Did you know that: A) Appendicitis, colon cancer, inflammatory bowel disease, hernias, diverticulosis, and hemorrhoids all may be caused by improper fecal elimination. B) I grew up using only an outhouse.

Although you might be puzzled, both of these statements have more in common than you think. Stay with me and I will show you why.

When I first came to the US, I was embarrassed that instead of a beautiful ceramic indoor toilet, we had a round hole cut in the ground, in a small wooden outhouse. What I didn’t know was that I wasn’t the only one. In the 1800’s, with the advent of indoor plumbing, the throne-like water closets – that before were reserved for royalty – became available to lay people. The fad started in Great Britain and soon the English colonies followed suit. The new indoor water closets with a sitting toilet were seen as a sign of progress, and squatting became associated with backwards, primitive practices. Fifty years later, most of Western Europe and bigger cities in North America enjoyed the luxuries of indoor toilet seats. If you read somewhere that sit down toilets were popular during ancient Rome here is an article that debunks that myth.


Roman toilets are commonly thought to have been used in the sitting position. But sitting toilets only came into general use in the mid-19th century in the Western world. The Roman toilets were probably elevated to raise them above open sewers which were periodically “flushed” with flowing water, rather than elevated for sitting. The Romans weren’t the first civilization to adopt a sewer system – the Indus Valley civilization had a rudimentary network of sewers built under grid pattern streets and it was the most advanced seen so far. Source

This trend didn’t affect much of Eastern European rural areas and so two-hundred years later my family still uses an outhouse. Fascinating cultural note: Both my father and my grandparents find the idea of defecating in a room inside the house disgusting in the same manner that some people find outdoors toilets unsanitary.

I will be honest, it took me a while to get used to indoor toilets when I came to the US. I literally had to change my bathroom habits. Going to the bathroom began taking longer and longer so I started changing my routines and times I had to go sometimes holding it in since I couldn’t afford to sit on the toilet for that long. Although taking probiotics helped a little with this problem and made my stools better formed and easier to pass, I was still taking sometimes up to fifteen minutes – and yes I do drink a lot of water and I eat good fiber from veggies and fruits.

Several months ago I stumbled on an article about the “squatty potty” and I was intrigued.  This little stool elevates your feet and opens your colon similar to the way actual squatting does. In fact, this article sang so many praises to squatting that I had to laugh. The dirty little backwards outhouse I grew up with had more health benefits for my colon than the beautifully white marble toilet seat most western culture treats as a sign of progress. Oh the irony! So I decided to get a squatty potty and experiment with it on myself. Since I have had the experience of squatting for over eighteen years and then using a sit down toilet for another ten, I figured I would be a prime candidate for the experiment.

Things changed folks. Elimination took a lot less time, I didn’t have to go as often, and my elimination was complete. I didn’t have the urge to go again a couple of hours later. Nothing lingers in my colon anymore, which is a great feeling! So why is squatting better for your health than just sitting on your toilet?

For one, sitting down on the toilet constricts the puberectalis muscles. This requires more straining to push things through.  It causes constipation, which leads to fecal stagnation and consequently hemorroids, hearnias, and diverticulitis.

Primary (simple) constipation is a consequence of habitual bowel elimination on common toilet seats. A considerable proportion of the population with normal bowel movement frequency has difficulty emptying their bowels, the principal cause of which is the obstructive nature of the recto-anal angle and its association with the sitting posture normally used in defecation. The only natural defecation posture for a human being is squatting. The alignment of the recto-anal angle associated with squatting permits smooth bowel elimination. This prevents excessive straining with the potential for resultant damage to the recto-anal region and, possibly, to the colon and other organs. Source

There are some claims that pushing down with the diaphragm while sitting on the toilet can force waste matter into the appendix and cause acute appendicitis. Source

One clue comes from the field of epidemiology. Appendicitis is a disease of westernized countries, virtually unknown in the developing world. The reason is that the cecum was designed to be squeezed empty by the right thigh, in the squatting position. On a sitting toilet, it is physically impossible to compress the cecum. Instead, one pushes downwards with the diaphragm, while holding one’s breath. This maneuver inflates and pressurizes the cecum. It is analogous to squeezing a tube of toothpaste in the middle and causing the bottom of the tube to inflate. The pressure can easily force wastes into the appendix, with disastrous consequences. Source

Two years ago I was rushed to the emergency room for an appendectomy.  Neither of my grandparents on either side had ever had appendicitis, nor my dad or brother.  Recently my father succumbed and built a sit down wooden frame toilet in our outhouse in an attempt to “modernize” our old style outhouse at the request of some of his children (we felt kind of embarrassed squatting over a hole in the ground when we came to visit). About  a year later my mother was rushed to ER with a ruptured appendix. Coincidence, maybe. My mama has a weaker constitution that my father and it could have been caused by other issues… but it does seem suspicious.

Another reason for choosing to squat  is that sitting puts pressure on the pelvic floor. We all strain when we go, especially if it doesn’t come easy. This causes  the pelvic floor to “descend”  over the course of time, stretching and injuring the nerves that supply the bladder, prostate, and uterus. Source

For more on how sitting on your toilet is contributing to hernias, appendicitis, injured bladder, and more, you can go here.

I urge you  to try squatting when going to the bathroom, and see for yourself if your bowl movements benefit from this change. I highly recommend the squatty potty, but it would be easy to build something similar at home too. The purpose is to elevate your legs and straighten the angle of your colon. The squatty potty works very well, but it is not as good as squatting over a hole in the ground. I am definitely planning to have this kind of Eastern European toilet in my home when I have the opportunity.

P.S. After I wrote this article I called my dad on skype and apologized for being embarrassed that we didn’t have a fancy inside toilet. I told him it came from my own insecurities and ignorance and that I was proud of who I am and where I come from. I told him I appreciated his attempts to appease and modernize his ways to make us more comfortable. I told him no matter what I loved him and I love the place I grew up and not a day passes by when I don’t miss our little farm. He didn’t say anything back. He just listened to me talk with his head down. “Also dad”, I said right as we waved goodbye “Apparently sitting on toilets can give you hernias and appendicitis while squatting strengthens your pelvic muscles. So… you should definitely take the seat off.”

(Image courtesy of Jacob Swanson. You can view his portfolio here.)

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