When you sit on a typical toilet, your puborectalis muscle, which is involved in bowel control, cannot fully relax
This is why you may need to push or even strain in order to have a bowel movement
While
squatting, the puborectalis muscle relaxes fully, making elimination
easier, which is why many experts believe squatting is the perfect
position to poop
By Dr. Mercola
If you live in the U.S., there’s a good chance you don’t put much
thought into the best position in which to poop. You simply sit down on
the toilet and let nature take its course. Except, for some people, this
process isn’t simple at all. Up to 27 percent of adults may be
chronically constipated,1 which can lead to other problems like anal fissures, rectal prolapse, fecal incontinence and urologic disorders.2
Meanwhile, so-called “pressure diseases,” such as hemorrhoids, varicose veins, diverticulitis and hiatal hernia
(in which part of your stomach pushes up through your diaphragm), which
may relate to straining excessively to have a bowel movement, are about
25 times more common in the U.S. than they are in rural Africa.3
What’s different? Many things, such as much of the African population
eating a traditional, nonprocessed and fiber-rich diet, and using a squatting position to poop.
This latter item may seem inconsequential, but it’s the way humans
have been pooping for hundreds of thousands of years. The flush toilet
wasn’t even invented until 1596 and didn’t become widely used until
1851.4
Prior
to this, elimination took place via chamber pots, outhouses or simply
outdoors, sometimes using holes in the ground. As the variety of latrine
changed, so, too, did the pooping position, and this swap of sitting
for squatting could be having negative consequences on human health.
The Problem With Sitting to Poop
Your puborectalis muscle is an important one, helping you to control
elimination during a bowel movement and prevent incontinence when you’re
standing. However, when you sit on a typical toilet, this muscle cannot
fully relax, which is why you may need to push or even strain in order
to have a bowel movement. While squatting, however, the muscle relaxes
fully, making elimination easier. Dr. Michael Greger explained via
Nutrition Facts:5
“For hundreds of thousands of years, everyone used the squatting
position, which may help by straightening the “anorectal angle.” There’s
actually a kink at almost a 90-degree angle right at the end of the
rectum that helps keep us from pooping our pants when we’re just out
walking around.
That angle only slightly straightens out in a common sitting
posture on the toilet. Maximal straightening out of this angle occurs in
a squatting posture, potentially permitting smoother defecation.”
That the anorectal angle straightens out via squatting is not a fact
based on hearsay. In 1966, researchers conducted a study involving latex
tubes filled with fluid that showed up on X-rays. Using volunteers, the
tubes were inserted and X-rayed as the participants moved in various
positions.6
In 2003, researchers conducted a study to compare how long it took
people to eliminate while using different positions: sitting on a
standard toilet, sitting on a lower toilet or squatting.
Compared to either sitting position, squatting significantly reduced
both the time needed for elimination as well as the self-reported amount
of straining necessary. “[S]ensation of satisfactory bowel emptying in
sitting defecation posture necessitates excessive expulsive effort
compared to the squatting posture,” the researchers concluded.7
Again in 2010, researchers examined the influence of body position on
defecation in humans. The study was small — only six participants — but
it also revealed that “the greater the hip flexion achieved by
squatting, the straighter the rectoanal canal will be and, accordingly,
less strain will be required for defecation.”8
Could Squatting Reduce the Risk of Certain Diseases?
If squatting makes it easier to eliminate and thereby reduces rates
of constipation, it could lead to significant benefits to overall
health. For instance, chronic pushing and painful stools may predispose
you to large hemorrhoids, which are irritating and painful.
Your colon was designed to hold a few pounds of stool, but when
constipated your colon may hold up to 10 pounds of dry, hard feces. Just
the sheer volume of stool can stretch your colon, irritate the lining
of the colon (mucosa) and produce toxins while waiting to be eliminated
from the body.
Chronic constipation can also lead to tearing of the anus, called an
anal fissure. These fissures are caused by trauma to the inner lining of
the anus, often before a large, dry stool.9 Chronic constipation can also affect the genital and urinary health of women.
Because the colon and female reproductive organs are structurally
close in the body, pressure from large amounts of stool in the colon can
lead to rectal prolapse in the vagina,10
and increase the potential that the bladder will not empty completely
or result in reflux of urine from the bladder back into the kidneys,
called vesicoureteral reflux.11
This reflux causes permanent kidney damage and increases the risk of
kidney infections. Pushing large, hard stool from the rectum can also
result in some of your intestines protruding from the anus, called
rectal prolapse. Chronic constipation is a recurring problem in 30
percent to 67 percent of patients who suffer from rectal prolapse.12
This requires surgery to repair. When people decide to postpone the
surgery, they risk stretching the anal sphincter even further and
increasing the amount of intestines that protrude from the body. Chronic
constipation has even been linked to rectal cancer, gastric cancer,
diverticulitis and ischemic colitis.13 Writing in the journal Lower Urinary Tract Symptoms, researchers further noted:14
“Historically, man has squatted in order to defecate. In Western
countries, the dissemination of the sitting toilet took place during the
19th century when sewage systems were developed to improve sanitation.
In contrast to Western countries, in Asian and African countries, their
dietary habits and use of a squatting posture might contribute to the
very low incidence of hemorrhoids, constipation and diverticulosis.
In addition, lower abdominal pressure on squatting defecation
might reduce the risk of defecation syncope, deep vein thrombosis and
stroke. Therefore, a new toiletry commode incorporating both Western and
Eastern approaches is anticipated.”
Do Potty Stools Work?
There are a number of stools on the market designed to help you squat while using a toilet. Do they work? Greger explained:15
“[T]hey don’t seem to work. Researchers tried adding a footstool
to decrease sitting height, but it didn’t seem to significantly affect
the time it took to empty one’s bowels or decrease the difficulty of
defecating. They tried even higher footstools, but people complained of
extreme discomfort using them. Nothing seemed to compare with actual
squatting, which may give the maximum advantage.”
If you live in the U.S., you can achieve this advantage by squatting
on top of your toilet, which does require strength, flexibility and
balance, especially if you’re not used to this method. Another option is
use of a simple footstool to help you get into a more “squatty”
position.
Greger also suggested leaning forward as you sit on the toilet, with
your hands on or near the floor. “[R]esearchers advise all sufferers
from constipation to adopt this forward-leaning position when
defecating, as the weight of our torso pressing against the thighs may
put an extra squeeze on our colons,” he said.16
Indeed, if your bowel habits are normal you may feel less inclined to
try a new pooping position, but you may be pleasantly surprised if you
do so. If you have trouble with bowel movements, especially
constipation, I urge you to give the squat position a try and get closer
to the ideal position even if you've been sitting for decades.
Having Trouble Eliminating? Address Your Lifestyle
Squatting can help you to eliminate if you’re constipated, but it
won’t address the reasons why you’re struggling with constipation in the
first place. And this is extremely important for optimal health. First
off, be sure you are well hydrated, drinking plenty of pure water daily.
The best way to determine how much water you need is to listen to
your body and let thirst be your guide. Water is important because as
the stool travels through your intestines your body removes water. If
you are well hydrated, less water may be removed, leaving the stool
softer and easier to pass.
The fiber
in your stool will help to draw more water and keep the stool soft.
This is why your doctor probably recommends increasing the amount of
fiber in your diet to help relieve constipation. However, be aware that
if you're eating a high-fiber diet
but not staying hydrated the stool will still get hard and be more
difficult to pass. A general recommendation is to make sure you get 20
to 30 grams of fiber per day, but I believe about 25 to 50 grams per
1,000 calories consumed is ideal.
Skip loading up on grains for their fiber content, choosing primarily
vegetables instead. Many whole foods, especially fruits and vegetables,
naturally contain both soluble and insoluble fiber, which serve as
excellent fodder for the microorganisms living in your gut.
Organic whole-husk psyllium is another great fiber source, as are sunflower sprouts and fermented vegetables,
the latter of which are essentially fiber preloaded with beneficial
bacteria. Regular exercise can also help reduce constipation.17
The movement helps increase the motility in your digestive tract and
can stimulate the urge to have a bowel movement. When you do feel the
urge, don't wait. The longer the stool sits in your colon, the more
water is removed and the more difficult it is to pass. Ignoring the urge
to go is also problematic because eventually you may stop feeling the
urge.
Certain medications, like antidepressants,
antacids (like calcium), blood pressure medications and iron
supplements, may also contribute to constipation, as can certain medical
conditions (Parkinson’s disease, hypothyroidism, diabetes and more), so be sure to rule out these other contributing factors.
What Does a Healthy Stool Look Like, and How Often Should You Poop?
If you’re constipated, the bloated feeling and need to strain to have
bowel movements will probably tip you off. However, you can also look
at the shape and texture of your stool for clues. Separate, hard lumps
that are difficult to pass are indicative of constipation. In fact, if
you need to push or strain, something is off, as moving your bowels
should take no more effort than urinating or passing gas.
Many people get caught up in believing they should be having a
certain number of bowel movements, but the ease of elimination is more
important than the frequency.
If you move your bowels every other
day, but the elimination is easy, you’re within a normal range, more so
than someone who moves their bowels more often but has to strain to do
so. What’s important is what’s regular for you; in general, three bowel
movements per day to three per week is considered the normal range.
As for appearance, healthy stool should be smooth and soft, formed
into one long shape and not a bunch of pieces. The Bristol Stool Chart
is a handy tool to help you learn what healthy stool looks like. Your
stool should approximate types 3, 4 and 5, but type 4 is considered
ideal.18
If you’ve addressed your lifestyle and are still straining or having
trouble eliminating, it’s time to adjust your position and adopt a
squatting position instead of sitting.
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