Squatting versus sitting as a defecation posture - The Squatty Potty - "healthy colon - healthy life"

  • jkeichholz
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Squatting vs. sitting

Linus on the EcoSanRes mailing list recently started a debate on which toilet seating style is better: squatting or sitting?

To move this discussion to a wider audience, I've tried to list here what contributors on the mailing list have already mentioned on both styles. Please feel free to keep this discussion alive and add your own input (or whatever I've forgotten to include):

Edit: I'll try to keep this list updated. Additional edits also made by Elisabeth von Muench on 13 December.

Sitting toilets (pedestals):

Positives:
  • said to be better for people with disabilities
  • said to be more relaxing for those who use the toilet to relax
  • more comfortable
  • users are able to read
  • better for wiping (with toilet paper)
  • Japanese washlets (toilets with bidet functionality) only work with this style?

  • Negatives:
    • Said to be worse for keeping intestines healthy (see under Positives for squatting toilets below)
    • Less hygienic in the case of public toilets (many women do not sit on public toilets, instead they "hover". Exact numbers unknown; my own personal guess: 50% of women do this - highly dependent on cleanliness state. E.g. a toilet at work might be OK thus more women sit there than on a public toilet at a train station).
    Squatting:
    Positives:
  • said to be better for washing (anal cleansing with water)
  • better defecation (more pressure applied on intestines)
  • quicker defecation, easier, "more complete"
  • could be more hygienic for public toilets; skin does not touch surface: many women always in suatting position while using public toilets
  • more hygienic, often preferred by those who have been using squatting toilets since childhood and wouldn't want to share the same seat with someone else - this again applies to public or shared toilets
  • targeting while using UDDTs is better (?)
  • easier and less expensive to build than sitting toilets (not necessarily true, e.g. bench UDDTs same cost as squatting UDDTs
  • more attractive on public toilets - in countries where people are used to squatting
  • also natural birth delivery position, 20-30% wider birth channel - do women who use squatting toilets give birth in squatting position more easily? (thx Ulrike!)

  • Negatives:
    • Difficult to use for unfit or sick people, people with disabilities, elderly, pregnant women
    • Might be regarded as "backward" if people aspire to "Western standards"
    Neutral
    • historical context, older style (?), originally comes from open defecation
    • popular in many developing countries

    Given that there seem to be more pro arguments for the squatting type, it's interesting that some EcoSanRes members active in South America reported that the sitting type was actually preferred when users were given the choice.

    N.b.: This post could also be a reason for locking some subjects from the public as not everyone will be open enough to talk about these details. What do you think?

    Juergen Eichholz
    watsan eng.
    water, sanitation, IT & knowledge management
    www.saniblog.org
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    • linusdagerskog
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    Re: Squatting vs. sitting

    Hello,
    I started this discussion on the ecosanres email-group a while ago, but it seems wise to move it into the SuSanA discussion forum (thanks Juergen). The squatting/sitting issue prompted more reactions than I would have imagined!

    I gave the links to two "popular articles" on the benefit of squatting:
    www.slate.com/articles/health_and_scienc...it_there.single.html

    www.marksdailyapple.com/squat-poop/

    Someone asked me if I was ready to have a squatting toilet at home, and in fact since about a month or so I only squat which feels great. I built a couple of foot supports to put on each side of the seat since I'm too big (1,97 m) and unflexible to squat directly on the toilet-rim. For me, squatting is also a way to work on my flexibility, it gives a good yogic stretch, as well as quick and easy emptying.

    But I do understand that aspirations/culture/status/comfort/age/handicap also play a big role when opting for sitting or squatting. As with ecological sanitation - I think the best is to let people make informed decisions, knowing the pros and cons with the different alternatives.

    Regarding the scientific evidence - as far as I could see there are two israeli studies (Sikorov) and one japanese study, that basically showed the reduced strain and ease of emptying (which seems to reduce problems with hemorroids etc) with squatting:
    www.toilet-related-ailments.com/sikirov.html
    www.springerlink.com/content/rlu7151837n07562/
    onlinelibrary.wiley.com/doi/10.1111/j.17...72.2009.00057.x/full

    The toilet of the future that allows for both sitting and squatting is already for sale:
    www.pinz.com.sg/wc/home.html

    Cheers
    Linus Dagerskog
    Research Associate
    Stockholm Environment Institute
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    • Ulrike
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    Re: Squatting vs. sitting

    Hello!

    On Jonathan Isbit’s webpage I found the interesting pro squatting argument that women who squat are better prepared for child delivery ( www.naturesplatform.com/health_benefits.html#pregnancy ).

    He states that because of the sitting toilet women are no longer capable of prolonged squatting – which would be the natural birth delivery position that allows for a quicker and more comfortable delivery compared to the recumbent position. The reason is that the birth channel is widened by 20-30% in the squatting position, according to a study in the Journal Obstet Gynaec Brit Cwlth from 1969.

    Maybe this is not a strong argument for shifting from sitting to squatting toilets in developed countries, but it could be a reason not to design sitting toilets for developing countries where home birth is common? Or is this not an issue? It would be nice to hear some thoughts on this. Thanks!

    Regards,
    Ulrike

    Eawag/ Sandec
    Dübendorf, Switzerland

    Ulrike Messmer
    Project Officer "Reinvent the Toilet Challenge"
    Eawag- Swiss Federal Institute of Aquatic Science & Technology
    Sandec - Department of Water & Sanitation in Developing Countries
    Dübendorf, Switzerland
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    • muench
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    Re: Squatting vs. sitting

    Dear Ulrike,

    Interesting! Maybe a way around it would be to include more squatting exercises in the ante-natal classes before birth to strengthen those muscles needed for squatting (or does one need years of practice?).

    One example: Even though the Dutch women also use sitting toilets and not squatting, they are doing very well in getting the baby out in the most natural way - at home and with a very low rate of C-sections. So if sitting/squatting was to play a role, maybe it is only minor compared to all the other factors and attitudes in society (need an enabling environment to properly support home births).

    As regards to the sitting/squatting discussion above, I was impressed by a statement by Patrick Bracken:

    Clearly squatting is better for us biologically as that's the posture our bodies evolved with for defecating and surely from a general health perspective.
    But people don't aspire to squatting (as Gunder said), even if it is anatomically better for them. Just like people take a car for short trips and don't aspire to eating a balanced caveman diet, even if human stomachs eveolved for this and not for the food we buy in supermarkets. Aspirations a rarely founded on the basis of what is best for human health.

    In terms of cleanliness, we need to distinguish between public and private toilets. Maybe the global trend will be: squatting for public toilets; sitting for household toielts.

    Regards,
    Elisabeth

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    • rahulingle
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    Re: Squatting vs. sitting

    Interesting discussion...

    As somebody who has squatted 50% of the times in his lifetime, I would say I have enjoyed pleasures of both the worlds. But recently when I was back in India visiting my family and relatives most of whom have now migrated to the western style due to their western aspirations, I realised it was not very comfortable anymore to squat. Its quite some pressure on the knees and the ankles.

    Secondly, its interesting to see the transition from a squatting toilet to a sitting type. The transition is not that smooth. People do not immediatly start sitting on them. There is an intermidiate stage where they usually climb it s4.hubimg.com/u/175479_f520.jpg It is only after a fall when people actually start sitting on it. Some pick up habits such as smoking, milk tea, milk coffee etc before using the toilets.

    Thirdly, squatting toilets can also be converted into sitting type. In my family when my father suffered a stroke and was paralysed, we installed a wall mounted foldable toilet seat which aimed straight at the squatting pan. So improvisations to suit physically challenged people is possible in squatting stlye.

    Also the toilet dimesnsions for a squatting toilet are 0.9m x 1.2m while for a sitting type it is 0.9m x 1.5m. i.e a saving of .27sqm of space or approximately 3 sq.feet. The per sq. feet rate in a city like mumbai in the suburbs is around Rs. 2000 to Rs. 5000 per sq. feet. @ Rs. 2000 per sq.ft the savings is Rs. 6000 i.e around 100€! :woohoo:

    cheers

    Rahul

    Best regards,

    Rahul Ingle
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    • JosSafiSana
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    Re: Squatting vs. sitting

    The argument that squatting would be more hygienic is not for all cases:

    My experience is that older people can have problems with getting their excreta in the squatting pan and so creating a less hygienic situation. Younger persons often prefer squatting instead.

    So at least for public toilets (with several toilet spaces) I am convinced you will need a balance between the number of squatting and sitting toilets. This will depend on the demand of the users.I think if users are 'forced' to use an non-preffered system you run into problems that people try to squat on sitting toilets etc.
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    • CeciliaRodrigues
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    Re: Squatting versus sitting as a defecation posture - The Squatty Potty - "healthy colon - healthy life"

    It looks like westerns are discovering the benefits of squatting (and commercializing it, of course!)

    Just out of curiosity! The video is from July 2012.


    Best regards,
    Cecilia.

    Programme Officer at GIZ - Sustainable Sanitation Programme
    and the SFD Promotion Initiative
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    • Florian
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    Re: Squatting vs. Sitting

    A question that recently crossed my mind: how do women in the last months of pregnance use squatting toilets? I mean is it a problem or not for them to use squatting toilets?

    Florian Klingel
    Water and Sanitation Specialist at Skat Consulting Ltd.
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    • muench
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    Re: Squatting vs. Sitting

    Dear Florian,

    From my own experience (some years ago...), I would say that squatting as a highly pregnant woman is not really a problem. Women also give birth while squatting... The thigh muscles are strong. But I would say it can be harder for older people. And of course people with disabilities.

    By the way, we had a detailed discussion on this issue on the forum in the past (thanks to Juergen for summarising the discussions from the old ecosanresforum). Thus, I have moved this post into that existing thread (please scrol up to see it).

    Cheers,
    Elisabeth

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    • christoph
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    Re: squat for money - The Squatty Potty - "healthy colon - healthy life" (product from the US)

    :ohmy:
    Very interesting - impressive sales numbers - never expected that.

    You have to watch it from 20:26 on:



    have a look if you have time for 5 min.

    Christoph
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    • denniskl
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    Re: squat for money

    had a look at the video and saw the product here: www.squattypotty.my

    The squatty potty is a great concept product for the western world (ie the land of the sitting toilet:)

    Elderly and sick in developing countries (ie squatting toilets land)

    Something like this may also be a way of addressing the issues of the elderly and the sick in the normal squatting toilets; it could mean we can do away with (or minimise) the need for hand rails, lift points etc as the elderly and sick can simply move their feet from the squatty potty stand to the normal sitting position before standing up.

    I like it; I think I will incorporate the concept (if not the specific product)in future design and planning thinking

    Creator of the JigSaw Puzzle in-country capacity building Programme

    See latest JigSaw Puzzle Programme overview here: tinyurl.com/JigSawPuzzle7

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    * See a problem.
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    • muench
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    Re: squat for money

    Ha, how did you find this video, Christoph? It's always nice to see sanitation discussed on mainstream media (with a bit of humor, too)! :-)

    Here is the direct link to the video in the right spot:



    If they have these very impressive sales numbers then why are they looking for further investors, I wonder? (interesting that they are hoping to get approval to be a "medical product" with rebates from health insurance companies).

    I wonder how obesity (a growing problem in the US and elsewhere) affects the sitting versus squatting debate.

    And I also wonder how one knows if one's colon is healthy or not? I.e. these people who start using this squatty potty, what health improvements do they notice? I guess less constipation is the main thing?
    Does that mean if one doesn't have problems with constipation then one also doesn't need this product?

    Greetings,
    Elisabeth

    Dr. Elisabeth von Muench
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