The art of defecation (doing a poo)

Author             Jóh-Ann Gouws BPhysT (UP) (NZRP)

Designation     Registered physiotherapist with a special interest in pelvic function

The Art of Defecation: Understanding the Importance of Position

You might be curious about the title, “The Art of Defecation.” This phrase captures the idea that achieving a healthy bowel movement is not just a biological function but an art form in itself.

In architectural discussions, bathrooms are often regarded as spaces for bodily renewal. A curator from the Biennale has even referred to the toilet as “the ultimate architectural element where the most intimate interaction between human and architecture occurs.”

Let’s explore the evolution of the toilet as we know it.

Before 1596, flush toilets did not exist; people relied on chamber pots, outhouses, and holes in the ground. The Romans had bathhouses where grooming was common, and they constructed latrines designed for sitting. These latrines were elevated to facilitate drainage and sewage flow, not necessarily for comfort. However, this sitting position is where many bowel issues began.

Anatomically, humans are designed to squat while emptying their bowels. In South Africa, this position is referred to as “Veldtie,” a term for defecating in the veld (the fields). Unfortunately, as access to modern toilets has improved, squatting has become less common. Globally, nearly one billion people still lack access to toilets and must practice open defecation, which poses significant health risks related to hygiene especially water safety.

So, how does squatting improve bowel movements?

The anatomy of the pelvis includes a muscle that wraps around the rectum, helping to control bowel movements. When this muscle is contracted, it can kink the rectum, preventing leakage. However, when it relaxes and elongates, the rectum straightens, allowing stool to pass more easily. Think of it like a garden hose: when kinked, water flow is restricted; when unkinked, water flows freely.

What happens if you remain seated instead of squatting?

Research indicates that sitting can prolong the time required to empty the bowels. In a squatting position, individuals typically experience a quicker and more effective release. Sitting can lead to increased straining, which further constricts the rectal muscles and makes complete evacuation more difficult. This can result in conditions such as anal fissures, hemorrhoids, constipation, and prolapse.

So, how can you modify your position? Surely squatting on the toilet isn’t practical, right?

No, you don’t have to resort to squatting on the toilet or returning to nature for relief. Instead, you can incorporate the principles of squatting into your toilet setup to enhance your bowel movements and reduce associated health issues.

Step 1 – Get a footstool

There is a very handy little footstool called the squatty potty. See their clever ads here https://www.youtube.com/watch?v=pYcv6odWfTM&t=26s and for the kids, they especially like this one here https://www.youtube.com/watch?v=YbYWhdLO43Q&t=8s.

You don’t need this specific brand though, any footstool that lifts the knees higher than the hips will do. For little kids who feel like they want to fall into the loo, it's advisable to have a narrow seat on top of the normal seat too.

Step 2 – With the knees lifted, the next step is to lean forward with a straight back.

**If you have a posterior wall prolapse you might need to alter this step.

Step 3 – In this position, you can then use your breathing to optimize your pelvic floor muscle function. Breathe in, relaxing the tummy and allowing it to drop down and fill with air, this in turn will help the pelvic floor muscle to relax and unkink the rectum.

Step 4 – To initiate pushing, use the top part of the abdominal muscles to generate pressure, relaxing the muscles in the pelvis around the rectum completely. You can use the word MOO to practice creating the right pressure. MOO to POO!

As you can see, the act of defecation (pooing) is an art. And as with any art, practice makes perfect! If you are struggling to get used to this way of getting rid of poo, keep at it, relax and if you need some help, visit a pelvic health physio to give you some guidance! You will be thankful for the many benefits you will get when you master this art.