"Should You Sit, Squat, or Lean During a Bowel Movement?"
Compared to rural African populations
eating traditional plant-based diets,
white South Africans and black and white Americans
not only have more than 50 times the heart disease,
ten times more colon cancer
and more than 50 times more gallstones and appendicitis,
but also more than 25 times the rates
of so-called pressure diseases—
diverticulitis, hemorrhoids varicose veins and hiatal hernia.
Bowel movements should be effortless.
When they’re not, when we have to strain at stool,
the pressure may balloon out-pouchings from our colon,
causing diverticulosis, inflate hemorrhoids around the anus,
cause the valves in the veins of our legs to fail,
causing varicose veins, and even force part
of the stomach up through the diaphragm into our chest cavity,
causing a hiatal hernia, as I covered previously.
When this was first proposed by Dr. Burkitt,
he blamed these conditions on the straining
caused by a lack of fiber in the diet,
but did acknowledge there were alternative explanations.
For example, in rural Africa they used a traditional
squatting position when they defecated,
which may have taken off some of the pressure.
For hundreds of thousands of years
everyone used the squatting position,
which may help by straightening the “anorectal angle.”
There’s actually a kink right at the end of the rectum,
almost a 90 degree angle that helps keep us from
pooping our pants when we’re just walking around,
but that angle only slightly straightens out
in a common sitting posture on the toilet.
Maximal straightening out of this angle
occurs in a squatting posture,
potentially permitting smoother bowel elimination.
(I remember sitting in geometry class thinking
when am I ever going to use this;
little did I know one day I'd be calculating
anorectal angles with it—
stay in school, kids.)
So how did they figure this out?
They filled latex tubes with radio-opaque fluid,
stuck them up some volunteers,
took x-rays with their hips flexed at various angles
and conclude that flexing the knees
towards the chest like one does squatting
may straighten that angle and reduce
the amount of pressure required to achieve
emptying of the rectum.
But it wasn’t put to the test until 2002
when researchers used defecography,
which are x-rays taken while the person is defecating
either a sitting or squatting position.
And indeed squatting increased the anorectal angle
from around 90 degrees all the way up to about 140.
So, should we all get one of those little stools for our stools,
like the squatty potty that you put in front
of your toilet to step on?
No, they don’t seem to work.
The researchers tried adding a footstool
to decrease sitting height,
but it didn’t seem to significantly affect
the time it took to empty one’s bowels
or significantly decrease the difficulty of defecating.
They tried even higher footstools but people complained
of extreme discomfort using them.
So nothing seemed to compare with actual squatting,
which may give the maximum advantage,
but in civilized countries, it may not be convenient.
But, a similar effect can be achieved
if you lean forward as you sit,
with your hands on or near the floor.
They advise all sufferers from constipation should
to adopt this forward leaning position when defecating,
as the weight of your torso presses against the thighs
may put an extra squeeze on your colon.
But instead of finding ways to add even more pressure,
why not get to the root of the problem.
The fundamental cause of straining is the effort
required to past unnaturally firm stools.
By manipulating the anorectal angle
through squatting or leaning you can
more easily pass unnaturally firm stools,
but why not just treat the cause,
and eat enough fiber-containing whole plant foods
to create stools so large and so soft
you could pass them effortlessly at any angle?
Cardiologist, Dr. Joel Kahn, once said,
you know you’re eating a plant based,
when you take longer to pee than to poop.
But seriously, even squatting
does not significantly decrease the pressure gradient
that may cause hiatal hernia,
It doesn’t prevent that pressure transmission
down into the legs that may cause varicose veins.
And this is not just a cosmetic issue.
Protracted straining can cause heart rhythm disturbances,
reduction in blood flow to the heart and brain,
sometimes resulting in defecation-related fainting and death.
15 seconds of straining can temporarily cut
blood flow to the brain by 21%,
cut blood flow to the heart nearly in half,
thereby providing a mechanism for the well known
bedpan death syndrome.
You think you have to strain sitting?
Try having a bowel movement on your back.
Bearing down for just a few seconds can send
your blood pressure up to nearly 170 over 110,
which may help account for the notorious frequency
of sudden and unexpected deaths of patients
while using bed pans in hospitals.
Of course hopefully, if we eat healthy enough,
we won’t end up in the hospital to begin with.