Going to the bathroom should be one of the easiest things in the world. For many people, however, this isn’t the case, and they have forces working against their pursuit of success in the bathroom. Some people have intestinal ailments like Crohn’s disease or IBS that complicate the situation. Other folks don’t consume enough dietary fiber or water.  Many people take medications that cause constipation. However, far and away, one of the most common causes of unsatisfactory bowel movements, especially in the Western world, is improper positioning while defecating.
Squatting: The Best Position
Although the modern toilet seat encourages a seated position, for defecating, squatting is better than sitting.  The reason for this, mostly, is simply mechanics — or the internal angle in which the rectum is positioned. Huh?
Let’s break it down some. Your midsection includes muscles, bowels, ligaments, intestines, and the like — it’s essentially an interconnected system of tubes and trails. Imagine your rectum as a garden hose. When you’re seated, it’s at an angle with a kink in it — it’s not completely blocked but it’s not going to operate at best capacity either. However, when you’re squatted, the muscles in and around the area help reduce the kink and position your rectum in a “straight-through” position that’s free of obstruction, this promotes smooth bowel elimination. Additionally, it prevents unnecessary straining and the problems that accompany. 
Squatting Just Works Better
The argument for squatting isn’t just logical, it’s been evaluated in clinical research. A few years back there was a study consisting of 28 healthy volunteers who compared sitting versus squatting during defecation. The results weren’t much surprise — squatting required almost no straining, sitting required excessive straining and effort. 
The argument for squatting has a more serious edge to it as well…
Squatting Might Help You Avoid a Cardiac Episode
Nobody wants to think about the possibility of having a medical emergency while seated on the toilet, but it happens. In fact, it’s not uncommon at all for cardiovascular problems to happen during defecation. Think about it, if someone is seated and straining excessively, that stresses their cardiovascular system. The stress isn’t negligible, either. Sitting is at least three times more straining that squatting.  Although most healthy people can tolerate the stress, persons whose cardiovascular system is less than healthy may experience problems as minor as fainting or as serious as death. While squatting won’t rejuvenate a problematic cardiovascular system, it is associated with reduced straining and may help you avoid a “situation.” 
Squatting and Urination
It’s been well established that squatting is the best position for defecation, but what about urination? There have been a few studies organized to answer that question as well, albeit for different reasons. In 2010, Chinese researchers recruited female university students to evaluate squatting against sitting. The positions were found to be mostly similar in terms of urinary flow and satisfaction. The topic of preference, however, produced the most profound difference. The vast majority of women, nearly 90%, preferred a non-sitting posture when… you guessed it, using a public toilet. 
The Shortcomings of Squatting
Despite the many advantages of squatting, it does have small limitations. First off, some studies have shown that squatting produces a small rise in blood pressure and it’s been suggested that people with hypertension or higher risk of stroke should avoid it. 
Secondly, apparently squatting while defecating does absolutely nothing for varicose veins… although would anyone expect it to? Not exactly, but let me explain. Back in the late 1970’s, a study took place in Tanzania in which an entire village was evaluated for varicose veins. At the time, the Tanzanian diet had come to include more refined carbohydrates and less fiber; the purpose of the research was to determine if a low-fiber diet contributed to the incidence of varicose veins. While researchers concluded that the dietary differences could increase the likelihood of developing varicose veins, they also discovered that squatting, which was common practice in Tanzania, offered no protection against varicose veins — even when it was a life-long habit.  So, if you’re looking for squatting to save you from varicose veins, you may be disappointed.
Lastly… and this probably goes without saying, there is another time when squatting is not ideal — during a rectal examination. This isn’t just one man’s opinion either, this has been studied. In mid-2011, a survey was conducted in which Brazilian urologists were asked which position they prefer a patient be in prior to receiving a rectal examination. Not only was squatting the least desired by urologists, patients didn’t like it either.  No surprise?
The Best Way to Squat
If you’ve traveled internationally, you may have noticed that not every culture in the world uses toilets similar to those in America. Some resemble a trench and encourage squatting. In some areas of the world, a literal trench in the ground IS the toilet, and squatting is simply how it’s done. Westerners who wish to adopt the squat without remodeling their bathroom may be enabled with a device such as the Squatty Potty which elevates one’s feet off the ground and allows them to experience a squat with their regular toilet.
Have you taken to squatting? If you have some words to share on the subject, please leave a comment below!
-Dr. Edward F. Group III, DC, ND, DACBN, DABFM
- Osman AA. Etiology of venous disorders. Int Surg. 1975 Oct;60(10):540-3.
- Jian LV. Re-recognizing the pathogenesis of inguinal hernias. Med Hypotheses. 2011 Mar;76(3):403-6. doi: 10.1016/j.mehy.2010.11.003. Epub 2010 Nov 26.
- Sikirov BA. Primary constipation: an underlying mechanism. Med Hypotheses. 1989 Feb;28(2):71-3.
- Sikirov D. Comparison of straining during defecation in three positions: results and implications for human health. Dig Dis Sci. 2003 Jul;48(7):1201-5.
- Sikirov BA. Etiology and pathogenesis of diverticulosis coli: a new approach. Med Hypotheses. 1988 May;26(1):17-20.
- Sikirov BA. Cardio-vascular events at defecation: are they unavoidable? Med Hypotheses. 1990 Jul;32(3):231-3.
- Yang KN, Chen SC, Chen SY, Chang CH, Wu HC, Chou EC. Female voiding postures and their effects on micturition. Int Urogynecol J. 2010 Nov;21(11):1371-6. doi: 10.1007/s00192-010-1204-3. Epub 2010 Jul 1.
- Chakrabarti SD, Ganguly R, Chatterjee SK, Chakravarty A. Squatting, blood pressure and stroke. J Assoc Physicians India. 2002 Mar;50:382-6.
- Richardson JB, Dixon M. Varicose veins in tropical Africa. Lancet. 1977 Apr 9;1(8015):791-2.
- Romero FR, Romero AW, Tambara Filho R, Brenny Filho T, de Oliveira Júnior FC. Patient positioning during digital rectal examination of the prostate: preferences, tolerability, and results. Int Braz J Urol. 2011 May-Jun;37(3):371-7; discussion 377-9.