Toilet footstool could offer relief for sufferers of constipation

PUBLISHED : Monday, 27 April, 2015, 6:55am
UPDATED : Tuesday, 19 May, 2015, 10:06am


Most of us would pick a modern toilet over a squatting one. But while sitting to do our business may be considered "civilised", studies show the squat position actually aids bowel elimination.

Enter Squatty Potty, a toilet footstool that helps put the body in a simulated squat position - that is, with knees raised above the hips and with a 35-degree angle between your thighs and torso - while you're on the throne.

Compared to typical sitting where the thighs are perpendicular to the torso, this simulated squat is said to relax the puborectalis muscle (a tight muscle around the colon), allowing the anorectal angle (the angle between the rectum and the anal canal) to straighten and the bowel to empty more easily and completely.

In the squatting position, gravity also 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.

According to a study done last year by Dr Gregory S. Taylor of St George Urology, when used as a treatment, the Squatty Potty significantly improved the severity of constipation syndromes within one month of use among 84 per cent of 153 study participants who were recruited via

Users of the stool report they experience relief from chronic bowel ailments such as irritable bowel syndrome, interstitial cystitis, pelvic floor prolapse, anal fissures, hemorrhoids, and as a treatment for constipation.

In Hong Kong, constipation is a common bowel complaint, according to the Centre for Health Protection, with a reported prevalence of 14.3 per cent among community-dwelling adults, 12.2 per cent among primary school students, and 28.8 per cent among preschool children.

Dr Renny Yien, a specialist in general surgery at Matilda International Hospital, says constipation is when you have two or more of the following for at least three months: straining more than 25 per cent of the time, hard stools more than 25 per cent of the time, incomplete evacuation 25 per cent of the time, and two or fewer bowel movements a week.

He supports the theory put forth by Squatty Potty. "Defecating in a squat position, such that your legs are more flexed at the hip joints, relaxes the puborectalis muscle [a muscle that contributes towards the maintenance of fecal continence]," says Yien.

"This muscle creates a kink to the rectum when contracting. The rectum is where the stool is stored. Squatting reduces this natural kink and aligns the colon and rectum. This should, in theory, aid bowel emptying."

Bill, Judy and their son Bobby Edwards created the Squatty Potty in their garage of their Saint George, Utah home in 2010. At the time, Judy was experiencing colon problems, and a medical professional recommended that she raise her knees as high as possible while using the toilet.

Boxes, books and stools were used to prop her feet up, but eventually Bobby decided he would custom-design a stool that would fit around the toilet. After several prototypes, he found a design that worked.

The Edwards gave out Squatty Potties to friends and family for Christmas 2010. People loved them, so Bobby started a website to market and sell the product.

Sales have been helped by plugs from celebrities such as Dr Oz and radio personality Howard Stern, who said on his show in 2013: "I had, like, a full elimination. It was unbelievable. I felt empty. I was like, 'Holy s***!'"

But Dr Henry Kwan Tim-lok, a specialist in general surgery at Hong Kong Adventist Hospital, says squatting only helps some people, not everyone.

"Defecation is a complex process that occurs under both voluntary and involuntary control," he says. "The difference in squatting and sitting during defecation appears to be the anorectal angle. The contents of the bowel are eliminated more easily in the squatting position. So squatting only helps those who find it hard to empty their bowels when sitting to begin with."

So you might benefit from using the Squatty Potty if you experience straining and/or incomplete evacuation during a bowel movement.

I have never had any serious problems doing a Number 2, because I eat a lot of fibre and drink plenty of water every day. Occasionally, I do find myself needing to strain a little when I'm sitting on the bowl.

Squatting only helps those who find it hard to empty their bowels when sitting to begin with
Dr Henry Kwan, Hong Kong Adventist Hospital

I tried the 18cm-high US$25 "Ecco" Squatty Potty for over a week, and found it made emptying my bowels a lot easier. The marketing material for the product instructs you to "stay tall and lean slightly forward, paying attention not to hunch over, and let gravity do the work." In that position, I noticed there was no need for me to strain, and I was in and out of the toilet in half the time it usually takes me.

I also wasn't left feeling like I hadn't emptied my bowels. I felt more comfortable during the day. Overall, using the toilet stool was a pleasant experience.

What's great about the Squatty Potty is it is suitable for the whole family - even kids. Plus, it is affordable, durable, easy to clean, and comes in various models and sizes, depending on the height of your toilet bowl and your design preferences.



The condition is usually due to a bowel function disorder as opposed to a structural problem, according to Dr Renny Yien, a specialist in general surgery at Matilda International Hospital. 

inadequate intake of water and fibre;
inadequate physical activity or immobility;
a disruption in one's regular diet or routine, such as when travelling;
eating large amounts of dairy products;
resisting the urge to have a bowel movement;
overuse of laxatives, which can weaken the bowel muscles;
neurological conditions such as Parkinson's disease or multiple sclerosis;
antacid medicines containing calcium or aluminium;
eating disorders;
irritable bowel syndrome;
colon cancer.

How to treat it Eating a fibre-packed diet and drinking lots of water can help aid bowel movements. "Dietary fibre refers to the edible parts of plants or carbohydrates that cannot be digested," says Yien.

"Water and these insoluble plant products form the bulk in the colon, so that the colon has something to 'push out'. This helps you to empty your bowels.

"A high-fibre diet ends chronic constipation for many people, but those who have slow transit or pelvic floor dysfunction may respond poorly to increased dietary fibre."

Try consuming warm liquids, especially in the morning, to stimulate your intestines and "get your system going".

Some foods can help you go, says Dr Henry Kwan Tim-lok, a specialist in general surgery at Hong Kong Adventist Hospital. For some people, it might be coffee, curry or chocolate.

If needed, use a very mild stool softener or laxative (such as Peri-Colace or Milk of Magnesia). Do not use laxatives for more than two weeks without consulting your doctor, as laxative overuse can aggravate your symptoms.

Exercise regularly, as it stimulates the natural contraction of the intestinal muscles. When the intestinal muscles contract efficiently, it helps move your bowel contents out quickly.

Yien says that the bowel movements of long-distance runners are so healthy that some of them even develop "runner's diarrhoea".

As colonic cancer may present with worsening constipation, it is important to see your doctor if your constipation persists for more than two weeks, says Yien.