You, Your Body, and a Toilet Footstool

Some frequently asked questions about the toilet footstool covered in this article:

• Is it worth getting a toilet footstool?

• Can I use something else instead of a toilet footstool?

• I tried the toilet step stool and didn't like it. Am I doing something wrong?

• Should I use a squatty potty if I have no problem with my bowel movements?

• How should I sit when I use a toilet footstool?

Pelvic floor

Back just a little straighter

Using a sqatty potty

Buyer beware: Before you buy the toilet footstool, you need to know something. The toilet footstool is just a tool; we all know it means nothing if you do not use it correctly.

So, before we tell you how to use the toilet footstool correctly, we have to tell you that you need to work WITH your body when you use it. It's you, your body, and the toilet footstool!

This article is written for those who have problems pooping but also for those who are fine and want to avoid problems in the future - such as the dreaded hemorrhoid.

You may be wholly unaware of it, but:

It Takes Two To Poop

When marching off to the outhouse, realize you are not alone. To have a good, productive experience, you and your body need to go in there together and work like a team.

Our bodies usually work in harmony with us without our awareness, but sometimes, we fall out of sync without realizing it.

So, first, work WITH your body, not against it.

Consider your body as your partner when things go awry.

For example, there are some things only your body can do, like withdrawing nutrients from the GI system. Then there are other things you can do to help, like deciding what you eat and how much exercise you do.

Having such a relationship with your body also means that there are times when you just let go; you have done your part, and now your body needs to do its part.

We do not have to be in control of everything all the time. Remember, our organs were programmed to do their job without our input.

Our bodies are highly adaptable, and you may be surprised to learn that minor changes can make a big difference when we work with our bodies.

Even though choosing your body as your partner is a very simplified way of viewing complex anatomy and physiology, it does seem to provide a helpful strategy during times of hopelessness. It gives us a map/guide to do the right thing and may help decrease anxiety.

With the purpose in mind of keeping things simple, let's explore where we can help our bodies when having a bowel movement.

Second, help your body out by doing the following:

During a bowel movement, our body creates spontaneous peristaltic motions, helping stool inside the rectum slide out into the world.

We can help during this process by trying the following:

• Going to the bathroom when we have an urge decreases the possibility of straining. It also means listening to our body's signal—answering nature's call.

• Trying to go about 20 minutes after a meal to summon the help of the gastrocolic reflex. This reflex happens when the stomach walls are stretched, resulting in increased peristaltic movements of the GI system and an easier push.

• Be consistent and go to the bathroom at the same time every day. Your bowels love consistency.

• Taking the time and not rushing out the door will also help the parasympathetic nervous system work optimally. Our GI system does not work well in rushed, fight-or-flight mode.

• Producing well-formed stool through diet, exercise, and adequate fluid intake.

• Executing a coordinated push without harming the surrounding tissues by not straining.

• Altering our posture when sitting on the toilet. (Please note that the rest of this article will focus on this point.)

Third, take having a great poop to the next level by adding a tool - the toilet footstool.

The pelvic floor muscles:

The pelvic floor (Puborectalis muscle) operates like a sling around the junction between the anus and the rectum (anorectal angle), always giving it a friendly hug, creating an angle of 80° to 90° while we are at rest or going about doing our daily work.

When we pick up heavy objects, the pelvic floor hugs even tighter, making the angle smaller to keep things safe and secure above the rectum.

Then, when it is time to evacuate, the pelvic floor relaxes and bulges, allowing the sling to lengthen a bit and the angle to widen (100° —110°), resulting in the rectum straightening out more and opening the path for stool to pass.

And there you go! Isn't our anatomy amazing?

Picture: The pelvic floor muscle operates like a sling to change the anorectal angle.

So, can we help widen the anorectal angle during a bowel movement?

The squat:

We help our bodies open the anorectal angle when we sit in the squatting position.

So, we recommend that you squat for better bowel health.

However, in our modern culture, squatting may not be perceived as appropriate, especially if done in the same way our ancestors did.

It could also be that our toilets are too convenient, that it feels uncomfortable or even painful to squat, or that, most of all, squatting may feel really awkward—so much so that we do not even want to do it behind closed doors.

What if we can modify a full squat into a semi-squat?

In 2010, a doctor recommended that a very constipated mom lift her feet when sitting on the toilet. That gave her a great deal of relief and was the beginning of using the toilet footstool, or the now-famous and world-renowned Squatty Potty. 1

The toilet footstool:

Let's explore more if it is worth getting a toilet footstool.

Sikiro. Dov. 2 looked at people sitting on a regular toilet, a low toilet, and a proper squat; the deeper we squat, the better.

But research by Modi et al. 3 has shown that using a toilet stool-type device during defecation can improve how fast you poop, how well you poop, and improve straining patterns. 

So here we have confirmation that a semi-squat is okay. But you decide. Maybe it is worth a try?

Picture: To help you squat, you can use any object that will support your feet flat and steady.

Can I use something else instead of a toilet footstool? 

You can use anything sturdy and safe in your available space.

You can purchase a toilet stool, a travel toilet stool, a squatty potty 4, a box, or a DIY homemade device designed to match your interior design and even mark where your feet should be.

I tried the toilet step stool and didn't like it. Am I doing something wrong?

If you are suffering from bowel problems, it may be worth experimenting a bit more to see if the footstool may benefit you.

Make sure the height works for you, and adapt to any restrictions you have in your joints.

In an article, the Physical Therapy Association (APTA)5 suggests putting your left foot on the step stool if you find elevating both feet too uncomfortable.

If you still don't like the toilet stool as your choice of bathroom furniture, try bending/leaning forward.

Should I use a squatty potty if I have no problem with my bowel movements? 

We highly recommend assuming a squatting type position if you suffer from any of the following: Pelvic floor dysfunction, pelvic pain, hemorrhoids, constipation, prolapse, GI disorders, IBS, anorectal issues, anal fissures, diverticula, rectal prolapse, dyssynergia, other bowel problems, or after surgery.

We also recommend everyone else use a toilet footstool for overall bowel health.6

However, some people's bodies work like clockwork and do not need any additional help.

How should I sit when I use a toilet footstool?

Lastly, how to use the tool correctly:

Learn how to Sit on the Toilet When Using a Toilet Footstool—The Ultimate Guide for Adults and Kids.

For kids: We teach them to get into the best position and fly their toilet plane.

• Pull out your box or toilet footstool before you sit on the toilet so it is within reach.

• Depending on what you wear, you may have to pull your pants down to your ankles or even pull one leg out.

• Sit flat on the toilet seat; do not hover.

• Place your feet flat on your toilet footstool and ensure your feet are supported well. (The always-on-guard anal sphincter and pelvic floor will contract with any instability down on the ground and also when you curl your toes or push through the balls of your feet.)

• Ensure your knees are higher than your hips.

• Sit with a straight back, lean forward, and rest your elbows on your thighs/knees.

• Have your knees and feet about shoulder-width apart. (A small footstool may not provide enough space to keep your feet flat and comfortably apart.7)

• Relax your mouth, jaw, arms, legs, stomach, and pelvic floor.

• Take a few deep belly breaths with your stomach pushing out towards your legs. Making your belly round, not pulling your stomach in.

• Give a little "urg" at the end of one of the breaths, which will help the pelvic floor descend a little more.

• Then, wait and see if your body does the rest through peristaltic movements.

• Avoid straining.

• Success?

• Please note that people with additional pelvic floor dysfunction may need more help. If that is you, please visit your favorite pelvic floor physical therapist.

Don't worry if you can't fully get into the suggested position.

Adapt the position until you are comfortable.

For some people, implementing just one of these suggestions might be sufficient to improve their bowel health and even be a game-changer.

Summary:

This article starts with why we propose that you partner with your body (It takes two to poop) when you have difficulty with bowel movements.

We recommend that you work with your body and not against it.

Understanding the body's functions helps you identify factors where you can make an impact and help your body and when it is time to sit back and let it do its job.

This article then continues to investigate how changing your posture using a toilet footstool can help your body have faster and better bowel movements.

We propose that small changes can be a game-changer for your bowel health.

(Please note that this article is the first in a series we call "It Takes Two To Poop" The next article to dive into is "The Perfect Poop.")

For the community:

Please let us know which of our posture tips have helped improve your bowel health and if you found the strategy of "It takes two to poop" helpful.

We would also love to hear funny toilet or outhouse stories—we know they are out there.

Thank you to Wix Media and Pelvic Global for the images used. Thank you to those in Albuquerque who trust us as their pelvic physical therapists.

References

1. https://www.squattypotty.com/pages/our-story

2. Sikiro, Dov. (2003). Comparison of Strai ing During Defecation in Three Positions: Results and Implications for Human Health. Digestive disease and sciences. 48. 1201-5. 10.1023/A:10241 0319005.

3. Modi, Rohan M. MD*; Hinton, Alice PhD†; Pinkhas, Daniel DO*; Groce, Royce MD, MS‡; Meyer, Marty M. MD‡; Balasubramanian, Gokulakrishnan MD‡; Levine, Edward MD‡; Stanich, Peter P. MD‡. Implementing a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects. Journal of Clinical Gastroenterology 53(3):p 216-219, March 2019. | DOI: 10.1097/MCG.0000000000001143

4. Squatty potty commercial: https://www.youtube.com/watch?v=YbYWhdLO43Q

5. https://www.aptapelvichealth.org/info/proper-toileting-posture

6. Bhattacharya S, Chattu VK, Singh A. Health promotion and prevention of bowel disorders through toilet designs: A myth or reality? J Educ Health Promot. 2019 Feb 15;8:40. doi: 10.4103/jehp.jehp_198_18. PMID: 30993133; PMCID: PMC6432810.

7. Chen Y-L, Sari RK, Liao Y-H, Lin W-C. Optimal Span between Feet of Public Squat Toilet Based on Anthropometric Data and Squatting Stability Assessment. Healthcare. 2021; 9(1):42. ttps://doi.org/10.3390/healthcare9010042

Knol ME, Snijders HS, van der Heyden JT, Baeten CI. Fecal Incontinence: The Importance of a Structured Pathophysiological Model. J Anus Rectum Colon. 2022 J n 28;6(1):58-66. doi: 10.23922/jarc.2021-040. PMID: 35128138; PMCID: PMC8801252.

About the author:

Dr. Sunel Vanderwalt owns Trailhead Pelvic & Visceral Physical Therapy in Albuquerque, NM, where she provides pelvic floor therapy for adults and kids. She combines orthopedic, pelvic, visceral manipulation, and manual physical therapy.

Dr Sunel is also a founding member of IPC - Clinical Excellence Network for Male Pelvic Health, where international therapists collaborate to provide excellent care for male pelvic floor PT.

The content on this site is provided for informational purposes only and should not be used as a substitute for direct medical advice from your doctor or another qualified clinician.

Pelvic Floor Therapist

Dr Sunel Vanderwalt Pelvic PT

Clinical Excellence Network

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