Is The Squatty Potty The Magic Answer for Constipation?
It’s true - position during defecation can affect the ease and effectiveness of the process in a positive way. The Squatty Potty, or any stool which increases hip flexion (the closer your knees are to your chest), helps for a few reasons -
Decreased straining (1)
Decreased duration (1)
Improved ability to completely empty your bowels (1)
Why does it help?
The rectum is the last 20 cm of your large intestine, while your anal canal, which is between the rectum and anus, is closed off by sphincter muscles. (2) The rectum is naturally at an angle that can create resistance against the passage of stool. (2) When you sit with increased hip flexion (knees closer to your chest) - whether that’s feet on a stool or leaning your trunk forward into the Thinker position - the anorectal angle is increased and aligns the rectum with the anal canal. (3)
This changed alignment between the anus and the rectum, can allow for a much smoother exit for stool. This can help with emptying, but it is not the end all be all. In fact, one small study found only 50% of participants had improvement in elimination. (4)
So what else can we do for constipation?
#1 Relax the pelvic floor.
During the expulsive phase of defecation (where you actually have a bowel movement) the pressure in the rectum, needs to exceed that in the anus. One can accomplish this one of two ways:
Relax the pelvic floor to decrease the anal pressure so that pressure in the rectum is greater (ideal).
Increase pressure in the abdomen (straining or pushing) which in turn increases pressure in the rectum to achieve that greater than pressure int the anus (not ideal).
The former is much more effective and limits unwanted strain on a contracted pelvic floor, which can in turn reduce risk of development of hemorrhoids.
#2 Optimize your intake.
There is a strong correlation between dehydration and constipation. (3) That means roughly half of your weight (in pounds) in ounces. If that seems like a lot, start by increasing in small increments - one more glass, one more water bottle, etc.
Dietary fiber also helps bulk up your stool and has been found to play a role in stool frequency. (5)
#3 Exercise
More and more research is supporting the role of exercise in constipation. (6) Due to the variety of exercise interventions, there is no set recommendation. At this time, we are using the same exercise guidelines for general health for rectal health (6):
150 minutes of moderate intensity aerobic exercise PLUS 2 days of strength training!
Just like most things with our health, there isn’t one magic answer to things we are dealing with, but rather a combination.
If you have questions about your bowel health and feel embarrassed or uncomfortable bringing it up to your doctor or physical therapist, please know we are here to help and answer any questions you may have!
Written by Aly Freitag PT, DPT
Sources:
Modi, R. M., Hinton, A., Pinkhas, D., Groce, R., Meyer, M. M., Balasubramanian, G., Levine, E., & Stanich, P. P. (2019). Implementation of a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects. Journal of clinical gastroenterology, 53(3), 216–219.
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. In brief: How do bowel movements work? [Updated 2021 Dec 13].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279481/
Morgan, A. 2024. Lecture Presented: Rectal Pelvic Health. Institute of Clinical Excellence. Online. September 2024.
Takano, S., & Sands, D. R. (2016). Influence of body posture on defecation: a prospective study of "The Thinker" position. Techniques in coloproctology, 20(2), 117–121. https://doi.org/10.1007/s10151-015-1402-6
Yang, J., Wang, H. P., Zhou, L., & Xu, C. F. (2012). Effect of dietary fiber on constipation: a meta analysis. World journal of gastroenterology, 18(48), 7378–7383. https://doi.org/10.3748/wjg.v18.i48.7378
LaCross, Jennifer A. PT, DPT, PhD(c)1; Borello-France, Diane PT, PhD2; Marchetti, Gregory F. PT, PhD2; Turner, Rose MLIS3; George, Susan PT, DPT4. Physical Therapy Management of Functional Constipation in Adults: A 2021 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association's Academy of Pelvic Health Physical Therapy. Journal of Women's Health Physical Therapy 46(3):p E59-E84, July/September 2022. | DOI: 10.1097/JWH.0000000000000244