What On Earth is That?

After house guests use our bathroom, I chuckle at the bemused look on their faces and prepare to answer the usual question – ‘What is that contraption around your toilet?’

Over 10 years ago I discovered a marvelous device that turns a western toilet into a ‘squatting’ toilet. Called the ‘In Lieu’, it was designed by an Australian engineer, Wal Bowles. This solid structure fits snugly around the pedestal with side platforms to support the feet while squatting over the toilet. Not everyone can get down into the position as squatting is rarely practiced in western cultures where sitting and standing are the most common positions. Why squat to open the bowel? Because this position straightens the rectum and allows for more complete emptying without straining.

When stiffness and pain in ankles, knees and hips prevents squatting, the safer, more comfortable option is to place both feet on a stool in front of the toilet. Lean forwards with a tall spine, rest hands or forearms on thighs and breathe deeply to open and relax the chest and abdominal wall. Tightening at the waist or sitting in a slumped, ‘c’ curved position increases anal sphincter closing and associated straining to empty the bowel. For easy, full emptying the anal sphincter must relax.

Some women rush this daily ritual due to a busy schedule and end up straining – habitual straining leads to in coordination between abdominal and pelvic muscles making bowel emptying difficult. Signs of straining include hemorrhoids, anal fissures with associated bleeding and pain from stretching or compression of nerves supplying the pelvic and pelvic floor areas. Conditions such as Irritable Bowel Syndrome, slow transit constipation, posterior vaginal wall prolapse, or poor water and fiber intake, medication, anxiety and lack of exercise also affect bowel emptying. (Following hip joint replacement, surgeons strongly advise against stretching the hip beyond 90 degree flexion and recommend a raised toilet seat to reduce the hip flexion angle.)

Some mothers worry when their children squat on the toilet for bowel emptying. This is reason for smiles all round as children often innately adopt this appropriate bowel opening posture. When squatting is regularly practiced, facets on the talus or ‘squatting bone’ in the ankle are retained into adult years. Without regular squatting these ‘squatting facets’ on the talus disappear which explains why some people cannot assume a full squat position.

Occasionally clients join the ‘gray nomad’ brigade and spend months touring around wilderness areas in their trailer or camper van. Without the benefit of park toilet facilities, they dig holes and squat to empty their bowel (as civilizations have done for thousands of years) and marvel at how easily it opens in this position. That’s when I introduce them to the ‘In Lieu’ toilet converter to continue squatting at home. Unfortunately squatting on porcelain toilet bowls is not advised as they have been known to break!

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