Comparison of Straining During Defecation in Three Positions: Results and Implications for Human Health
Abstract
The aim of the study was to compare the straining forces applied when sitting or squatting during defecation. Twenty-eight apparently healthy volunteers (ages 17–66 years) with normal bowel function were asked to use a digital timer to record the net time needed for sensation of satisfactory emptying while defecating in three alternative positions: sitting on a standard-sized toilet seat (41–42 cm high), sitting on a lower toilet seat (31–32 cm high), and squatting. They were also asked to note their subjective impression of the intensity of the defecation effort. Six consecutive bowel movements were recorded in each position. Both the time needed for sensation of satisfactory bowel emptying and the degree of subjectively assessed straining in the squatting position were reduced sharply in all volunteers compared with both sitting positions (P < 0.0001). In conclusion, the present study confirmed that sensation of satisfactory bowel emptying in sitting defecation posture necessitates excessive expulsive effort compared to the squatting posture.
https://link.springer.com/article/10.1023/A:1024180319005
3 surprising risks of poor posture
Slouching promotes heartburn, incontinence, and more.
America, we have a posture problem. Whether it’s the result of sitting at a desk all day, looking down at a smartphone, or lounging on a couch, poor posture is dogging people of all ages. And health experts are worried. “It’s a common and important health problem among Americans, and it can lead to neck pain, back problems, and other aggravating conditions,” says Meghan Markowski, a physical therapist at Harvard-affiliated Brigham and Women’s Hospital.
Other posture-related problems
While back and neck conditions top the list of potential posture woes, there are many others — such as poor balance, headaches, and breathing difficulties. “Researchers are also looking into whether posture affects mood, sleep, fatigue, and jaw alignment,” Markowski says.
Three other problems linked to poor posture may surprise you.
1. Incontinence. Poor posture promotes stress incontinence — when you leak a little urine if you laugh or cough. “Slouching increases abdominal pressure, which puts pressure on the bladder. The position also decreases the ability of the pelvic floor muscles to hold against that pressure,” notes Markowski, who specializes in helping people overcome bladder, bowel, and pelvic floor problems.
2. Constipation. Poor posture on a toilet — hunched over with your knees lower than your hips — can promote constipation. “That position closes the anus somewhat and makes it harder for the abdominal muscles to help move feces out,” Markowski says. Constipation is characterized by fewer than three bowel movements per week; hard, dry stools; straining to move the bowels; and a sense of an incomplete evacuation.
3. Heartburn and slowed digestion. Slouched posture after a meal can trigger heartburn caused by acid reflux (when stomach acid squirts back up into the esophagus). “Slouching puts pressure on the abdomen, which can force stomach acid in the wrong direction,” explains Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital. “And some evidence suggests that transit in the intestines slows down when you slouch. In my opinion, it probably does play a small role.”
What you can do
Markowski recommends seeing a physical therapist if you suspect you have poor posture that is causing problems for you. The therapist will customize a program of exercises and stretches to improve your core muscle strength and flexibility. The core muscles (in the abdomen, pelvic floor, and back) support the spine.
The goal is a neutral, upright spine position — not flexed too far forward or backward.
A neutral spine is also important when it’s time to move your bowels. “Keep your back straight and lean forward at the hips. Keeping your knees higher than your hips — by placing your feet on a footstool — mimics a squatting position, which is best for helping to open the anus so you can pass feces without straining,” Markowski says.
https://www.health.harvard.edu/staying-healthy/3-surprising-risks-of-poor-posture
What’s the Best Position for Pooping?
Pooping regularly is part of keeping your digestive system healthy. But when nature calls, it’s doesn’t always come so naturally. While it’s not abnormal to have discomfort during a bowel movement on occasion, pooping should not be a source of constant pain.
Some people swear there’s an ideal position that will reduce the pain and friction felt when having a bowel movement, but others have pooh-poohed this idea. Can changing the position really make the process smoother?
Squatting, as opposed to sitting, may be a game-changer when it comes to emptying your bowels. Let’s take a look at some of the most commonly used positions for pooping.
What type of position makes pooping easier?
There are three primary positions that humans can use to poop. In medical literature, they’re referred to as defecation postures:
- sitting
- sitting with hips flexed
- squatting
To envision the way your body empties your bowels, picture a flexible pipe as the exit canal from your body. This pipe is your rectal canal.
If the pipe is at all compressed or bent, it can’t completely empty the chamber above it. When the pipe is straight, it forms a direct route that’s the most efficient way out of your body.
Hip flexion, the degree to which your legs are elevated or tilted during a bowel movement, can also help your rectal canal reach its potential as an evacuation route
Sitting
Sitting is the typical defecation posture for most people in the Western hemisphere who use a traditionally shaped pedestal-type toilet bowl. The pedestal toilet came into prevalence in the 19th century when indoor plumbing became more mainstream.
Some researchersTrusted Source who study the digestive system trace health conditions such as irritable bowel syndrome and chronic constipation to this type of toileting position. They point out that the natural human impulse is to squat while emptying the bowels, and that the sitting position doesn’t allow for your rectal muscles to relax in a straight line.
Sitting with hips flexed
Sitting on a toilet with your hips flexed away from your body at a 60-degree angle may help your rectal muscles into a more neutral position, reducing the straining it takes to get your poop out.
There are currently no studies to indicate that sitting with hips flexed is better than squatting to use the toilet, though some researchTrusted Source suggests it may be better than just sitting.
Squatting
Squatting, or sitting with your knees raised and your legs slightly spread, may indeed be the most natural and most effective way to empty your bowels.
A 2019 study with a small sample size showed that a toilet modification device that elevated the hip flexors into a squatting position resulted in less straining and more complete bowel movements. Study participants also spent more time pooping when they used this type of device.
What about using a potty stool?
Certain products can lift, elevate, and angle your legs when you use the toilet. This category of products, called potty stools, can put the body in an ideal position for pooping.
Potty stools are simple to use and relatively affordable. Purchase a potty stool online.
What other things can I do to improve pooping and relieve constipation?
Besides changing the position that you use to poop, there are other best practices you can use to make pooping a more pleasant and efficient part of your day.
- Eat plenty of fiber. The recommended amount of fiber is 25 to 38 grams per day. Consuming fiber can help stool pass through your bowels efficiently and out without straining.
- Stay hydrated. The water content in your stool matters when it comes time to poop. Being dehydrated can cause hard, dark stools that lead to constipation.
- Exercise. Your colon can be stimulated by regular exercise, which can help clear things out. Exercise may also stimulate blood flow to the abdominal area, triggering a bowel movement.
- Try to defecate at the same time each day. When it comes to digestion, our bodies tend to operate on autopilot. Visit the bathroom each day around the same time and attempt a bowel movement to get on a regular schedule.
- Don’t ignore the urge to go. When you feel the pressure that indicates it’s time to use the bathroom, don’t try to “hold it in.” Get in the habit of going as soon as you feel the need to.
Key takeaways
It’s not just marketing hype — pooping in a squatting position really is better for many people’s bodies. Not only does squatting provide a clearer exit for your bowel movements, but it also gives some of the job of emptying your bowels to gravity, thereby cutting down on the strain on your muscles as you poop.
If you have frequent constipation, it’s probably worth your while to try a new pooping position to see if it helps. If it feels uncomfortable at first, stick with it for at least a week before you decide if it makes a difference or not.
Occasional constipation is normal, but pain every time you go isn’t. Speak to your doctor if you’re concerned about ongoing constipation.
https://www.healthline.com/health/best-position-for-pooping#takeaway
Abstract
Purpose
We hypothesized that bending the upper body into what we have termed “The Thinker” position facilitates defecation. This study aimed to assess the influence of “The Thinker” position on defecation.
Methods
This is the prospective single-group study. Patients who could not evacuate the paste in normal sitting position on cinedefecography between January and June 2013 were enrolled in this study. Cinedefecography was first performed in the sitting position; if the patient was unable to evacuate the paste, images were obtained in “The Thinker” position. Patients who were able to evacuate the paste were excluded from the study. Anorectal angle (ARA), perineal plane distance (PPD), and puborectalis length (PRL) during straining in both positions were measured from the radiographs.
Results
Twenty-two patients unable to evacuate the barium paste underwent cinedefecography in “The Thinker” position. Seventeen patients were female, average age of 56 (range 22-76) years. “The Thinker” position had significantly wider ARA than the sitting position (113° vs. 134°, respectively; p = 0.03), larger PPD (7.1 vs. 9.3 cm, respectively; p = 0.02), and longer PRL (12.9 vs. 15.2 cm, respectively; p = 0.005) during straining. Eleven patients could evacuate completely in “The Thinker” position.
Conclusion
“The Thinker” position seems to be a more efficient method for defecation than the sitting position. This technique may be helpful when retraining patients with constipation.
https://europepmc.org/article/med/26690926
Bowel retraining
program of bowel retraining, Kegel exercises, or biofeedback therapy may be used by people to help improve their bowel movements.
Information
Problems that may benefit from bowel retraining include:
- Fecal incontinence, which is the loss of bowel control, causing you to pass stool unexpectedly and involuntarily. This can range from sometimes leaking a small amount of stool and passing gas, to not being able to control bowel movements.
- Severe constipation.
These problems may be caused by:
- Brain and nerve problems (such as from multiple sclerosis)
- Emotional problems
- Spinal cord damage
- Previous surgery
- Childbirth
- Overuse of laxatives
The bowel program includes several steps to help you have regular bowel movements. Most people are able to have regular bowel movements within a few weeks. Some people will need to use laxatives along with bowel retraining. Your health care provider can tell you if you need to take laxatives and which ones are safe for you.
You will need a physical exam before you start a bowel training program. This will allow your provider to find the cause of the fecal incontinence. Disorders that can be corrected such as fecal impaction or infectious diarrhea can be treated at that time. The provider will use your history of bowel habits and lifestyle as a guide for setting new bowel movement patterns.
DIET
Making the following changes to your diet will help you have regular, soft, bulky stools:
- Eat high-fiber foods such as whole-wheat grains, fresh vegetables, and beans.
- Use products containing psyllium, such as Metamucil, to add bulk to the stools.
- Try to drink 2 to 3 liters of fluid a day (unless you have a medical condition that requires you to restrict your fluid intake).
BOWEL TRAINING
You can use digital stimulation to trigger a bowel movement:
- Insert a lubricated finger into the anus. Move it in a circle until the sphincter muscle relaxes. This may take a few minutes.
- After you have done the stimulation, sit in a normal position for a bowel movement. If you are able to walk, sit on the toilet or bedside commode. If you are confined to the bed, use a bedpan. Get into as close to a sitting position as possible. If you are unable to sit, lie on your left side.
- Try to get as much privacy as you can. Some people find that reading while sitting on the toilet helps them relax.
- If you do not have a bowel movement within 20 minutes, repeat the process.
- Try to contract the muscles of the abdomen and bear down while releasing the stool. You may find it helpful to bend forward while bearing down. This increases the pressure within the abdomen and helps empty the bowel.
- Perform stimulation with your finger every day until you start to have a regular pattern of bowel movements.
- You can also stimulate bowel movements by using a suppository (glycerin or bisacodyl) or a small enema. Some people find it helpful to drink warm prune juice or fruit nectar.
Keeping to a regular pattern is very important for a bowel retraining program to succeed. Set a regular time for daily bowel movements. Choose a time that is convenient for you. Keep in mind your daily schedule. The best time for a bowel movement is 20 to 40 minutes after a meal, because eating stimulates bowel activity.
Most people are able to establish a regular routine of bowel movements within a few weeks.
KEGEL EXERCISES
Exercises to strengthen the pelvic and rectal muscles may help with bowel control in people who have incompetent anal sphincters. Kegel exercises that increase pelvic and rectal muscle tone can be used for this. These exercises were first developed to control incontinence in women after childbirth.
To be successful with Kegel exercises, use the proper technique and stick to a regular exercise program. Talk with your provider for instructions about how to do these exercises.
BIOFEEDBACK
Biofeedback gives you sound or visual feedback about a bodily function. In people with fecal incontinence, biofeedback is used to strengthen the anal sphincters.
A rectal plug is used to detect the strength of the rectal muscles. A monitoring electrode is placed on the abdomen. The rectal plug is then attached to a computer monitor. A graph displaying rectal muscle contractions and abdominal contractions will show up on the screen.
To use this method, you will be taught how to squeeze the rectal muscle around the rectal plug. The computer display guides you to make sure you are doing it correctly. Your symptoms should begin to improve after 3 sessions.
Alternative Names
Fecal incontinence exercises; Neurogenic bowel – bowel retraining; Constipation – bowel retraining; Obstipation – bowel retraining; Bowel incontinence – bowel retraining
References
Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 127.
Deutsch JK, Hass DJ. Complementary, alternative, and integrative medicine. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 131.
Iturrino JC, Lembo AJ. Constipation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 19.
Pardi DS, Cotter TG. Other diseases of the colon. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 128.
https://medlineplus.gov/ency/article/003971.htm
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