By Dr. Mercola
Is the Western toilet in part responsible for problems like hemorrhoids, constipation, IBD (Inflammatory Bowel Disease), appendicitis, and even heart attacks? If you examine the data, there is a great deal of evidence this is true. The modern toilet has required us to change the position we use to evacuate our bowels, which changes the anatomy of… well, a poop, to put it bluntly. Infants instinctively squat to defecate, as does the majority of the world's population. But somehow the West was convinced that sitting is more civilized. Sitting on the modern Thomas Crapper-style sit-down toilet is designed to place your knees at a 90-degree angle to your abdomen. However, the time-honored natural squat position places the knees much closer to your torso, and this position actually changes the spacial relationships of your intestinal organs and musculature, optimizing the forces involved in defecation.1 Sitting to evacuate your bowel requires you to apply additional force (straining), which has some unwanted biological effects, including a temporary disruption in cardiac flow.
Can the Toilet Be Blamed for Increasing Rates of Colon and Pelvic Disease?
Squatting is the way our ancestors performed their bodily functions until the middle of the 19th Century. Chair-like toilets were reserved for the royals and the disabled. But the "progress" of westernized societies may be partly to blame for higher rates of colon and pelvic disease, as described by a report in the Israel Journal of Medical Science:2 "The prevalences of bowel diseases (hemorrhoids, appendicitis, polyps, ulcerative colitis, irritable bowel syndrome, diverticular disease, and colon cancer) are similar in South African whites and in populations of prosperous western countries. Among rural South African blacks with a traditional life style, these diseases are very uncommon or almost unknown." As globalization continues to make its way across the world, squat toilets are being converted to sitters. For example, Thailand's Health Ministry just announced it will replace squat toilets with the sit-down varieties at all public facilities.3 This may be a bad thing for public health, as a wide range of health problems have been associated with the transition from squatting to sitting. In fact, health problems potentially stemming from the sitting position include the 15 outlined in the following table.
Contamination of the Small Intestine
Gynecological Disorders, including Pelvic Organ Prolapse and Uterine Fibroids
Hiatal Hernia and GERD
Pregnancy and Childbirth
Reduced Risk of Cardiac Events
The Straight Poop
Evidence suggests bowel and pelvic problems may be related to improper potty posture. Only with the traditional squat position is your body aligned in a way that promotes complete bowel emptying. As you can see from the diagram, squatting actually straightens and relaxes your rectum.
According to Jonathan Isbit of Nature's Platform: "For safety, nature has deliberately created obstacles to evacuation that can only be removed by squatting. In any other position, the colon defaults to 'continence mode.' This is why the conventional sitting position deprives the colon of support from the thighs and leaves the rectum choked by the puborectalis muscle.These obstacles make elimination difficult and incomplete – like trying to drive a car without releasing the parking brake. Chronically incomplete evacuation, combined with the constant extraction of water, causes wastes to adhere to the colon wall. The passageway becomes increasingly constricted and the cells start to suffocate. Prolonged exposure to toxins will often trigger malignant mutations." He goes on to explain how the kink where your sigmoid joins your rectum (refer to the colon diagram above) serves an important function in continence. It "applies the brakes" to the flow of peristalsis, reducing the pressure on your puborectalis muscle. According to Isbit's article, squatting offers seven advantages:
Makes elimination faster, easier and more complete. This helps prevent "fecal stagnation," a prime factor in colon cancer, appendicitis and IBD
Protects the nerves that control the prostate, bladder and uterus from becoming stretched and damaged
Securely seals the ileocecal valve, between the colon and the small intestine; in the conventional sitting position, this valve is unsupported and often leaks during evacuation, contaminating the small intestine
Relaxes the puborectalis muscle which normally chokes the rectum in order to maintain continence
Uses the thighs to support the colon and prevent straining. Chronic straining on the toilet can cause hernias, diverticulosis, and pelvic organ prolapse
A highly effective, non-invasive treatment for hemorrhoids, as shown by published clinical research
For pregnant women, squatting avoids pressure on the uterus when using the toilet; daily squatting helps prepare pregnant women for a more natural delivery
Two common problems are hemorrhoids and constipation. Unfortunately, many people needlessly suffer because they are too embarrassed to broach the topic with their healthcare providers. Fortunately, these all-too-common problems can be resolved with similar strategies because they share the same causative factors, including the typical Western diet, inadequate exercise, chronic dehydration, and stress. Surveys suggest that, in westernized countries, as much as half the population over age 40 may suffer from hemorrhoids. Hemorrhoids are veins in the wall of your rectum and anus that have become twisted, swollen and inflamed. They can form either internally or externally, and the resulting lumps can cause pain and bleeding. Hemorrhoids are most often created by an increase in pressure, usually from straining to have a bowel movement. Hemorrhoids are common in people with chronic digestive disturbances – especially constipation. They are also seen in the elderly, and during pregnancy. If you're pregnant, the additional pressure your growing baby places on your uterus can result in hemorrhoids. Childbirth can increase the problem, but fortunately, most hemorrhoids caused by pregnancy resolve after delivery. There is research casting doubt on the theory that hemorrhoids are caused by insufficient dietary fiber, but instead by other factors such as the loss of the "ancestral diet," and the straining associated with defecating from a sitting position.4 Dr. Berko Sikirov, an Israeli physician who studied the health effects of squatting for elimination, found that hemorrhoids were virtually eliminated when hemorrhoid sufferers switched their toileting position from sitting to squatting.5 Sikirov concluded hemorrhoids result from continual aggravation and injury from excessive straining by defecating in the sitting position. Straining is necessary to overcome the constriction in the rectum designed to maintain continence. To prevent hemorrhoids, you should also stay hydrated with adequate water daily, seek to control your emotional stress, and get plenty of exercise. Make sure your diet includes plenty of probiotics, such as those present in traditionally fermented foods like sauerkraut and other fermented vegetables, which are important for maintaining optimal intestinal flora. For a complete discussion of hemorrhoid prevention and treatment, refer to my earlier article on this topic. Occasionally a deficiency of bioflavonoids allow blood vessels to break easier and if this is the case a supplement called rutin is particularly helpful at correcting. If you bruise easily this is a strong suggestion that you would benefit from taking rutin.
Natural Constipation Relief Strategies
Constipation and hemorrhoids are two sides of the same coin. Your risk for hemorrhoids increases greatly if you have recurring episodes of constipation. One of the biggest hindrances to your success may be not realizing you're constipated in the first place. Regular bowel movements are extremely important for your health because, without them, toxins accumulate and are recirculated in your bloodstream. If elimination is not regular and complete, the wastes will dry and become cemented to the walls of your colon. Constipation has been shown to increase your risk of colon cancer and has been implicated in diverticulosis and appendicitis. The cumulative lifetime use of commercial laxatives has been associated with increased risk of colon cancer.6 Conventional medicine typically defines constipation as fewer than two or three bowel movements a week. But you should really be having one bowel movement a day, and preferably two or three. So if you are having less than one bowel movement per day, you should take steps to increase them. Some of the common causes of constipation include laxative abuse, hypothyroidism, IBD, and ignoring the urge to go. If you consistently ignore the urge to have a bowel movement – for instance, to avoid using a public toilet – eventually you may stop feeling the urge. Laxatives are NOT a good option as your body may become dependent on them. Laxatives may decrease your colon's ability to contract and can even eventually damage your large intestine's nerves, muscles, and other tissues. This applies to both pharmaceutical laxatives, as well as herbs like cascara. Fortunately, although constipation is very common, it is also usually temporary and relatively easy to resolve – without resorting to laxatives. Squatting is one of the best interventions, preventing constipation in four ways:
- Gravity does most of the work. The weight of the torso presses against the thighs and naturally compresses the colon. Gentle pressure from the diaphragm supplements the force of gravity.
- The ileocecal valve, between the colon and the small intestine, is properly sealed, allowing the colon to be fully pressurized. The pressure creates a natural laxative effect. In the sitting position the IC valve is unsupported and tends to leak, making it difficult to generate the required pressure.
- Squatting relaxes the puborectalis muscle, which normally chokes the rectum to maintain continence.
- Squatting lifts the sigmoid colon to unlock the "kink" at the entrance to the rectum. This kink also helps prevent incontinence, by taking some of the pressure off the puborectalis muscle.
Preventing and treating constipation is very similar to preventing and treating hemorrhoids. Pay attention to your diet, exercise, hydration and stress level. Consume probiotic-rich foods and possibly add a probiotic supplement.
Chia and organic psyllium are excellent sources of soluble and insoluble fiber, aloe vera and magnesium supplements can also be useful tools to speed up your bowel movements.
For a complete discussion of constipation prevention and treatment, refer to my earlier article on this topic.
Are You Ready to Assume the Position?
The scientific benefits of squatting have sparked efforts to design devices that help would-be squatters to return to a more natural pooping position. However, if you've been using a sit-down toilet your entire life and haven't squatted since childhood, squatting may present somewhat of a physical challenge – to say the least! Various devices have appeared in the marketplace to assist with this problem, such as the Squatty Potty, developed by Robert Edwards, a 37 year-old contractor and designer in Utah who sought a way to help his mother relieve her problems with constipation and hemorrhoids.7 You may wish to check out some of these contraptions on the Internet.8 Squatting involves strength and flexibility that adults tend to lose over time, but children have naturally. These devices – special toilets and stools that get your body into a more "squatty" position – may help you get closer to the ideal. Another advantage of squatting? Killer thighs. Nothing builds your thighs like a squat. Adding some squats at the gym will undoubtedly help you with your squats in the bathroom!