How the Squatty Potty Works: Muscles & Research

The Squatty Potty and similar toilet footstools work by lifting your feet and bringing your knees above hip level, which mimics a partial squat while you sit on a standard toilet. This position relaxes a key pelvic muscle called the puborectalis, widening the pathway stool travels through and reducing the effort your body needs to push things along. The concept is straightforward, but the research behind it is a mix of genuinely encouraging findings and some important caveats that rarely make it into the marketing.

The Muscle That Makes It All Work

To understand why foot elevation matters, you need to know about one muscle: the puborectalis. This sling-shaped muscle wraps around the junction where the rectum meets the anal canal, creating a natural kink. When you’re standing or sitting upright, the puborectalis stays contracted, pulling the rectum forward and maintaining what doctors call the anorectal angle. That kink acts like a bend in a garden hose, helping you maintain continence throughout the day.

When you squat, the puborectalis relaxes and lengthens. The kink straightens out, and the anorectal angle opens up. Imaging studies have measured this directly. In one study using defecography, the anorectal angle during squatting averaged about 126 degrees, compared to roughly 100 degrees during normal upright sitting on a toilet. That 26-degree difference represents a meaningfully straighter path for stool to travel.¹

A Squatty Potty doesn’t put you into a full squat. You’re still sitting on the toilet, but your knees are raised, your hip flexion increases, and the puborectalis gets closer to the relaxed state it achieves in a true squat. The device is essentially a compromise between the biomechanical advantages of squatting and the comfort and accessibility of a modern seated toilet.

What Happens to Straining and Emptying Time

The earliest and most cited study on toilet posture had 28 healthy volunteers time their bowel movements and rate the effort required in three positions: sitting on a standard-height toilet, sitting on a lower toilet, and squatting over a platform. Both the time to feel satisfactorily empty and the perceived straining effort dropped sharply in the squatting position compared to either sitting arrangement. The difference was dramatic enough that it held across every single participant in the study.²

A larger and more recent study specifically tested a “defecation posture modification device,” which is the clinical term for a toilet footstool like the Squatty Potty. In that trial, using the device was associated with roughly three and a half times greater odds of feeling completely empty after a bowel movement. Users also reported substantially less straining. When participants stopped using the footstool, their bowel movements took about 25 percent longer on average.³

These results are real and reproducible, but they come with an important qualification: both studies enrolled people with normal bowel function. The volunteers were not constipated. The question of whether a footstool helps people who actually have digestive problems is separate, and the answer is more complicated.

When a Footstool Doesn’t Seem to Help

A randomized trial specifically designed to test footstools in people with constipation found no benefit. Participants used a simulated defecation test (expelling a small balloon), and using a footstool did not change how quickly they could do it, regardless of whether the stool was short or tall. Subjective ratings of effort and comfort also showed no significant difference.⁴

This is a finding that gets buried under the enthusiasm, but it matters. Constipation has many causes. Some people struggle because their pelvic floor muscles don’t coordinate properly during evacuation, a condition called dyssynergic defecation. Others have slow transit, where the colon itself moves stool too sluggishly. For these underlying problems, changing the angle at which stool exits the body may not address the actual bottleneck. In dyssynergic defecation specifically, the gold-standard treatment is biofeedback therapy, which retrains the pelvic floor muscles to relax on command during evacuation, and randomized trials have found it more effective than laxatives.⁵

The takeaway isn’t that footstools are useless for constipation. It’s that the mechanism they exploit (widening the anorectal angle) addresses only one part of a complex process. If the puborectalis muscle is already relaxing fine and the problem is elsewhere in the system, changing your posture won’t fix it. A footstool is best understood as one tool among several, not a universal fix.

The Thinker Position and Other Posture Modifications

You don’t strictly need a product to change your toilet posture. A prospective study tested what the researchers called “The Thinker” position: leaning forward on the toilet with elbows on knees, mimicking Rodin’s famous sculpture. Compared to sitting upright, The Thinker position significantly widened the anorectal angle and lengthened the pelvic floor, creating a straighter evacuation path. In that study, some patients who couldn’t fully evacuate while sitting upright could do so in The Thinker position.⁶

This suggests the key variable isn’t the footstool itself but the degree of hip flexion. Anything that gets your torso closer to your thighs, whether that’s elevating your feet, leaning forward, or some combination, moves the puborectalis toward relaxation. A footstool just happens to be a convenient, consistent way to achieve this without thinking about it every time you sit down.

Research on pelvic floor muscle relaxation positions reinforces this idea from a different angle. One study measuring muscle activity with surface sensors found that a deep-squat position was among the more effective postures for relaxing pelvic floor muscles, though a modified butterfly pose (sitting with the soles of the feet together and knees out) actually produced slightly more relaxation.⁷ You obviously can’t sit in butterfly pose on a toilet, but the finding confirms that the underlying principle, getting the pelvis into a position that lets the muscles let go, is well supported.

Why Straining Matters Beyond Comfort

Reducing straining isn’t just about making bathroom visits faster or more pleasant. Prolonged straining triggers the Valsalva maneuver, the same forced-exhalation-against-a-closed-airway response you get when lifting something heavy. When straining lasts more than about 15 seconds, it causes significant swings in blood pressure, which matters for people with cardiovascular disease, recovering stroke patients, or anyone at risk for blood pressure spikes.⁸

Research on the relationship between straining effort and anal canal pressure shows the connection isn’t uniform. In healthy people, the pressure generated during a Valsalva maneuver barely predicts what happens during actual evacuation. But in people with defecatory disorders, the two become tightly linked, meaning that excess straining translates much more directly into elevated pressure in the anal canal.⁹ For these individuals, anything that reduces the need to bear down hard has genuine clinical value, whether that’s a footstool, biofeedback, or dietary changes.

Hemorrhoids, Diverticulosis, and the Long-Term Picture

The clinical literature has long noted that hemorrhoids are far less common in populations that habitually squat for defecation. The proposed explanation connects directly to the mechanism described above: squatting straightens the anorectal angle, reduces the time spent on the toilet, and minimizes episodes of forceful straining, all of which reduce the pressure on the hemorrhoidal veins. Clinicians sometimes advise hemorrhoid patients to adopt a squatting posture for this reason, though a definitive causal relationship hasn’t been established through controlled trials.¹⁰

Diverticulosis, a condition where small pouches develop in the colon wall, shows a similar pattern. A study comparing people who primarily used sitting toilets with those who used squat toilets found that the sitting-toilet group had higher rates of diverticulosis. The hypothesis is that the increased intra-abdominal pressure required for seated defecation, over years and decades, contributes to the formation of these pouches.¹¹

These associations are suggestive but hard to untangle from confounding factors. Populations that squat also tend to differ from sitting-toilet populations in diet, fiber intake, physical activity, and other health-related behaviors. Still, the mechanical logic is sound: less chronic straining means less chronic pressure on structures that are vulnerable to it.

Using Footstools with Children

Functional constipation is common in kids, and it often comes with a cycle of withholding and discomfort that can be tough to break. A pilot study enrolled toilet-trained children aged four and older who met clinical criteria for functional constipation and gave them a footstool to use for four months. No injuries or adverse events were reported. Nearly all the families said they’d recommend the device to others, and children who used the footstool had a lower rate of fecal incontinence compared to those who didn’t.¹²

This is a small study, so the numbers should be treated cautiously. But the safety profile was clean, and for a condition where treatment often involves prolonged laxative use, adding a zero-risk mechanical intervention makes practical sense. Children, especially younger ones, also sit on adult-sized toilets where their feet dangle well above the floor, which means their hip angle is far from optimal even compared to a seated adult. A footstool may offer proportionally more benefit for kids simply by restoring a functional foot-on-ground position.

Who Should Think Twice

A 2025 scoping review that analyzed 42 studies on toilet posture found that while squatting-type positions generally benefit bowel evacuation, they come with trade-offs for certain groups. Older adults and people with joint problems may find that the increased knee and hip flexion required by a footstool causes discomfort or instability. Ergonomically designed seated toilets, including raised-height models, can actually reduce joint stress for these populations.¹³

People with pelvic organ prolapse represent another group that deserves a nuanced approach. Prolapse patients often already struggle with bowel movements and may rely on manual support to evacuate. While reducing straining sounds beneficial in theory, the posture change alone doesn’t address the structural issues involved. These patients are better served by working with a pelvic health specialist who can assess whether posture modification fits into a broader management plan.

If you have any form of lower-limb disability, balance issues, or use a wheelchair, a standard footstool may be impractical or unsafe. Some adaptive designs exist, but the evidence base for those specifically is thin. Leaning forward (The Thinker approach) may achieve some of the same benefit without requiring foot repositioning.

What Height Should the Stool Be

Squatty Potty sells models in different heights, typically around 7 inches and 9 inches, and competitors vary further. The research doesn’t give you a precise optimal number. The constipation trial that tested two different footstool heights found no difference between them, though it also found no benefit overall for that population.⁴ The biomechanical principle suggests that more hip flexion equals more puborectalis relaxation, up to the point of a full squat. But comfort and stability matter too, especially if you’re going to use the thing every day.

Taller people on standard-height toilets may need a taller stool to achieve the same degree of knee elevation that a shorter person gets from a smaller one. Shorter people or those on lower toilets may find even a modest stool sufficient. The underlying study showing a wider anorectal angle compared sitting at standard height (about 41-42 cm) versus a lower seat (31-32 cm), with squatting widest of all, suggests that any meaningful increase in hip flexion helps.² A stack of old books would work as well as a branded product, if ergonomics were the only consideration.

The Gap Between Biomechanics and Clinical Outcomes

The most honest summary of this research field is that the biomechanics are well established and the clinical outcomes are still catching up. Nobody seriously disputes that squatting widens the anorectal angle and relaxes the puborectalis. Imaging confirms it. The question is how much that mechanical change matters in practice, for which people, and for which conditions.

For healthy individuals who don’t have bowel problems, the evidence is genuinely positive. Footstools make bowel movements faster and more complete, with less effort.³ For people with chronic constipation, the picture is muddier because constipation has so many possible causes, and posture only addresses one of them. For conditions that involve chronic straining over many years, like hemorrhoids and diverticulosis, the epidemiological patterns are consistent with the mechanical theory, but a randomized trial proving that footstools prevent these conditions would take decades and hasn’t been done.

The device is cheap, safe, and requires no prescription. For many people, that makes it worth trying regardless of whether the evidence meets the bar of a gastroenterologist’s recommendation. Just don’t expect it to replace medical evaluation if you have persistent symptoms that aren’t resolving with simple measures.