Why Toilet Posture Matters: A Pelvic Floor PT’s Guide to Healthier Bathroom Habits
As a pelvic floor physical therapist, I often emphasize that the way we sit on the toilet plays a critical role in our overall pelvic and digestive health.
Toileting posture isn’t just about comfort; it’s about optimizing the body’s natural mechanics to support bowel and bladder function.
Over the past decade, growing research has shown that simple posture changes can lead to meaningful improvements in both elimination and pelvic floor health.
Why toilet posture is important
One of the key concepts to understand is the anorectal angle, which refers to the angle formed between the rectum and the anal canal. When we sit in a typical 90-degree seated position, this angle remains somewhat kinked, making elimination more difficult.
However, studies using videomanometry have found that when people adopt a squatting position, either by fully squatting or by elevating the feet on a small stool, the anorectal angle straightens significantly. This alignment reduces resistance in the rectal canal, making bowel movements easier and requiring less straining.
Less straining during defecation is more than a matter of convenience.
In a study involving 52 healthy individuals, researchers found that using a toilet stool significantly improved bowel habits. Most participants reported decreased straining and faster bowel movements.
These findings reinforce what we see clinically: many patients with constipation or difficulty emptying the bowels benefit tremendously from simply raising their knees above their hips when seated on the toilet.
Furthermore, toileting posture may also influence the risk of developing diverticulosis.
A 2023 clinical study involving over 900 patients found a strong association between sitting toilets and an increased incidence of diverticulosis, with sitting being a significant risk factor compared to squatting.
The hypothesis is that excessive and repeated straining in the seated position increases pressure in the colon, potentially leading to the formation of diverticula, or pouches in the colon wall. These structural changes can contribute to long-term gastrointestinal issues.
A 2024 scoping review that analyzed over 40 studies further supports the physiological benefits of squatting. It found that squatting not only reduces digestive strain but also improves evacuation completeness.
Interestingly, the review also noted that for individuals who may have difficulty with balance or mobility, such as older adults, ergonomically designed sitting toilets that allow some degree of hip flexion may offer a safer alternative while still improving elimination compared to standard seating.
Beyond bowel health, toileting posture also affects bladder function.
Many people, especially women, tend to “hover” over the toilet in public restrooms to avoid contact with the seat. However, hovering compromises pelvic floor relaxation and makes it more difficult to completely empty the bladder.
This can lead to urinary retention, increased urgency, or urinary tract infections. As a pelvic floor physical therapist, I always encourage patients to fully sit, even in public restrooms, and to use seat covers or clean the seat if necessary rather than hovering.
Best practice for pooping
Many therapists will recommend a toilet stool to elevate the knees and discourage straining.
Patients should also avoid breath-holding or bearing down forcefully, as this can lead to increased pressure on the pelvic floor, potentially worsening symptoms of pelvic organ prolapse or contributing to the development of hemorrhoids.
From an evolutionary standpoint, humans have historically squatted for elimination. In many parts of the world, squatting toilets remain the norm, and gastrointestinal disorders like constipation, hemorrhoids, and diverticulosis are far less common in these populations.
This natural posture aligns the body for efficient elimination and supports the coordination of pelvic floor muscles, abdominal pressure, and rectal emptying.
Healthier Toileting Habits
When guiding my patients toward healthier toileting habits, I recommend a few simple steps.
First, place a footstool or low bench under your feet while seated on the toilet. This should raise your knees above your hips and simulate a squatting position.
Next, lean forward slightly and rest your elbows on your thighs to help open the pelvic outlet.
Most importantly, breathe and allow the pelvic floor to relax; avoid holding your breath or pushing forcefully.
For urination, always sit fully on the toilet rather than hovering, as this promotes complete emptying of the bladder.
That said, it’s important to note that squatting or elevating the knees may not be appropriate for everyone.
For individuals with pelvic organ prolapse or certain joint conditions, this posture may cause discomfort or even exacerbate symptoms. In these cases, personalized guidance from a pelvic floor therapist is essential to determine the best toileting strategy.
For older adults or those with balance issues, the priority should be safety, and an ergonomic seat with appropriate foot positioning may offer the right balance between posture and stability.
Even among individuals without pelvic concerns, the impact of proper toilet posture is tangible.
One of my patients reported that using a toilet stool made urination feel easier and left less residual irritation afterward. These experiences are not uncommon and often reflect improved coordination and relaxation of pelvic floor muscles.
Small change for big improvements
Adjusting your toileting posture is a small, low-cost change that can lead to big improvements in your bowel and bladder health.
From reducing constipation and straining to preventing pelvic floor dysfunction and urinary issues, the evidence strongly supports a more squatting-like position during elimination.
These adjustments, when done correctly and safely, can be a key part of maintaining long-term pelvic health.
Looking for help with constipation, pelvic pain, or pelvic floor physical therapy in Jacksonville Beach, FL?
If you’re looking for personalized, one-on-one sessions to address your constipation, pelvic pain, or pelvic floor symptoms, we provide pelvic health physical therapy services to women in the Jacksonville Beach area.
If you’re looking for providers who will listen to you and help you get to the root cause of your pelvic concerns, we’ve got you. We’re here to help you if you’re experiencing tailbone pain, pelvic heaviness, leaking, or are pregnant/postpartum and want to continue safely working out/running/lifting during your pregnancy and get back to your sport after birth.
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Resources:
Anonymous. “Scientists Say This Popular Bathroom Accessory Really Does Help You Poop Better.” Time, about 6.6 years ago. Reports on a Journal of Clinical Gastroenterology study of 52 participants showing 90% less straining and 71% quicker bowel movements with a footstool.
Ohio State University Wexner Medical Center. Research finds toilet stool may solve common bowel issues. Ohio State News, 9 Jan. 2019. Reports that after four weeks using a toilet stool, 90% reported less straining and 71% faster bowel movements, with two-thirds continuing use.
Buldukoglu, Osman Çağın, et al. “Sit or Squat? Toilet Type Is a Determinant of Diverticulosis Development.” Turk Journal of Gastroenterology, vol. 35, no. 6, June 2024, pp. 475–480. Found sitting toilets significantly increased risk of diverticulosis (OR 3.36; p = .001).
Colonic diverticulosis… frequency of sitting during defecation… PubMed Abstract. Prospective study: higher frequency of sitting during defecation in diverticulosis group (72.2% vs. 53.5%); sitting toilet use and age were independent risk factors.
Bhattacharya, et al. “Sitting vs. squatting: a scoping review of toilet postures and associated health outcomes.” BMC Public Health, 2025. Scoping review of 42 studies linking squatting with reduced straining and better bowel evacuation, noting some risks and context-specific outcomes.