The Best Poop Position for Constipation

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In my last poop video, I talked about the potential efficacy of prunes and dried figs in order to keep us regular. What about the influence of body position on defecation? While squatting continues to be the traditional position in populations of Asia and Africa, Westerners have become accustomed to sitting on toilet seats. And when we do that, when we sit upright, our poop is forced to make a nearly 90-degree turn, the so-called recto-anal angle. Now, that’s a good thing in terms of keeping us from pooping our pants every time we sit down. But when it comes to doing our business, the sitting toilet posture defeats the purpose of our body’s brilliant design—like trying to drive a car without releasing the parking brake. Yet, many physicians are hesitant to discuss such an unmentionable bodily function or may just be ignorant. Doctors don’t know squat.

Of course, this is coming from someone who owns a company selling people squatting platforms for their toilets. In a previous video, I talked about those little footstools you can use to raise your knees when you assume a pooping position, but they were not found to make a difference in terms of self-described difficulty in defecating or the average time spent emptying one’s bowels. But those stools give only a measly 4-inch boost. The so-called Squatty Potty is twice that height, and while you have to admire their graphics, from booty blockage to fecal fiesta, complete with little rainbow poops, it had never been put to the test, until now.

The implementation of a Defecation Posture Modification Device, i.e., Squatty Potty, and…it worked! Increased feelings of bowel emptiness, reduced straining, and about a minute off of their on-the-pot reading time. The only downside is the discomfort, even just a 6-inch riser was found to cause such extreme discomfort in research subjects in a previous trial they abandoned even trying to study it.

How else can we get that same change in angle you get from raising your feet? How about just tipping forward? Look familiar? It’s like that famous sculpture by Rodin, The Thinker. And indeed, Cleveland Clinic researchers set out to study “The Thinker” position for defecation, and were able to show an opening of the ano-rectal angle, as measured using cinedefecography, your SAT word for the day—meaning basically x-ray poop movie—opening to more than 130 degrees, better than what you can get just raising your feet, which is only around 90 degrees. So, ‘‘The Thinker’’ position may be a more efficient method for defecation, it may help with constipation, but it has not yet been formally put to the test.

As an aside, you can imagine how the worst position might be flat on your back using a bedpan, because of the spike in blood pressure in your heart and brain when you bear down, straining at stool is associated with sudden death from heart attack and stroke. In fact, it has been found to be the most common activity of daily living being performed at the time of death in Japan, and those who can’t get out of bed would seem to be especially at risk. That’s why, if at all possible, it can help to sit people up in bed to cause less strain on the system.

It’s important to take a step back, though, in this sitting vs. squatting debate, as this commentary did, nearly 50 years ago. Yes, the squatting position is said to be natural, since it is used by so-called primitive peoples who pass large stools easily, such that squatting advocates blame the porcelain throne for all manner of Western maladies, but does the position really make a difference if you’re eating the right foods? The man who squats because he has no modern plumbing also tends to eat more natural foods that haven’t had the fiber processed out. Adding fiber to the diet can enable constipated patients to poop effortlessly without having to squat over some hole in the ground. So, maybe if we just change the design of our diets, we don’t have to change the design of our plumbing.

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• Sakakibara R, Tsunoyama K, Hosoi H, et al. Influence of body position on defecation in humans. Low Urin Tract Symptoms. 2010;2(1):16-21.
• Isbit J. Is the porcelain throne to blame? Tech Coloproctol. 2015;19(3):193-4.
• Sikirov D. Comparison of straining during defecation in three positions: results and implications for human health. Dig Dis Sci. 2003;48(7):1201-5.
• Squatty Potty The Original Bathroom Toilet Stool Height, White, 9 Inch (Pack of 1). Amazon.com.
• Modi RM, Hinton A, Pinkhas D, et al. Implementation of a defecation posture modification device: impact on bowel movement patterns in healthy subjects. J Clin Gastroenterol. 2019;53(3):216-9.
• Takano S, Sands DR. Influence of body posture on defecation: a prospective study of “The Thinker” position. Tech Coloproctol. 2016;20(2):117-21.
• Imai M, Kuwahara Y, Hirai M, et al. Effects of defecation strain at various bed reclining angles on intrarectal pressure and cardiovascular responses. Nurs Res. 2015;64(6):413-21.
• Editorial: Straining, sitting, and squatting at stool. Lancet. 1975;2(7923):18-9.
• Isbit J. Preventing diseases of civilization. J Pediatr Surg. 2018;53(6):1261.

Motion graphics by Avo Media

• Africa
• Asia
• bowel movements
• constipation
• fiber