We’ve Been Pooping Wrong All Along
But even prior to the pandemic, alternative toilets were entering the conversation in the name of wellness. Inspired by our ancestors and international neighbors, “innovations” like the Squatty Potty and bidet toilet attachments alter and supposedly optimize the way we poop.
“I think the United States is ass-backwards, always,” says Dr. Evan Goldstein, a proctologist and anal surgeon at his own New York and Los Angeles practice, Bespoke Surgical. “When you look at Europe, you look at the trends of bidets and appropriate hygiene from an anal perspective, the U.S. has always lagged behind.”
“I think the United States is ass-backwards, always.”
In colonial America, going to the bathroom was a seated affair. Privy pits — circular brick-lined wells — and outhouses with round holes cut from wood planks serving as a seat were precursors to the modern toilet. Elsewhere in the world, like China, squat toilets were commonplace, requiring a user to squat to floor level to reach the toilet opening. Just as popular outside Western culture were bidets, a basin for washing the nether regions.
Only recently did these previously foreign aspects of bathroom tradition trickle into American homes. In 2011, a Utah man and his parents debuted the Squatty Potty, a seven-inch footstool meant to replicate the experience of squatting while using the toilet. Marketed as a device that straightens out a kink where the rectum meets the anus, called the anorectal angle, allowing for a more productive and less strainful poop, the Squatty Potty quickly became a pop culture fixture and has inspired a number of similarly designed competitor stools.
Before the coronavirus pandemic, bidets never really managed to crack the American market. When American soldiers witnessed their use in European brothels during World War II, the basin was long associated with debauchery. Though Americans first combined a bidet with a toilet seat in the 1960s, these attachments are still catching on. Brands like Tushy and Brondell, which sell bidet toilet seats and toilet attachments, tout specific health benefits, such as preventing urinary tract infections.
Long before the privies of early America and the eventual invention of the modern toilet, the only way to move your bowels was to find a spot and squat. With history in mind, the Squatty Potty is branded as a more natural way to poop. “I have two kids, and you watch them poop, especially on an adult toilet, how they engage themselves to defecate is in this squatted seated position,” Goldstein says. “That’s just natural. That’s just a tendency.”
The squatting position has been shown to reduce the relative strain of pooping as well as the amount of time needed to achieve a full bowel movement, according to a 2003 study. More recently, a 2019 study of defecation posture modification devices (the scientific term for items like the Squatty Potty, which enable users to adjust their body position while pooping) showed the footstools reduced strain, cut down on time spent defecating, and allowed for increased bowel emptiness.
“This is a simple physics problem,” says Dr. Rajeev Jain, a patient education adviser for the American Gastroenterological Association. “If the angle becomes too acute, there is resistance and difficulty in passing stool.” And Squatty Potties do help open the anorectal angle, he says.
However, there are plenty of other factors contributing to a painless poop, Goldstein and Jain agree. One person’s rectum may naturally kink at a slightly different angle than the next person, and they may be able to achieve an ideal pelvic angle for defecating simply by leaning forward while on the toilet, Goldstein explains. Diet and lifestyle also affect bowel movements. A lack of fiber and exercise can cause constipation, and making healthier lifestyle changes may be more efficient than a step stool at the foot of your toilet, Goldstein says.
Currently, there are no studies suggesting bathroom step stools may reduce hemorrhoids like the Squatty Potty purports to do. The cause of painful hemorrhoids — swollen veins in the anus and rectum — may not be sitting itself but sitting for too long, Goldstein says. Instead of viewing pooping as a respite from reality, the process should be quick since our bodies direct blood to the rectum and anus when we poop, he says.
“Blood goes to a hemorrhoid, and it acts like a cushion so you don’t tear anything because there’s so much force generated when you go to the bathroom,” Goldstein explains. “When you’re done, the blood is going to leave, but if you’re sitting for too long, more blood goes there. You’re swelling these hemorrhoids, and they become symptomatic.”
Wet wipes, previously used on babies and messy children, were rebranded as Dude Wipes and Stall Mates. While many view these wipes as a more sanitary alternative to toilet paper, they may be causing more harm than good. A small 2010 study found that a preservative in wipes can act as an anal irritant. “It wipes away the good bacteria,” Goldstein says. “And now it’s wet and it’s moist. I see people coming to me all the time with tears, dermatitis. It totally wreaks havoc.”
Instead of viewing pooping as a respite from reality, the process should be quick since our bodies direct blood to the rectum and anus when we poop.
Water itself is more than effective at cleansing the area, Jain says. Bidets, long used elsewhere in the world, never quite caught on in America, but bidet toilet attachments are helping to popularize the practice of bum cleansing. However, don’t expect the washlets to have disinfecting powers as brands like Tushy claim. “The water will dislodge solid material, but I doubt it will eliminate bacteria,” Jain says.
A 2017 study suggests that regular bidet use may heal hemorrhoids and genital irritations, perhaps only because people with such irritations may simply prefer to use a bidet toilet anyway, researchers noted. Another study, from 2011, concluded that bidets could help reduce anal pressure due to the spritz of warm, low-to-medium pressurized water from the bidet. However, other research condemned bidet use as the cause of anal fissures.
Since overwiping can cause irritation, Goldstein suggests using a bidet immediately after a bowel movement to cleanse the rectum, then use toilet paper or a towel to blot the area dry. Just as keeping all areas of the body clean and dry is essential to avoid rashes, so is maintaining a dry bum. “If someone has a rash in the perianal region, a bidet cleansing technique would make the area wet, which could aggravate some skin conditions,” Jain says.
Ultimately, the rise of toilet tech stems from Americans’ ignorance of healthy poop habits, Goldstein says. Devices meant to create a more pleasurable, cleaner experience simply showcase how an ideal bowel movement should occur. “It’s taking away your lack of knowledge for you,” Goldstein says, “and supplementing it with something that is healthier, and you potentially may not even know it.”