DEFECATION POSTURE – SITTING VERSUS SQUATTING
Abstract
Background: Despite emerging debates on what should constitute a recommended defecation posture the research in this area has been mostly non-conclusive. In the countries of Europe, America, Australia the sitting position forced by a design of water toilet prevails while in many Asia and Africa countries the squatting posture dominates. The postures have their distinctive impact on digestive, musculoskeletal, and overall body health. Both of them have advantages and disadvantages.
Aim: This systematic review aimed to critically evaluate previous research on the defecation posture. The comparison of changing the defecation position from squatting to sitting was performed and its effects analysed.
Material and methods: A search of relevant research databases was conducted as well as a hand search of selected journals to identify eligible papers.
Results: A total of 20 studies were reviewed and results indicated a mean prevalence rate of sitting posture between 10%–24%. Findings also indicated correlates such as the presence of health problems related to the defecation posture. Most studies showed poor external validity, with the majority of them scoring high on risk of bias.
Conclusions: Overall, the findings indicate inconsistencies in terms of methodology and diagnostic criteria of health problems related to defecation posture. Further research in this area using long-term clinical trials to avoid biases is recommended.
References
Chakrabarti S, Ganguly R, Chatterjee S, Chakravarty A. (2002). Is squatting a triggering factor for stroke in Indians? Acta Neurologica Scandinavica 2002;105(2):124–7. https://doi.org/10.1034/j.1600-0404.2002.1o196.x
Dimmer C, Martin B, Reeves N, Sullivan F. Squatting for the prevention of haemorrhoids? Townsend Lett Doctors Patients. 1996; 159: Pages: 66–70. https://documents.uow.edu.au/~bmartin/pubs/96tldp.html
García-Zermeño K. R., et al. (2019). Sa1658 – Influence of a Defecation Posture Modification Device (Squatty Potty®) in Healthy Volunteers and Dyssynergic Patients Gastroenterology, Volume 156, Issue 6, Page S-356, https://doi.org/10.1016/S0016-5085(19)37725-X
Koo E., Chey W. D., Ezell G., Baker J. R., Armstrong M., Nojkov B. (2023). Can a Defecation Posture Modifying Device Correct an Abnormal Balloon Expulsion Test in Chronically Constipated Patients?, Clinical Gastroenterology and Hepatology, Volume 21, Issue 3, Pages 847 – 848, https://doi.org/10.1016/j.cgh.2021.12.048
Modi R. M., Hinton A., Pinkhas D., Groce R., Meyer M., Balasubramanian G., Levine, E., Stanich P. (2019). Implementation of a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects Journal of Clinical Gastroenterology 53 (3), Pages 216-219, March 2019, https://doi.org/10.1097/MCG.0000000000001143
Sikirov D. (2003). Comparison of straining during defecation in three positions: Results and implications for human health. Dig. Dis. Sci. 2003; 48 (7): Pages 1201–5. https://doi.org/10.1023/a:1024180319005
Sohrabi S., Malekzadeh R., Ansari R., Kamangar F. (2012) Squatting and risk of colo-rectal cancer: a case-control study. Middle East J. Dig. Dis. 2012; 4 (1): Pages 23–7. https://pmc.ncbi.nlm.nih.gov/articles/PMC4017696/
Trieu R. Q., Prott G., Sequeira C., Jones M. P., Mazor Y., Schnitzler M., Malcolm A. (2022). 956: Using a Footstool Does Not Aid Defecation: a Randomized Controlled Trial, Gastroenterology, Volume 162, Issue 7, Supplement, 2022, Pages S-223-S-224, https://doi.org/10.1016/S0016-5085(22)60535-3
Yu S. (2018). Research on toilet redesign based on ergonomics. Int. J. Eng. Sci. 2018; Vol. 4, Issue 7: Pages 24–30. https://doi.org/10.9790/1813-0704022430
Cai D., You M. (1998). An ergonomic approach to public squatting-type toilet design. Appl Ergon. 1998; 29(2) : Pages 147–53. https://doi.org/10.1016/s0003-6870(96)00023-3
Rane A., Iyer J. (2014) Posture and micturition: does it really matter how a woman sits on the toilet? Int Urogynecol J. 2014; 25(8): Pages 1015–21. https://doi.org/10.1007/s00192-013-2284-7
Ozturk O., Koklu H., Akbal E., Aksoy E., Altan E., Basar O. (2018) et al. Diverticular disease and posture during defecation: a prospective comparative study. Acta Gastroenterol Belg. 2018; 81 (4): Pages 490–5. https://pubmed.ncbi.nlm.nih.gov/30645917/
Bhattacharya S., Chattu V. K., Singh A. (2019) Health promotion and prevention of bowel disorders through toilet designs: A myth or reality? J Educ Health Promot. 2019; 8(1): Page 40. https://doi.org/10.4103/jehp.jehp_198_18.
Buldukoğlu O. Ç., Öcal S., Atar G. E., Harmandar F. A., Çekin A. H. (2024) Sit or Squat? Toilet type is a determinant of diverticulosis development. Turk J Gastroenterol. 2024; 35(6): Pages 475–80. https://doi.org/10.5152/tjg.2024.23652.
Gupta S., Karkra R., Chhabra R., Karkra S. (2023) Is defecation posture and diet associated with functional constipation in Indian children? Ann Pediatr Gastroenterol Hepatol ISPGHAN. 2023; 5(1): Pages 2–4. http://dx.doi.org/10.5005/jp-journals-11009-0121
Takano S., Sands D. (2016) Influence of body posture on defecation: a prospective study of “The Thinker” position. Tech Coloproctol. 2016; 20: Pages 117–21. https://doi.org/10.1007/s10151-015-1402-6
Sakakibara R., Tsunoyama K., Hosoi H., Takahashi O., Sugiyama M., Kishi M. (2010) et al. Influence of body position on defecation in humans. Low Urin Tract Symptoms. 2010; 2(1): Pages 16–21. https://doi.org/10.1111/j.1757-5672.2009.00057.x
Uzun N., Yildirim E. (2022) Relationship between toilet type and hemorrhoids. Bezmialem Sci. 2022; 10 (6): Pages 698–702. https://doi.org/10.14235/bas.galenos.2022.60352
Shekokar A. V., Borkar K. (2017) Comparative role of squatting posture & sit-ting posture of defecation in anorectal bleeding. Int J Ayurveda Res. 2017; 8 (2): Pages 101–4. http://dx.doi.org/10.47552/ijam.v8i2.980
Lam T., Islam N., Lubowski D., King D. (1993) Does squatting reduce pelvic floor descent during defaecation? Aust N Z J Surg. 1993; 63 (3): Pages 172–4. https://doi.org/10.1111/j.1445-2197.1993.tb00512.x
Parasuraman S., Wen L. E., Sam A. T., Christapher P. V., Kumar K. V. (2016) Analysis of correlation between defecation posture and risk of urinary tract infections among adolescent populations. Environ Dis. 2016; 1 (2): Pages 77–82. https://doi.org/10.4103/2468-5690.185305
Yang K. N., Chen S. C., Chen S. Y., Chang C. H., Wu H. C., Chou E. C. L. (2010) Female voiding postures and their effects on micturition. Int Urogynecol J. 2010; 21 (11): Pages 1371–6. https://doi.org/10.1007/s00192-010-1204-3
Moore K. H., Richmond D. H., Sutherst J. R., Imrie A. H., Hutton J. L. (1991) Crouching over the toilet seat: prevalence among British gynaecological outpatients and its effect upon micturition. Br J Obstet Gynaecol. 1991; 98 (6): Pages 569–72. https://doi.org/10.1111/j.1471-0528.1991.tb10372.x
Mahdavinejad M, Bemanian M, Farahani SF, Tajik A. (2011) Role of toilet type in transmission of infections. Int J Acad Res. 2011; 1 (2): Page 110. http://www.savap.org.pk/journals/ARInt./Vol.1(2)/2011(1.2-11).pdf
Mohsin M., Zargar H. R., Bhat T. A., Bhat H. A., Mir F. A., Wani A. H. (2020) Open ten doachilles injuries due to squatting type of toilet seats: five-year prospective observational study from a tertiary care center in India. Injury Care Inj. 2020; 51 (10): Pages 2316–21. https://doi.org/10.1016/j.injury.2020.06.051
Dar T. A., Sultan A., Dhar S. A., Ali M. F., Wani M. I., Wani S. A. (2011) Toilet seat injury of the Achilles tendon a series of twelve cases. Foot Ankle Surg. 2011; 17 (4): Pages 284–6. https://doi.org/10.1016/j.fas.2010.11.002
Snijders C. J., Molenbroek J. F. M., Plante R. A. (2011) Biomechanical aspects of defecation with implications for the height of the toilet. Assist Technol Res Ser., 2011; 27: Pages 207–13. https://doi.org/10.3233/978-1-60750-752-9-207
Edgar C., Sohail M., Cavill S. (2017) Rethinking the effectiveness of defecation postures and practices: It’s not what you do it’s the way that you do it!, Waterlines. 2017; 36 (4): Pages 367–73. http://dx.doi.org/10.3362/1756-3488.17-00019
Ali, W., An, D. Z., Yang, Y. F., Cui, B. B., Ma, J. X., Zhu, H., et al. (2022). Comparing bioaerosol emission after flushing in squat and bidet toilets: Quantitative microbial risk assessment for defecation and hand washing postures. Building and Environment, 221, 109284. https://doi.org/10.1016/j.buildenv.2022.109284
Rahgoshay, N., Rahdar, M., Nikoo, L. et al. (2025) Sitting vs. squatting: a scoping review of toilet postures and associated health outcomes. BMC Public Health 25, 2192 https://doi.org/10.1186/s12889-025-23379-8
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