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How bathroom posture affects your health. (slate.com)
164 points by carnevalem on Aug 31, 2010 | hide | past | web | favorite | 100 comments



>sitting on toilets—a recent phenomenon, stemming from the invention of the flush toilet in 1591—might be unhealthy

There's a Roman museum near here that has a model barracks toilet which is basically like a modern compost loo - it's like an enclosed bench with holes to defecate through. I guess you might be supposed to stand on it but it's certainly not presented that way.

I've seen toilets in medieval château and castles with wooden seats on a knee height enclosure too. Doesn't appear to be an invention that followed the flush toilet. Nor can I see how a flush toilet would need a change in posture.


>Nor can I see how a flush toilet would need a change in posture.

You're definitely correct. South East Asia (at the minimum) has millions of flushable porcelain squat toilets. :)


The ruins of Leptis Magna, Roman ruins dating from 1100 BCE–650 CE, features sit-down toilets.

http://www.flickr.com/photos/libyan_soup/650693182/


I have heard people argue, that the Roman toilets were for squatting on top.


Like wikipedia.

>the Roman toilets were probably elevated to raise them above open sewers, rather than for sitting.

However in the image http://en.wikipedia.org/wiki/File:Ostia-Toilets.JPG accompanying one can see that this would mean that the Romans were wasting a lot of well prepared stone building the toilets twice as high as needed (note the extra stone below the opening).

One thought was that this could be an economy of parts, the "seat" and front pieces appear same-dimensioned - but then I noticed that the bottom part has a corner that the top part didn't and so in this instance that theory appears unsound.

Given the Romans amazing engineering prowess I can't see them wasting materials like this in order to make the toilets harder to use.

http://books.google.com/books?id=RIRlPwAACAAJ&printsec=f... appears to be the major ref on Wikipedia and is widely cited in scientific papers but unfortunately I can't find a place to read it online (and don't have a copy!).

Edit: http://www.amazon.com/gp/product/0715638505?ie=UTF8&tag=... "Latrinae Et Foricae: Toilets in the Roman World" clearly, to me, shows a Roman toilet as a seat on the front (my posterior would fit but my feet wouldn't fit either side of the hole to squat). Review - http://bloggingpompeii.blogspot.com/2009/12/latrinae-et-fori...


Thanks for the investigation.

Perhaps the Romans started out squatting, and later changed to sitting. I predict this is the point in time when the rise of the Romans stopped and their fall began. (Tongue-in-cheek.)


There's a joke there about tongues in cheeks but I'm too refined to make it.


first real flush toilets were probably from 26th century BC en.wikipedia.org/wiki/Flush_toilet The Knossos palace on Crete (1700BC) had flush toilets (and 3 separate systems for managing water) en.wikipedia.org/wiki/Knossos


This article speaks the truth. I was traveling in China last year and was averse to pooping in the squat toilets there (they're generally quite filthy). In any case, eventually push came to shove and I had to bite the bullet.

It was like an awakening, I had not realized how uncomfortable are our western toilets until this experience.


See the award-winning "How to do the Asian Squat" documentary from 2002: http://vimeo.com/12977039


I'd say mockumentary. Highly enjoyable, but if you actually want to learn how to squat properly, then Craig Weller has some advice in "The Third-World Squat" (http://www.t-nation.com/portal_includes/articles/2007/07-210...).


Another advantage of a squat toilet is your buttocks don't touch any of that filth.


Here in Asia, you most always find both western and squat toilet in houses, hotels and public toilets.

In public toilets squat toilets are still more hygienic to use than sitting on the western toilet seats.

Moreover if the flush doesn't work, which usually would be the case, you can always pour a bucket of water.


At the risk of sounding quite childish - I've never used a squat toilet, is there much chance of you accidently soiling your pants when using one?


I spent a few month in Turkey, and I never did spoil anything.

For public toilets, I actually preferred the squatting version: You do not have to touch them. Just remember to bring your own toilet paper.


Pouring a bucket of water also works with western toilets. Try it one day. You'll probably have to do a few buckets but it works.


You would only need to use a few buckets on an American toilet. European ones use a lot less water.


The bucket size is a small one, about 1L


yep. However no suction is necessary like in western toilets and everything works perfectly just with gravity. Thus, the squat ones do save lot of water, 1 ltr is sufficient for flush. Of course, the plumbing particularly the inclination & depth of column below, has to be done right.


Yes, there were lots of western toilets in the more populated areas (Shanghai, Xian, Beijing, etc), but less once we got away from the cities. Squat toilets definitely seem more hygenic :)


What if I can't properly squat? How can I overcome this? I've tried doing different squat stretch's but I just can't seem to squat..I'm always on my tippy toes.


I just submitted an article that deals with the matter (http://news.ycombinator.com/item?id=1652595). The short version: Practice. Hold onto something at first, if you can't keep your balance.

(I do recommend dry practice.)


Take a look at your shins. Mine have a significant negative camber, curving out to about 10-15 degrees. Because this puts my feet a few inches forward of a normal person's, I can't rest in a squat; I have to actively lean way forward.

If your shins are normal, though, just work on the leg strength to control your descent, and the ankle forward flexibility required to shift your center of gravity the inch or so foward to compensate for going from the balls of your feet to the whole foot.


Sorry, but I don't know a polite way to ask this. How do you urinate while on a squat toilet without peeing all over your pants?


Found the answer to my own question: http://en.wikipedia.org/wiki/Toilets_in_Japan#Squat_toilet

Turns out, you only pull your pants down to your knees, so the area between your feet is unobstructed for peeing.


You've ideally got two independent flows occurring. Aim them in the same place... preferably not in your pants.


This i found to be the biggest drawback of squat toilets . When you pee from standing position you pee all over the steps .


Take your pants off?


You have to take your pants off, or you will poop right in them ;)


"My 10-minute routine dropped to a minute ..."

Jesus, what the hell is wrong with this guy? Or maybe I'm the freak, but I don't spend ten minutes on the toilet. Usually it takes 30s-2m to do my business.

Maybe he should consider a change in diet?


Yeah, it sounds like this guy has some kind of specific problem, which maybe squatting can relieve.

I looked him up, assuming he might be an old guy, but he appears to be early-to-mid 20s, meaning that spending ten minutes just to take a crap on a regular basis is not normal.


What if he has a good book on hand? I've been known to spend hours in there due to good books. It gets very uncomfortable, but you just can't put the book down!


If you think it's uncomfortable now, wait until you get hemorrhoid surgery to undo the damage you're doing with this.


I was a little kid at the time. I haven't had enough fixating books since then.

Thankfully, I don't think children are especially susceptible.


>>I've been known to spend hours in there due to good books.

http://sheddingbikes.com/posts/1281257293.html


Don't read on the toilet seat. loewenskind has already said it, but I think it's important enough to repeat clearly. Sitting on that ring puts pressure on the anal muscles.

Again, do not read on the toilet seat!


How old are you? I've found the good 'ol GI tract and related equipment doesn't work as efficiently as you start to approach 30.

Also you can't read magazines or check email while you're "perched" so maybe that has something to do with it. ;)


I've found the good 'ol GI tract and related equipment doesn't work as efficiently as you start to approach 30

Perhaps if you have a diet that consists mainly of cheese. "Approaching 30" is a bit early for your colon to start clogging up... you might want to get that checked out.


six subjects had their rectums filled with a contrast solution and then released the fluid from a squatting or a sitting position while being filmed with X-ray video.

yikes.


Science!


Only if they were wearing lab coats.


Grad students would be my guess...


Yeah, I think I've seen that one on the porn store rack.


Kudos to those who participated in the studies (particularly the Japanese study). They sounded extraodinarily uncomfortable. As odd as it sounds, I'm thankful for the lengths some will go for science (I'm going to pretend this was the motivation).


Can't you just lean forward on the toilet to achieve the same result?


If you're removing your rear from the seat while leaning forward, then maybe. The point of squatting, besides the angle of the innards involved, is the pressure on your bum. Leaning forward, or raising your feet of the ground, as is mentioned, won't decrease the pressure. That motion is more likely to increase the pressure. There are a number of articles regarding this rectal pressure as it contributes to hemorrhoids. IANAD...just my 2 cents.


Or raise your legs a bit, continuing to let the seat carry your weight but raising your knees by pointing your toes or just lifting them. Though I've only thought about trying out squat toilets (or "perching"), I can anecdotally report that leg-raising by itself does have some effect.


I've been perching for 2 years and subjectively recommend it.


The logistics of this baffle me. Do you have the seat up? Any problems with splashing? Do you do this in public restrooms? Friends' houses?


Seat down; no splashing problems really, you are only 2 or 3 inches higher; only at home.


There is something else to through into the argument- flexibility.

The use of western toilets reduces our ability to reach the full squat position and some reckon this is why pulled hamstrings and achilles injuries are more common.

When western people squat, we tend to go up on our toes to reach full depth due to our inflexibility gained from using toilets.

This inflexibility changes the way we do things- when a western adult wants to pick up something from the floor they bend over at the hip. Watch a young child that has recently started to walk do it- they do a full squat with their heals on the ground!


My grandfather, a physicist, had many odd friends. One of them was a Brit who in the 1950's invented a toilet that permitted squatting. He said of the work, "I believe the savages had it right all along."

The toilet was never produced.


One of them was a Brit who in the 1950's invented a toilet that permitted squatting

I do believe I have seen somewhere a flyer by the British National Health Service advocating putting one's feet on a (step)stool in order to achieve a more optimal position when using a traditional toilet. So perhaps his legacy lives on.

(I am too scared to try and google for proof).


> advocating putting one's feet on a (step)stool in order to achieve a more optimal position when using a traditional toilet

I haven't seen the NHS flyer but I have seen a photo of a sign from Japan indicating that this is a good idea (also that you should rest your elbows on your knees and bulge your stomach out). I think it certainly helps things (this has got to be the oddest thread I've seen on HN in a while).


Seed funds didn't exist in the 50s.


News the laxative industry doesn't want you to hear!


The study claims squatting is better than sitting for hemorrhoids, but what is the effect of squatting on the knees?


Deep squatting is good for the knees.

I do it as a weight lifting exercise three times a week. Please squat below parallel (i.e. hip below knees, the bone in your leg should be below parallel to the ground). High squatting above parallel can wreck your knees.


I'm still holding out for the Three Seashells toilet.


Technically and nerdily, I believe that was a form of toilet paper and not a toilet.


Squat toilets are also more sanitary. I'd much prefer public toilets in the US be of the squat variety.


The public squat toilets I've seen have been more of a mess than public sit toilets, and the standing area can be as bad as the porcelain rim of a sit toilet -- a place I would not choose to step. So while more sanitary under ideal proper use, in public places they appear to me less sanitary, at least in their effect on all floors nearby.

I wonder if this contributes to the higher rates of hepatitis and related illnesses in Asia -- and that in turn to the custom of removing shoes before entering households.


> I wonder if this contributes to the higher rates of hepatitis and related illnesses in Asia -- and that in turn to the custom of removing shoes before entering households.

Removing shoes before entering households is standard practice in quite a few (most?) European countries as well, so I imagine it is not related to higher rates of hepatitis and subsequent fear of infection.

(Frankly, from a subjective viewpoint, I consider this custom to be related mostly to common sense. It seems mind-boggling to me not to remove shoes before entering your home. Not only does it keep your home cleaner, but it is more comfortable to boot.

The only valid exception would be not asking guests to remove shoes, since they may not be comfortable with that.)


Frankly, I always considered it extremely rude and boorish to not remove shoes when entering someone's house (I'm american, if it matters). Think about it- would you drag an object through city streets, gutters, mud, sewage, and other bad areas, then drag it all over the floor of your house?


Of course, if that's the host's custom, guests should follow it as well. But many hosts don't take their own shoes off.

While you never know what's on the streets, well-off areas of the US generally have clean, dry walkways -- it's rare for sewage to be tracked about. We have comparatively little dirt/mud/feces-transmitted disease -- such as typhoid, hepatitis, cryptosporidiosis, or various other waterborne parasites.

And, North American children face rising rates of allergies and autoimmune disorders, which, if the hygiene hypothesis is to be believed, are made worse by too little exposure to mild pathogens from unclean environments.

So the most health-promoting custom might vary a lot by region.


It's customary to remove your shoes in at least Germany, Sweden and Switzerland. British people are strange. They keep their shoes on.


It's not a national custom, but a lot of people do take off their shoes when entering a house. It's the first thing I do when I get home - even more so if it's been raining because we have cream coloured carpets throughout the house and my wife would rip my balls off if I was to walk mud through the house ;)

That said, I quite often take my shoes off at work as well.


Until they move to Canada - then they remove them again. I always got looks for removing my shoes at work, it's much more comfortable to wear socks.


I often remove the socks, too. Depends on the temperature.


It's very good if you are handling static sensitive electronics. Sweaty feet and a concrete floor is much better than nylon carpets and plastic shoes.


I would say that except one or two, all the other public squat toilets which I've seen were horrible. Though I agree that they're more sanitary because your butt doesn't touch them.


For what it's worth, I've been squatting since preadolescence. As a counterpoint to the experience of the sitters in the study who rated their experiences squatting "more comfortable" than sitting, I've tried going back to sitting from time to time to no avail; I find it unnatural and difficult.

I always figured it was because I was used to doing it my way, not because it was easier. I didn't switch for comfort reasons, and certainly I never dreamed it might prevent hemorrhoids later in life!


Besides sitting vs Squatting, the other (and more important) issue with the western style toilet is the use of "papers" instead of bidet (water hose) for cleaning after oneself.

At home we always install a home-made bidet: usually a water hose connected to the shower somehow with a mechanism to turn it on/off.

When I'm in a public place, I try to avoid using public bathrooms. Sometimes I can't avoid it, like when I'm at work.


I was told once that in China, people squat a lot more than in the West. Both for toilet use, but also just for "sitting down" somewhere.

Example: I was told that upon seeing a bench, whereas westerners would normally sit on it, a Chinese person will squat on it. This supposedly also makes their legs much stronger.

Can anyone confirm this?


Squatting trivia: South Asians do squat in repose, but notice that the heel of the foot is in full contact with the ground.

I read somewhere that the typical Westerner, or someone not used to squatting for extended periods, will squat on the balls of their feet. Apparently this can tire you out quickly.

I'm embarrassed that I can't quite manage to squat on my heels either, despite being South Asian.


>I read somewhere that the typical Westerner, or someone not used to squatting for extended periods, will squat on the balls of their feet.

My calf muscles don't allow my thighs to press against my calves along their length as in images of people squatting full footed. The lever created means a huge amount of pressure on my knees like when you use a bar under a claw-hammer to increase upward force. I've tried squatting flat footed and holding onto something - it's very painful on the front of my legs and my thighs don't go closer than about 15deg from my calves.

I crouch down a lot as I spend a lot of time next to tables talking to people sitting.

I also can't sit cross-legged comfortable, never could. It made school assemblies hard for me I have to hold my legs crossed in an elevated position (knees away from the floor) which then adds pressure on the buttocks.

Perhaps it's just me. I don't consider myself to appear obviously anatomically dissimilar to those around me.


I spent a couple years in South Korea a number of years ago and challenged myself to squat as the natives did. It didn't take long to achieve full heel contact with the ground but I never felt entirely balanced.

FWIW I found regular sitting toilets in most homes and establishments that I visited. The "squatter" was actually not common in the parts I traveled (25 years ago and mostly in Seoul). I think I used one twice in 2 years.


IMHO it's because they are two different kinds of squats. On the balls of your feet, you a ready to spring into action at any second- it is more like a quick breather than a resting position. It comes much more naturally. On your heels, you can't exactly break into an instant run.


That was just my point - it comes naturally to Westerners because they are not used to squatting. South Asians can execute either stance equally naturally.

I've seen people go from standing to squatting position (not in a toilet) and they don't go through an intermediate ball-of-foot-squatting phase.


Yes. But sliverstorm wasn't saying that they go through an intermediate ball-of-foot-squatting.

By the way, practice makes perfect in squatting as in every thing else.


I think it's affected with whether you're skinny person or not. Skinny people are easier to squat on heels, as they have smaller flesh/muscle.

I observe football players have difficulty in squatting on heels.


I know it is quite common to see people squatting in Japan.

http://www.kirainet.com/english/japanese-crouching/


This is the stereotypical Asian squat. Interestingly, young children do it by default. I think we lose flexibility as we age. I can't squat back on my heels without straining my shin muscles to keep from falling backwards, but the more I do it, the easier it becomes.

It is certainly a lot healthier for your knees than squatting on the balls of your feet, if only because your knees stay roughly on the same vertical as your toes. This is old powerlifter wisdom, and anyone with a knee injury can tell you first-hand. I can't squat on the balls of my feet without my right knee squealing in pain. Squatting on my heels is, at least, tolerable.


Yep! I was about to post that I learned this from my toddler... and trying to squat (western style) next to him to play.


Yes. But the loss of flexibility does not come automatically with age. If you keep moving, you will keep your flexibility. And you can get it back with practice.


I don't think it's as simple as keeping moving. I lost that flexibility fairly early on, certainly in the middle of playing multiple sports through high school, and I'm still very active today.

I know I don't do enough stretching, though. It's just frustrating because my hamstrings never seem to improve, and as soon as I stop stretching, I go back to base (about 12" from touching my toes while standing).


> I was told once that in China, people squat a lot more than in the West. Both for toilet use, but also just for "sitting down" somewhere.

In rural midwest US, the instead-of-sit squat is called a "hunker". Yes, folks talk about "hunkering" and will say "come over her and hunker with us for a while". "Hunker down" is different.

> I was told that upon seeing a bench, whereas westerners would normally sit on it, a Chinese person will squat on it.

I've never seen anyone hunker on a bench - they always hunkered on the ground.


It's true. Especially in the northwest China.

But things seem to change a little bit. The white collars think it looks strange. They would rather stand than squat.

Thanks for the post. I don't feel ashamed when waiting for a bus with squat now.


If your interested in outfitting your own house with something else,

http://www.naturesplatform.com/index.html

I've tried myself to squat while hiking outdoors and I keep falling over.


And how can you argue with those endorsements!

I've been balancing on toilet seats for twenty years. I've broken a few, and dislodged my share of toilets from their anchors to considerable expense. The stability, comfort and ease of Nature's Platform is a great relief.

Charlie Walters, M.B.A. Boone, North Carolina

http://www.naturesplatform.com/testimonials.html#Walters


I lived in Turkey for a while and almost every house has one normal toilet and one old school toilets (hole in the floor) which hasn't got a place to sit so you have to squat.

AFAIK also muslims prefer squating over sitting as it's the suggested practice, also they don't pee standing up (I think this is due to health reasons as well but can be about being clean,not sure).

I always prefer squating over sitting however when you get old generally you need to sit as squatting is literally requires effort, many elderly people sits due to this.

I can't imagine squating in a normal sit toilet, that's just dangerous.


> I can't imagine squating in a normal sit toilet, that's just dangerous.

Only if you have trouble supporting your bulk, be it due to obesity or lack of muscle conditioning. Or balance issues, obviously.


Are you imaginining standing on the seat, standing on the rim, or standing on the ground in a martial arts horse stance? Because I can see significant possible problems with all of these. (technically, problems with the last would be due to "lack of muscle conditioning," but not many people are conditioned well enough to stay in a horse stance for long).


The rim. The seat, provided it is solidly built and attached. Anecdotally I feel quite stable either way.

Edit: the trick to perching on various narrow surfaces, for me, is to have the heel on one side an the ball of the foot on the other. "Gripping" as it were.


Let's just say that this squatting thing really does have all the benefits that the article says it does.

Does is occur to anyone else that instead of squatting precariously on a sit toilet, risking a fall and backsplash on the feet, one could simply put a stack of phonebooks or a kiddie stool in front of the toilet, and then put your feet on it while you take a dump? Same angle for the core/legs, but less danger.


One of the commentators on the original article suggested using a stool. It's a good idea, but what a choice of words!


I'd think you'd want something on each side of the toilet, not just in front.


I haven't sat on a toilet in years. I spend less time in the rest room and I've also got some good quad muscles to show for it.


The article probably should have mentioned that squatting is still common in Muslim dominated countries.

We squat because that's the cleanest way to release waste. We also squat when we urinate, that way no urine is splashed back to your pants, which happens when you stand and urinate.


I believe I saw a diagram once of one's internals in both postures. The squatted one looked more "natural" or at least less... "tangled". I had no luck finding that picture to share though. Can anyone assist?




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