The End of the Story (for this topic, I promise)

If you have been following my blog all along, you've read my comments about adjusting to the Asian style toilet here in Chanaute. Since it's not a topic people generally like to talk about, I had planned to put the topic to rest. However, as fate would have it, I started reading an ebook entitled "GUT: The Inside Story of Our Body’s Most Underrated Organ" by Giulia Enders. I purchased this ebook a ways back, but with school and board exams I'm just now getting into it. In the book, the author gives an insightful explanation of why squatting is beneficial, and for the benefit of all reading this blog, I felt it was my duty as a health care practitioner to give you the end of the story so to speak. Bad pun intended.




Are You Sitting Properly?

It’s a good idea to question your own habits from time to time. Are you really taking the shortest and most interesting route to the bus stop? Or, indeed, are you sitting properly when you go to the toilet? There will not always be a clear, unambiguous answer to every question, but a little experimentation can sometimes open up whole new vistas. That is probably what was going through the mind of Dov Sikirov when the Israeli doctor asked twenty-eight test subjects to do their daily business in three alternative positions: enthroned on a normal toilet; half-sitting, half-squatting on an unusually low toilet; and squatting with no seat beneath them at all. He recorded the time they took in each position and asked the volunteers to assess the degree of straining their bowel movements had required. The results were clear. In a squatting position, the subjects took an average of 50 seconds and reported a feeling of full, satisfactory bowel emptying. The average time when seated was 130 seconds and the resulting feeling was deemed to be not quite so satisfactory. Why the difference? The closure mechanism of our gut is designed in such a way that it cannot open the hatch completely when we are seated. There is a muscle that encircles the gut like a lasso when we are sitting or, indeed, standing, and it pulls the gut in one direction, creating a kink in the tube. This mechanism is a kind of extra insurance policy, in addition to our old friends, the sphincters. Some people will be familiar with this kinky closing mechanism from their garden hose. You ask your sister to check why there’s no water coming out of the hose. When she peers down the end, you quickly unbend the kink, and it’s just a few minutes until your parents ground you for a week. But back to our kinky rectal closure mechanism: it means our feces hit a corner. Just like a car on the highway, turning a corner means our feces have to put on the brakes. So, when we are sitting or standing, our sphincters have to expend much less energy keeping everything in. If the lasso muscle relaxes, the kink straightens, the road ahead is straight, and the feces are free to step on the gas. Squatting has been the natural defecation position for humans since time immemorial. The modern sitting toilet has existed only since indoor sanitation became common in the late eighteenth century. But such “cavemen did it that way” arguments are often met with disdain by the medical profession. Who says that squatting helps the muscle relax better and straightens the feces highway? Japanese researchers fed volunteers luminous substances and X-rayed them while they were doing their business in various positions. They found out two interesting things. First, squatting does indeed lead to a nice, straight intestinal tract, allowing for a direct, easy exit. Second, some people are nice enough to let researchers feed them luminous substances and X-ray them while they have a bowel movement, all in the name of science. Both findings are pretty impressive, I think. Hemorrhoids, digestive diseases like diverticulitis, and even constipation are common only in countries where people generally sit on some kind of chair to pass their stool. This is due not to lack of tissue strength, especially in young people, but to the fact that there is too much pressure on the end of the gut. Some people tend to tense up all their abdominal muscles when they are stressed. Often, they don’t even realize they are doing it. Hemorrhoids prefer to avoid internal pressure like that by dangling loosely out of the anus. Diverticula are small light-bulb-shaped pouches in the bowel wall, resulting from the tissue in the gut bulging outward under pressure. Of course, the way we go to the toilet is not the only cause of hemorrhoids and diverticula; however, it remains a fact that the 1.2 billion people in this world who squat have almost no incidence of diverticulosis and far fewer problems with hemorrhoids. We in the West, on the other hand, squeeze our gut tissue until it comes out of our behinds and we have to have it removed by a doctor. Do we put ourselves through all that just because sitting on a throne is more “civilized” than silly squatting? Doctors believe that straining too much or too often on the toilet can also seriously increase the risk of varicose veins, a stroke, or defecation syncope—fainting on the toilet.
A text message I received from a friend who was on holiday in France read, “The French are crazy! Someone’s stolen the toilets from the last three service stations we stopped at!” I had to laugh, first, because I suspected my friend was actually being serious, and second, because it reminded me of my first experience of French squat toilets. “Why am I being forced to squat here when you could just as easily have put in a proper toilet?” I mournfully complained to myself as I recovered from the shock of the emptiness I saw before me. Throughout much of Asia, Africa, and southern Europe people squat briefly over such toilets in a kind of martial arts or downhill skiing pose to defecate. We, by contrast, take so long, we have to while away the time until we’ve finished our business with reading the paper, carefully prefolding pieces of toilet paper for imminent use, scanning the corners of the bathroom to see if they could do with a clean, or staring patiently at the opposite wall. When I read this chapter out to my family in our living room, I looked up to see disconcerted faces. Are we going to have to descend from our porcelain thrones and squat precariously over a hole to poop? Of course not, hemorrhoids or no hemorrhoids! That said, it might be fun to try climbing up onto the toilet seat to do our business while squatting there. But there’s no need for that, either. It is possible to squat while sitting. It’s a particularly good idea when things don’t come so easily, so to speak. To do it, just incline your upper body forward slightly and put your feet on a low footrest placed in front of the toilet, et voilá!—all the angles are correct, and you can read the paper, prefold your tissue, or stare at the wall with a clear conscience.

P.S. - I believe Bed, Bath and Beyond or possibly some other retailer sells a footrest that is specifically designed to place you into a squat like position and then slide under the toilet when not in use. I'm sure if you google it you can confirm. I'd Google it for you, but as is often the case, my internet is down currently.

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