BEST WAY TO SIT ON THE TOILET WHEN CONSTIPATED | 5 GUIDELINES
Reviewed by: Horia Marculescu, MD
The semi-squat position is the best way to sit on the toilet when constipated because it relaxes the puborectalis muscles and keeps unlocked the kink at the entrance of the rectum.
It also increases the anorectal angle and relaxes the sphincter. After defecation, the anorectal angle will decrease, and the kink locks again to prevent incontinence.
Use a footstool the get the best out of this sitting position. This object raises your knees higher than your hips.
By using this way of sitting on the toilet bowl, you will be able to have stool evacuation often and without much effort. For better results, squatting before going to the toilet is recommended.
1. THE SEMI-SQUAT WAY
The semi-squat position is the best way to sit on the toilet when constipated because it starts to relax the puborectalis muscles and the anal sphincter.
In this position, the kink at the entrance of the rectum will unlock, and the anorectal canal will have a clear path for the stool to move. After defecation, the anorectal angle decreases, and the kink at the entrance of the rectum will lock itself.
Locking the kink is natural, and it prevents leaks and fecal incontinence.
The only unnatural way to have stool evacuation is to permanently keep the kink locked.
Keeping the kink in this way is usually a consequence of staying at a desk for long periods with the knees at the same level as the hips.
By staying in this way, the anorectal muscles and the hips will numb. This thing means that blood circulation and motility in this area will suffer.
What is semi-squatting?
Semi-squatting posture is a way of combining ordinary squatting with the modern way of sitting on the toilet bowl.
It takes the typical posture from sitting on a chair with the hips and bottom on the upper seat. It simulates the squat posture that raises the knees higher than the hips.
It is an excellent combination that releases tension from your bottom, intending to move the stool inside the large intestine.
The differences between squatting and semi-squatting are:
- Your bottom sits on the toilet seat
- The heels sit on the footstool
- The entire soles of the feet stay on the footstool
People invented semi-squatting out of necessity in the modern era. The typical way that most people use when defecating does not relate to that from ancient times. Times when our body was eliminating the stool in a primitive way.
Put a footstool near the bowl
When you feel the need to have stool evacuation, place a footstool in the front margin of the toilet bowl.
Turn your back and put your foot on the footstool. Next, put the second foot and keep balance. Lower your body slowly until it reaches the toilet seat. It is really that easy.
Now stay in this way for 1-5 minutes, until you feel your bottom relaxed enough to poop.
If it takes longer than five minutes to have stool evacuation, then stay in this way for five more minutes.
If nothing happens after 10 minutes in the semi-squat way, move away from the toilet and try again later.
Put a footstool under your desk. Keep your feet higher than your hips while you are working or studying.
When you eat, you can also place a footstool under the table. Eating while standing on your feet is better because it releases the tension inside the intestines.
What do the experts say?
The Department of Colorectal Surgery, Cleveland Clinic, made a study in 2016 about the Influence of body posture on defecation: a prospective study of "The Thinker". 
The results were released on the US National Institute of Health website. The conclusion was that the semi-squat way of sitting on the toilet (under the form of “The Thinker” position) helps defection in patients suffering from constipation.
"The Thinker" position seems to be a more efficient method for defecation than the sitting position. This technique may be helpful when retraining patients with constipation.
The Digestive Health Foundation, with the contribution of The Gastroenterological Society of Australia, presents a useful article about constipation. 
The guidelines present how to use the semi-squat posture to have stool evacuation.
When sitting on the toilet it may be useful to make sure the knees are bent above the level of the hips and the feet are flat on the floor. A small foot-stool under the feet may be necessary to get the best position.
The references (Alexander Kira’s The Bathroom 1976) and the research include the variations in the distribution of weight borne by buttocks according to sitting height and posture. Also, there is a comparison of seat shapes and their effect on spreading the buttocks.
A survey of the medical literature had convinced him that throne-style water closet designs were a major cause of constipation, described by physiotherapist F. A. Hornibrook as “the greatest physical vice of the white race.”  Noting the medical view that the optimal posture was a squat, Kira proposed a semi-squat water closet with a redesigned seat that supported the ischial tuberosities and brought the knees above seat level, which would gradually strengthen abdominal and upper leg muscles and forestall many medical problems of the aged. 
The conclusion was that the semi-squat was the optimal posture to have stool evacuation. [back to top]
2. BENEFITS OF THE SEMI-SQUAT POSTURE
The semi-squat position is the best way to sit on the toilet when constipated because it makes the anorectal and puborectalis muscles to create a clear path for the stool to move.
By using this posture often, you will be able to:
- Have stool evacuation often
- Have stool evacuation without too much effort
- Have less abdominal and rectum straining
- Create a good pooping routine
When the body learns to squat and to recognize this way of sitting on the toilet bowl, it will naturally relax the puborectalis muscles. The more often the body is in the semi-squat position, the better it will handle defecation.
This way of sitting is an excellent remedy to prevent the numbness of the hips and the bottom. People who stay longer than five hours at the desk or in a car can use this position to keep the blood flow active.
Putting too much pressure on your abdomen and rectum will require to strain them even more. Straining the abdominal muscles and rectum will cause even more sourness and numbness.
That is the reason why straining is not that great for evacuating the stool at first. It takes a bit of time and some practicing of squatting.
Another great thing about this way of sitting is that: is easy to practice. It does not take effort at all and supports the weight of your body.
Also, if there is no footstool around, you can use the soles of your feet and have the same results.
If there is no footstool at your disposal, do the following:
- Position yourself on the toilet seat
- Raise your heels as much as you can
- Stay in this way for 1-2 minutes
- Take a pause
Repeat these steps 1-3 times until you get the desired result. The aim is to relax the puborectalis muscles and to open the kink at the entrance of the rectum.
If your heels and ankles start to feel sourness, then it is time to take a break.
What do the experts say?
The Inside Out guide is a professional publication that helps people with pelvic floor dysfunction exercise such as pelvic prolapse, incontinence after hysterectomy.
The Essential Women's Guide to Pelvic Support (by Inside Out) presents the semi-squat position as a way to improve pelvic floor muscles and blood flow. The main benefit of pelvic floor exercise is that it improves bladder control. 
There are many other exercises and positions in this guide that pelvic floor functionality.
Lying down … Standing with feet slightly apart or in stride stance. Semi-squat position with your hands resting on your knees as you lean forward slightly.
This exercise is a great exercise program with lots of variations and techniques. [back to top]
3. THE NORMAL WAY
The typical way of sitting on the toilet when constipated is having the knees at the same level as the hips.
It could also be with the knees a little bit higher than the hips. Usually, this thing happens when the toilet bowl is smaller than usual.
Sitting with the knees lower than the hips is not that great. It puts too much pressure on the bottom and hips. This thing happens when the toilet bowl is larger than the typical size.
The typical way of sitting on the toilet bowl is not great if you suffer from constipation.
The majority of people who stay at the office desk from 9-5 and suffer from constipation have a hard time when it comes to stool evacuation.
This thing also applies to:
- Drivers who stay in their cars for longer than five hours
- People who have to write all-day
- Kids at school who stay 5-7 hours and they can’t do exercise
- People who can’t move because of injuries
They put too much pressure on the sphincter and anorectal canal. Not to mention the hips that slow the blood flow.
But fortunate, for some people, this way of sitting does not affect the way they have stool evacuation.
This thing happens because they have proper intestinal transit and motility. Somehow, they manage to relax the puborectalis muscles and sphincter.
It is in their genes, or they do some kind of movement, unaware of them.
Why not continue with this posture? It is an unfavorable position, although it is easy to practice. Not everyone has a footstool at his disposal, especially in the public restrooms or at the office.
If you can’t have a footstool where you work most of the time, at least take your time at home and sit o the toilet in the right position.
What do the experts say?
The International Foundation for Functional Gastrointestinal Disorders in a study called Chronic Constipation: from Evaluation to Treatment, explains the dysfunctionality of the pelvic floor. 
The study explains that persons with pelvic floor dysfunction tend to have a defect in the coordination necessary for defecation. This defect is a functional outlet obstruction.
This usually occurs due to the failure of the pelvic floor muscles (including the anal sphincter) to relax appropriately during evacuation efforts, thus making stool passage much more difficult regardless of whether stool transit in the colon is normal or delayed. In some cases, individuals contract their pelvic muscles instead of relaxing them.
People who can poop without too much effort have functional pelvic floor muscles that contract naturally. In this way, the stool can easily pass through the rectum.
Another interesting study published by the US National Library of Medicine is called Comparison of straining during defecation in three positions: results and implications for human health. 
The study concludes that stool evacuation in the sitting posture implies effort, compared to squatting.
In conclusion, the present study confirmed that sensation of satisfactory bowel emptying in sitting defecation posture necessitates excessive expulsive effort compared to the squatting posture. [back to top]
4. THE FULL SQUAT
Squatting is a great way to prepare for stool evacuation. For most of us, squatting needs a place where people can be alone and feel comfortable.
Squatting on an Indian toilet is the best way to sit on the toilet when constipated because it relaxes the bottom.
But unfortunately, for 99% of people, thins thing is not possible in everyday life.
We can rarely find Indian toilets or Turkish toilets. And if we find an Indian toilet, it will be a dirty place. Or it will be out of order.
If you have a Turkish / Indian toilet with just a hole then, you don’t need much to do. Lower your body and position the rectum above it. And stay focus to keep balance.
The benefits of squatting make defecation easier.
View squatting as a way of preparing the stool to move towards evacuation. That's why you should squat 15-30 minutes before you go to the toilet, even if you stay in a typical way on the toilet bowl.
How to squat?
- Stand on your feet straight.
- Keep a foot distance between your legs. Lower your body until your knees are higher than your hips.
- Stay like this for 1-3 minutes.
Now take a break for one minute. Repeat the step twice and take a five-minute break. It is that easy.
Stay in this position for 15 minutes.
Squatting should come naturally and easily. If you fell sourness and numbness on your hips and knees, take a break and relax.
The main thing to keep in mind is to relax the puborectalis muscles and the anal sphincter. These are the only thing that matter when you practice squatting.
Try to have a ten-minute break once every hour. This thing means to stay on your feet or walk slow. The idea is to relax your bottom and keep the blood flow going.
Ideally, it would be great to have a ten-minute break every hour. But not more than ten minutes every two hours.
If you stay at the desk for longer than 5 hours daily, you can squat in the middle of the program.
Let’s say after 3 hours you can take a break before eating lunch. Walk 10 minutes and after that, squat for another 5 minutes.
Combine these two techniques in an empty room with no one around. After these exercises, you can eat while you stand on your feet. Try to focus and feel what happens in your belly.
What do the experts say?
A study published on the US National Institutes of Health website about the Influence of Body Position on Defecation in Humans concluded that squatting straightens the anorectal canal. 
In this way, there will be less straining required for stool evacuation.
The results of the present study suggest that the greater the hip flexion achieved by squatting, the straighter the rectoanal canal will be, and accordingly, less strain will be required for defecation.
The objective was to compare three positions by measuring abdominal pressure and the anorectal angle. [back to top]
5. OTHER WAYS TO SIT
Are there any other ways to sit on the toilet when constipated?
Besides the semi-squat way and full squatting, there aren’t any other ways.
Toilet bowls limit the way people sit on them. The body posture, and the need to defecate, need to be similar to squatting as much as possible.
A standard toilet bowl makes the body stay in such a way that it is not ideal for stool evacuation.
It is impossible to sit in any other way and have proper stool evacuation because:
- the kink at the entrance of the rectum locks itself
- the kink unlocks only when the anorectal angle increases
- the puborectalis muscles feel pressure if you don’t relax them enough
It may be more useful to think that there are ways to prepare and improve stool evacuation.
Squatting is a great way to prepare stool evacuation because it relaxes the bottom and the hips.
Drink hot tea before deciding to visit the restroom. This way of preparing bowel movement is excellent because it creates pressure inside the intestines.
Natural pressure creates gas. Gas makes the stool shrink, expand, and move towards the rectum.
Drink orange juice. It is a great way to create pressure and release it when the stool is ready.
Chicory has laxative effects. So, a glass of warm water and chicory might be a great way to improve bowel movement. [back to top]
6. A WORD OF CAUTION
If you suffer from severe constipation for more than three months, then it is time to see a doctor.
You will need to take some blood and stool tests to help you and the doctor establish a diagnostic.
The guidelines presented in this publication cannot replace the opinion and the diagnostic of a certified board-member.
If you suffer from high blood pressure, then you should start slowly to practice squatting.
In a study about Squatting, blood pressure, and stroke, the authors concluded that this position could affect patients that are hypertensive or are likely to develop stroke. 
Most Indians still adopt squatting posture in toilets. ..changes noted above on squatting appears to be more than fortuitous. We would suggest that hypertensive subjects and those at risk of stroke should avoid squatting and urge physicians to check squatting BP while monitoring anti-hypertensive therapy. [back to top]
The semi-squat posture is the best way to sit on the toilet when constipated because it relaxes the bottom. It creates pressure and a clear path for the stool to move towards evacuation.
It is easy to use with or without a footstool. And it is even more effective when your squat before you poop. So, the entire puborectalis muscles and sphincter get to chance to relax. [back to top]
- Best Position to Poop In When Constipated
- How to poop when constipated on the toilet
- Stuck on toilet with constipation
- What to do when constipated on the toilet
About the author
My name is Sebastian D., and I am the senior editor of constipationguide.com. With the help of my mentor, Dr. Horia Marculescu, I decided to create a practical guide to constipation relief.. read more