform for correct advice on how to use these simple devices. Do not attempt to squat by placing the feet on a the seat of a traditional seating toilet. This can be dangerous for people who are not sturdy and may lead to falls and injuries.