Constipation occurs when bowel movements become less frequent and stools are difficult to pass. This common condition can be frustrating, but changing your physical position on the toilet can ease the process of elimination. Understanding how your body is designed to eliminate waste is the first step toward finding relief.
Understanding the Biomechanics of Sitting
The standard seated position on a Western toilet is inefficient for complete bowel evacuation. This inefficiency is due to a specific muscle called the puborectalis, which forms a sling around the lower end of the rectum. The puborectalis muscle is responsible for maintaining continence by keeping a kink, known as the anorectal angle, in the pathway. When sitting at a 90-degree hip angle, this muscle remains somewhat contracted, maintaining the angle at about 80 to 90 degrees.
To achieve easier elimination, the puborectalis muscle must relax to straighten the passage. This natural relaxation happens when the body is in a deep squatting position. Squatting widens the anorectal angle to approximately 100 to 110 degrees, effectively removing the “kink.” By mimicking this squat-like posture, you can reduce the effort needed and promote a more complete bowel movement.
Optimizing Your Posture for Elimination
The goal of optimizing your toilet posture is to replicate the beneficial mechanics of a natural squat. The most effective modification involves elevating your feet so that your knees are positioned higher than your hips. Using a small footstool or a purpose-built defecation posture modification device (DPMD) achieves this elevation. This simple adjustment straightens the anorectal angle, encouraging the puborectalis muscle to relax.
Once your feet are elevated, lean your torso forward from the hips, aiming for an approximate 35-degree angle relative to your thighs. Rest your elbows on your knees to help stabilize this forward lean and maintain a straight spine. Avoid slouching or rounding your back, which can compress the abdomen and hinder the process. Your feet should be spread roughly hip-width apart to further open the pelvic floor area.
This combination of elevated knees and a forward lean aligns the rectum with the anal canal, creating a clear exit path. Taking time to ensure this posture is comfortable and stable before attempting to bear down is important. If the position causes hip or back discomfort, adjust the height of the stool until you find a balanced and relaxed position. Finding the right height can reduce the sensation of satisfactory bowel emptying and the need for straining.
Safe Techniques for Bearing Down
After establishing the optimal physical position, the next step is to use gentle, coordinated effort to expel the stool. Avoid aggressive straining, which can put pressure on the pelvic floor and lead to issues like hemorrhoids. Instead of tightening the entire abdomen, focus on a technique that engages the deeper abdominal muscles without forcing.
Take a deep breath and let your abdomen bulge outward, known as the “belly big” technique. As you exhale, gently push down by tensing your abdominal muscles, directing the pressure toward your bottom. Keep your mouth slightly open during this process to prevent contracting the pelvic floor muscles. It is also important to consciously relax the anal sphincter to allow the stool to pass freely. If a movement does not occur after a few minutes of gentle effort, it is best to get up, walk around, and try again later rather than continuing to strain.