By Jacqueline Crowell, PT, DPT
February, 2013

While I am proud to be an American I must question some of our cultural comforts including drive-thru’s, television, and toilets.  The first two likely make sense and we all have had to limit ourselves from spending too much time with either, but you may be wondering… why toilets?

Sitting styled toilets were designed in the 1800’s and have become commonplace in Western culture. What has also become increasingly popular in Western culture is colon disease and pelvic floor dysfunction.  Colon cancer is three times higher in developed countries as compared to non-developed countries. What are we missing?

One of the major differences between the developed and non-developed countries is that squatting is ubiquitous in non-developed countries; squatting to rest, squatting to prepare food, to eat, and to eliminate their bowels. Prior to the invention of the porcelain throne we too squatted.  In this age, we are lucky to squat to pick something up off the floor. We often get in our car to drive to our desk job where we spend most of the day in a chair and then drive home to sit at the dinner table and then move to the couch. We are missing out on a fundamental activity that our body was designed to do. Our digestive system is 20-40 feet long. How can we expect food to move through this system effectively if we sit all day? The pressure of the thighs on the belly in a deep squatting position efficiently moves food through the intestines and colon. Diet and exercise are also important to consider if slow motility is an issue.

If you’ve taken care of toddlers, you might have noticed the preferred pooping position for them is the deep squat. This is because the colon is able to straighten, allowing gravity to assist with elimination. The deep squatting position also stretches the puborectalis, a pelvic floor muscle. If one avoids squatting, the puborectalis can become tight, creating a kink in the rectum, causing constipation.

Hemorrhoids have been deemed a result of “Western lifestyle”.  If you’ve ever spent time overseas you may have also spent time over a squatting toilet or basic hole in the ground. Using a standard American toilet has been shown to cause increased straining with elimination and incomplete evacuation of the bowels. Incomplete evacuation leads to fecal stagnation meaning toxins to sit inside our body and in turn create diseases such as diverticulitis, appendicitis, and irritable bowel and Crohn’s disease. The very act of straining creates hemorrhoids, hernias, pelvic organ prolapse and a host of other pelvic floor dysfunctions.

If you are interested in changing your body mechanics with bowel movements there are a number of techniques you can try. Try using a stool to elevate your feet and lean forward to assist with hip flexion to add pressure to your abdomen. A full squat is best and can be done on top of a standard toilet. There are also full squatting tools available for purchase.

Squatting is also a very popular birthing position in many countries and considering gravity, it is common sense. Women who squat on a regular basis have no difficulty birthing in this position because they are accustomed to it. However, we who do not regularly squat find ourselves on our back in the delivery room making a hard job more difficult. In 2010, almost 33% of all births in the US were performed via cesarean section (http://www.cdc.gov/nchs/fastats/delivery.htm) while the World Health Organization states 5-15% is the appropriate range for cesarean sections. Squatting, as discussed above, helps to stretch the pelvic floor which is necessary to allow baby through the canal.

I often recommend squatting as an exercise for my pregnant patients. If you are unsure if squatting is an appropriate exercise for you, please seek assistance on the proper technique by a physical therapist or other exercise specialist. If you have any low back or hip pain or difficulty balancing I would recommend you be evaluated by a physical therapist or your doctor.

Jacqueline Crowell, PT, DPT graduated with a Doctorate in Physical Therapy from Armstrong Atlantic State University in Savannah, Georgia. She has been practicing at BreakThrough Physical Therapy in Sunnyvale, California since 2010 specializing in pregnancy, postpartum and pelvic floor dysfunction.

For more information about pain and dysfunction associated with pregnancy and post-partum changes, click here.

For more information about pelvic floor dysfunction please visit our Pelvic Floor Dysfunction page.

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