Here’s your don’t-read-while-eating warning: this is an article about bowel movements. We’re all grown-ups here, so we can talk about it like grown-ups without cutesy euphemisms – but if you’re eating lunch, maybe come back and talk about it like a grown-up at some other point.
Almost all of us have been constipated at one point or another, and a surprising number of people today have chronic, recurring constipation. If you take an evolutionary perspective and start thinking about what in the modern world specifically might be causing such incredible rates of constipation, there are a bunch of potential causes:
- Low-fiber diets: fiber increases stool bulk, so diets low in fiber can cause constipation. Some types of fiber also make stool more slippery. At least in some areas of the world, Paleolithic humans used to eat a lot more fibrous plant foods than we do now (although it’s always worth noting that not everyone responds well to fiber and that the Inuit and some other groups ate very few fibrous plant foods). Read more about fiber here.
- High blood sugar: high blood sugar can actually cause damage to the intestines that makes it harder to pass feces. Today, the combo of sedentary lifestyles + high-sugar diets is a recipe for constantly high blood sugar. You can read more about this here.
But there’s also another factor: toilet posture. Back in the Paleo days, there was no indoor plumbing and there weren’t any “toilets” in the modern sense. Paleolithic humans probably did what people in hunter-gatherer groups and parts of Asia still do: squat.
The squatting posture actually has significant benefits for passing stool easily and painlessly. And in fact, you don’t actually have to squat to get those benefits – there are ways to do it on a regular toilet without any special equipment. So if you’re eating lots of fiber and your blood sugar is fine, but you’re still having constipation issues, take a look!
The Benefits of Squatting to Defecate
Basically, the benefit of squatting is that it changes the position of your colon and gives feces more of a “straight shot” down into the toilet bowl, so you have to strain less to push them out.
If you squat all the way down, you’ll notice that your lower back naturally flattens a bit (it shouldn’t curve outward, but the inward curve gets less pronounced). This is an outer sign of the way the angle of your whole torso is changing – and so is everything inside your torso, including your colon.
One study compared three different toilet seats: a standard seat (16 inches off the ground), a low seat (12 inches), and a squat toilet. The subjects reported on how long it took them to achieve “a sensation of satisfactory emptying” and also “their subjective impression of the intensity of the defecation effort.” Compared to both sitting positions, squatting helped the subjects have bowel movements more quickly and with less effort. The researchers concluded that
“the present study confirmed that sensation of satisfactory bowel emptying in sitting defecation posture necessitates excessive expulsive effort compared to the squatting posture.”
“Excessive expulsive effort” – which might contribute the hemorrhoids for the poor person straining away on the toilet, not to mention an unpleasant daily routine.
Evidence from Yoga
Evidence from traditional yoga poses also supports the idea that the angle of the back, torso, and hip can make it easier to pass stool. For example, take the “wind-relieving pose,” which is supposed to help people pass gas. To do it, you hug one knee at a time to your chest, and then do the same with both knees while lying on the floor, basically creating the same torso/leg angle that you have in a squat.
Squatting to have a bowel movement is just re-creating the wind-relieving pose on the toilet.
How to Squat on a Modern Toilet
The benefits of squatting all very nice from a theoretical perspective, but most of us can’t just go ripping out our bathroom furniture and replacing it with squat toilets. But you don’t have to – you can “squat” in all the ways that count without anything special.
For toilet purposes, the point of a squat is just to have your feet roughly level with your buttocks, so you get the correct back/hip/torso angle. It doesn’t matter at all how your weight is being supported. You don’t have to put your weight on your feet the way you do when you squat. You just have to elevate your feet.
You can do this by just putting any random thing in front of the toilet and putting your feet up on it. There’s a company that makes special footrests but there’s no need to spend money on that. A laundry basket is a good height for most people; you could also use a children’s stool, a milk crate, or anything else.
But what if you’re not flexible enough to make that work? Luckily, there’s a workaround!
The Benefits of Squatting, Without the Squatting
This study started with the idea that squatting might be too much for some people – not everyone can actually hold a full squat, much less comfortably enough to defecate while they’re doing it. So the researchers looked at an intermediate position between sitting and squatting. They called it the “Thinker” position, after the famous statue.
When you sit on a toilet normally, your back is straight up and down. For the “Thinker” posture, researchers had subjects put their elbows on their knees, lean forward, and look down at the ground.
The study gave all the subjects a faux-poop to try to defecate – basically the researchers mixed various ingredients into the consistency of feces and inserted them into the patients’ anuses. The advantage of this is that the researchers could also mix in a material that they could see on an X-ray, so they could take X-rays while defecation was in progress and see what was going on.
The patients first tried to defecate in a normal upright sitting position: 22 of them couldn’t do it. But after they switched to the “Thinker” position, 15 of those 22 patients defecated without a problem. That’s about 68% of people whose constipation was cured just by leaning forward on the toilet.
The people sitting in the “Thinker” position had a better angle between the anus and the rectum for easier defecation, and various other postural changes that amounted to an easier time passing the artificial stool. It’s the same “straight shot” benefit that you’d get from squatting, but without actually having to squat.
Summing it Up
Constipation is a symptom with all kinds of potential causes – there’s no guarantee that any one particular person is constipated because of the posture they use on the toilet. But there’s enough evidence at this point to show that toilet posture might help make bowel movements faster, smoother, and easier, with less straining or discomfort.
It’s definitely “more Paleo” than sitting on a toilet in the traditional posture, and it’s worth a shot if you’re eating all the right things but still constipated.