Many of you may already know that I have a long-standing interest in Irritable Bowel Syndrome. I wrote the first book ever for patients with this disorder in 1989 and 3 editions of a second book. The last one was published in 2001. Since then, I have created plenty of interesting and current information on our blog. In some circles, I am referred to as #1 for #2. It is only fitting that I should comment on a trend that may create more problems with constipation in our patients.
Millions of Americans suffer from constipation. Are you one of them? You may think that being constipated means less frequent bowels, such as one every 3 days. That is not necessarily true. You can have more frequent bowel movements and the stool may be hard and difficult to pass, resulting in straining and possibly even Hemorrhoids. Several factors may play a role in constipation, but have you considered that the height of your toilet may be affecting your bowel movement?
The Elimination Process
First, it’s important to have a basic understanding of how your digestive system works. Food moves from your stomach to your small intestine where it gets broken down into nutrients. The indigestible parts of food then move to the colon, where excess water becomes absorbed and stool forms. Stool then collects in the rectum at the end of the colon. A U-shaped muscle called the puborectalis wraps around the rectum holding the stool. When the rectum contracts, the puborectalis muscle relaxes, and it releases the stool.
Now that you feel comfortable with the elimination process, let’s plunge a little deeper into how elevated toilet posture plays a role in the elimination process… or lack thereof.
The Height Of A Handicap Toilet
A standard toilet is about 15 inches from the ground to the seat. A handicap toilet otherwise known as a comfort height toilet (or ADA-compliant toilet) is 17 to 19 inches from the ground to the seat. The extra added elevation from a handicap toilet makes it ergonomically challenging for smooth elimination because the angle of the rectum to the anus (anorectal angle) becomes more narrow. This leads to an upward pressure placed on the rectum and holds in the bowels creating potential blockages, extra strain, and even hemorrhoids.
This is where the concept of squatting comes into play.
Bowel movements may become more easily facilitated in a squatting position where the hips are slightly below the height of the knees. This allows the anorectal angle to shift, the rectum to open up, and the puborectalis muscle to relax. The result is that the bowel can empty easily, enhancing elimination, and decreasing strain and hemorrhoids.
Innovative defecation postural modification devices or DPMDs mimic a natural squat posture that is ergonomic and comfortable.  DPMDs like the Squatty Potty are convenient to use and you can store them directly under your toilet when they’re not in use. The Squatty Potty comes in two sizes 7” for standard toilets and 9” for comfort toilets. The Journal of Clinical Gastroenterology completed a 4-week study with 52 participants who used a Squatty Potty and found that 71% had faster bowel movements and 90% of participants strained less. 
While you’re considering the addition of a DPMD in your bathroom regime, you may find it helpful to know that I also recommend a handheld bidet. You can purchase a bidet and mount it on your toilet tank or on the wall next to your toilet. After you have a bowel movement, you use the bidet to rinse your bum off. While using a bidet may be a change to your routine, there are multiple benefits to consider when deciding if it’s a good choice for you.
Benefits Of Bidets
If you have a disability, the use of toilet paper requires more dexterity with your hands, with a bidet you can aim the nozzle and spray. For handicapped individuals, there are attached bidet seats that come equipped with a drying function available.
Aggressive wiping with toilet paper can irritate the skin and can be painful with hemorrhoids. Other conditions that may be painful when using toilet paper are diarrhea, rashes, and infections. With a gentle spray of water, you can decrease the need for wiping with toilet paper and feel cleaner down there. If you’re not convinced to try a bidet, then other benefits include saving money on toilet paper and less impact on the environment. Here’s a bonus for parents – you can use your bidet to rinse cloth diapers!
Here at The Care Group, we want you to have optimal digestion and enhanced elimination. If you have questions, we’re happy to address them. Please contact us at (303) 343-3121 to schedule an appointment.
 Implementation of a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects.
Modi RM, Hinton A, Pinkhas D, Groce R, Meyer MM, Balasubramanian G, Levine E, Stanich PP.
J Clin Gastroenterol. 2019 Mar;53(3):216-219.