Have you ever asked for the toilet and found yourself standing in front of a hole on the floor?
The first time I saw one of those was several years ago at a gas station in France. I was quite young and it really shocked me. What I saw was literally a hole on the floor. Nothing else. I remember thinking “This must be a joke. Come on, show me the real toilet now.” I couldn’t understand how someone could label a hole as a toilet and using it seemed to be as straightforward as surreal.
Fast forward some years, when I travelled to Vietnam, I found myself again in front of one of those weird toilets. At least, this one wasn’t just a mere hole, it had a surface to place your feet and it looked much nicer. Still, I couldn’t understand why on Earth would people squat down when going number two, greatly reducing the comfort of your bathroom visit. It’s so comfy to just sit on a toilet instead of having to squat down and keep your balance. Also, being so close to the toilet floor made me feel like the bathroom was huge and I was really really small.
All this toilet experiences stayed just as random and fun stories, until some weeks ago when I came across an article talking about squatting toilets. Apparently, this was a thing! So I decided to dive deeper into the world of the toilets and investigate a little bit more about our toilet routines. And what I discovered was kind of fascinating.
Why squatting toilets exist: A close look into our anatomy
To understand the existence of squatting toilets, we have to pay attention to how our bodies are designed and work.
You (and me and all human beings) have a large intestine, a long tube inside your belly, whose function is to absorb water from the food you eat and store and remove the remaining material (aka poop). The large intestine is made of 4 parts: the cecum (where water is absorbed), the colon (where poop is actually made), the rectum (where your poop is temporarily living) and the anus (where your poop meets the outer world).
The body relies on a very simple yet clever mechanism to know when it’s time for the poop to abandon the rectum and say hi. The rectum has a natural bend in it where it meets the anus, often referred to as the anorectal angle, which is what keeps us in ‘continence mode’. When it’s time for the poop to get out, the anorectal angle widens and so the poop can freely leave your body. And what makes the anorectal angle narrow or widen is a muscle called puborectalis.
This muscle is tensed when you’re standing or sitting, making your poop stay inside. This is helpful for when you’re sitting and don’t want to poop, but unhelpful for when you’re sitting and do want to poop. For your puborectalis muscle to fully relax, you have to be in a squat position. Squatting is the position that, by relaxing the puborectalis muscle, makes the anorectal angle to widen, the bend at the entrance of the rectum to unlock and the poop flow completely and freely to the bottom of the toilet.
Imagine your rectum as a garden hose. Now, imagine yourself grabbing the garden hose and elevating it, making it bend. That’s what the puborectalis does. The water could still flow through the hose, but the pressure should be higher and some water wouldn’t be able to pass through. Same happens when you’re sitting, waste can still be eliminated, but you need to strain and, most of the times, some waste remains there.
However, if you relax your arm, the bend of the hose would disappear and the hose would be in a straight position. The water would pass through with ease.
There’s still another reason why squatting was our choice back in the old days. When in a squat position, the weight of the torso presses against the thighs to naturally compress the colon, making defecation easier. Also, the gentle pressure from the diaphragm gives gravity a helping hand.
Modern-day flushing toilets have become a synonym of progress and hygiene, but probably the first inventors had little knowledge of human physiology. Our natural evolution hasn’t made allowances for our quest to become more civilized. So, whilst our toilets may be convenient and sanitary, they don’t promote the best way to empty our bowels. We can still do it (we’ve done it for years), but it’s not as complete and as easy as it should be.
As proctologist Michael Freilich famously told TIME magazine in 1978, “we were not meant to sit on toilets, we were meant to squat in the field.” And this is actually what we do instinctively when we’re children and when we’re in nature and don’t have a loo.
Squatting seems the way to go, but is it scientifically proved?
Experiments have been carried out on the differences between sitting and squatting. Israeli researcher Dov Sikirov studied 28 healthy volunteers who were asked to record how long their bowel motions took and how difficult their efforts were. The average time for passing a bowel motion during squatting was 51 seconds, compared to the average times for the lower and higher toilet seats: 114 and 130 seconds respectively. Participants found defaecation easier while squatting than when seated.
Another Japanese study looked at six volunteers who had their rectums filled with contrast solution and were asked to release the fluid from a sitting and squatting position. The researchers found the anorectal angle had greater widening in the squatting position. Participants also had less abdominal straining while squatting.
People who strain excessively are more prone to developing tears of the anal lining, known as a fissure. One study conducted in Pakistan looked at participants who had chronic anal fissures with symptoms such as painful defecation, passage of blood from the rectum and difficulty sitting. They were found to have significantly reduced symptoms compared to the sitting position.
Although squatting may be helpful for people with chronic constipation, it’s no panacea. Other factors, like the makeup of the stool – which your diet, activity level, and overall health influence –also determine how easy it is for you to go to the bathroom.
The benefits of squatting – and harms of sitting – are at times overstated. There’s no firm evidence to suggest, for instance, that squatting can prevent or cure haemorrhoids. There is also no firm data that the sitting position causes colonic diverticulosis (pouches in the wall of the colon), nor is there evidence to suggest that the sitting position leads to a greater risk of developing colon cancer.
While it’s difficult to draw definitive conclusions given the lack of long term-studies, squatting is biologically our natural position for a number two and seems to have some benefits. The main one is that makes elimination faster, easier, and more complete. Your average time on the toilet can be greatly reduced!
That being said, most of us still value comfort and luxury over the (relatively minor) health benefits. But we can have all! We don’t need to give up our toilets and make a hole on the floor to gain the benefits of squatting. A simple stool or box can do the trick.