Humans use one of two types of defecation postures to

defecate Defecation (or defaecation) follows digestion, and is a necessary process by which organisms eliminate a solid, semisolid, or liquid waste material known as feces from the digestive tract via the anus. The act has a variety of names ranging fro ...

: squatting and

sitting Sitting is a List of human positions, basic action and resting position in which the body weight is supported primarily by the bony ischial tuberosities with the buttocks in contact with the ground or a horizontal surface such as a chair seat, in ...

. People use the squatting postures when using

squat toilet A squat toilet (or squatting toilet) is a toilet used by squatting, rather than sitting. This means that the defecation posture used is to place one foot on each side of the toilet drain or hole and to squat over it. There are several types of s ...

s or when defecating in the open in the absence of toilets. The sitting posture on the other hand is used in

toilet A toilet is a piece of sanitary hardware that collects human urine and feces, and sometimes toilet paper, usually for disposal. Flush toilets use water, while dry or non-flush toilets do not. They can be designed for a sitting position popu ...

s that have a pedestal or "throne", where users generally lean forward or sit at 90 degrees to a toilet seat. In general, the preferred posture is largely a cultural decision. People adapt their defecation posture to the toilet type available to them, e.g. while travelling or if moving to another country.

Sitting

The sitting defecation posture involves sitting with hips and knees at approximately right angles, as on a chair. So-called "Western-style"

flush toilet A flush toilet (also known as a flushing toilet, water closet (WC) – see also toilet names) is a toilet that disposes of human waste (principally urine and feces) by using the force of water to ''flush'' it through a drainpipe to another loca ...

s and also many types of

dry toilet A dry toilet (or non-flush toilet, no flush toilet or toilet without a flush) is a toilet which, unlike a flush toilet, does not use flush water. Dry toilets do not use water to move excreta along or block odors. They do not produce sewage, and a ...

s are designed to be used in a

posture. In Europe, America and other western countries most people are accustomed to sitting toilets, although this fashion has only been present for around 100 years. Sitting toilets only came into widespread use in Europe in the nineteenth century. Sitting toilets requires users to strain in an unnatural position. In the sitting position, the

puborectalis muscle The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of the ...

chokes the rectum, and the anorectal angle is unfavorable, at almost 90 degrees. This may lead to constipation symptoms such as incomplete evacuation of stool, irregular bowel movements, hard stools and the need for excessive straining. Compared to the more natural squatting position, western-style toilets may lead to health issues such as inflamed hemorrhoids. Special devices exist in the form of "wrap-around foot stools" to allow users of western-style toilets to defecate in a posture that is somewhat similar to squatting.

Squatting

The squatting defecation posture involves squatting, or crouching. It requires standing with knees and hips sharply bent and the buttocks close to the ground.

Squat toilet A squat toilet (or squatting toilet) is a toilet used by squatting, rather than sitting. This means that the defecation posture used is to place one foot on each side of the toilet drain or hole and to squat over it. There are several types of s ...

s are designed to facilitate this posture. Squatting is considered the natural, traditional and most common defecation posture in Asian and African countries. However in some urban areas of India people are gradually switching to western style sitting toilets. Compared to the sitting defecation posture, the squatting defecation posture is more physiological, ideal and relaxed. This is because it allows for better relaxation of the

and hence straightening of the anorectal angle, and for faster, easier and more complete evacuation of stool. The squatting position therefore prevents excessive straining, and hence protects stretching of the nerves, such as the

pudendal nerve The pudendal nerve is the main nerve of the perineum. It carries sensation from the external genitalia of both sexes and the skin around the anus and perineum, as well as the motor supply to various pelvic muscles, including the male or fem ...

. Damage of these nerves can lead to permanent problems with urinary, defecation and sexual function. The squatting position also increases intraabdominal pressure. The squatting position is often recommended as part of a range of measures to manage

constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...

and its subtyptes, including obstructed defecation syndrome and

dyssynergic defecation Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of ...

. Chronic, excessive straining during defecation, which is more likely to be needed in the sitting position, may be associated with the development of hemorrhoids any of the spectrum of

pelvic organ prolapse Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. In m ...

disorders, such as

rectocele In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges ( herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pe ...

rectal prolapse A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depen ...

, etc. However, according to some sources, excessive straining in the squatting position while defecating may increase the risk of severe hemorrhoids, or increase the tendency of prolapse of hemorroids, because of increased perineal descent and intraabdominal pressure. Prolonged and repeated straining on a sitting toilet has the same effect.

Semi-squatting

People who are not used to squat toilets, and people who do not have the flexibility, strength, or balance needed to lower into, sustain, or rise from a squatting position without pain or assistance may not find it easy to use the squatting posture. This may include the elderly,

people with disabilities Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, se ...

, overweight people or people suffering from a skeletal or muscular disease. A semi-squatting position can be achieved by placing a stool or box under the feet while using a sitting toilet. This raises the legs and allows for some degree of widening of the anorectal angle. The anorectal angle can be further increased by leaning forwards in this semi-squatting position. Using a box to raise the legs has been recommended for various straining related medical conditions such as obstructed defecation syndrome, and

solitary rectal ulcer syndrome Solitary rectal ulcer syndrome or SRUS is a chronic, benign disorder of the rectal mucosa (the lining of the rectum). It commonly occurs with varying degrees of rectal prolapse. The condition is thought to be caused by different factors, such as l ...

. For elderly people or people with mobility issues, this "semi-squatting" position is closer to the more natural squatting position, and gives some of the benefit of the squatting position such as reduced need for straining. The semi squatting position is one of the practical solutions for avoiding constipation. Various "squat assist devices" are also commercially available.

References

{{DEFAULTSORT:Defecation posture Human positions Squatting position Toilets

Sitting

Squatting

Semi-squatting

See also

References