MEN IN THE BATHROOM: SQUATTING
Back in the sixties, Brian Sear, an industrial designer, received a brief from British Rail to design toilets for a flashy new interurban train. He took his commission seriously and researched the topic extensively. Besides attending anatomy lectures in London, he did the rounds of hospitals, watched X-ray film of all kinds of ‘stool’ excretion and carefully noted the effects of diet, posture and toilet type.
Sear’s overwhelming conclusion was that humans function best at evacuation when they squat. He claimed he found that 85 per cent of the world’s population squats and is relatively free of the rectal problems which plague people in the West who prefer to sit on elevated toilets.
Realizing that British Rail was conservative, he designed a compromise between a hole in the floor and a pedestal. The important thing was for the knees to be higher than the backside. To achieve this, he lowered the pedestal considerably and replaced the usual flat seat with one that was saddle shaped. The flush system was redesigned to avoid water splashing, and a prototype was then built by Doultons. It was triailed in-house and functioned well.
Needless to say, British Rail panned it and used a conventional toilet instead. Sear, who now lives in Helensburgh, south of Sydney, still believes in squatting and at home has a brick in front of his toilet to raise the knees.
But is squatting really any better for you than sitting? The issue is controversial and the scientific evidence scant. One advocate of squatting, Dr B. A. Sikirov, took twenty men and women who had had haemorrhoids for years and made them change their defecation habits. They could only squat.
In the absence of a squatting lavatory they were advised to use a suitable flat container and they were only allowed to defecate in response to a strong urge instead of at a fixed time each day In fact, they were advised to postpone the attempt until they were absolutely certain of its necessity.
Sikirov claimed that most patients showed significant improvement in their haemorrhoids after squatting. He believes the toilet in its present form should be modified to allow defecation in a squatting position and says a special program may need to be devised to reacquaint man with his natural habits.
Wal Bowles, an ex-pilot, aircraft engineer and aircraft accident investigator from Sydney, has found a way of enabling people to squat on an ordinary toilet without actually resting on the porcelain. Squatting on the porcelain is dangerous as it can shatter and cause awful injuries. He has invented a device which converts an ordinary toilet into a squatting one. Called ‘In Lieu’ it’s made of moulded plastic and fits around the base of the toilet. It allows the toilet to be used in a full squat or in the usual sitting position.
Bowles’ interest in squatting began about thirteen years ago when he was forced to use a squat trench in the bush. He was so impressed with the feeling of ease that resulted that he began to use his investigative skills to explore the issue. ‘Squatting has absolutely fantastic potential, if only people can be persuaded to do it,’ he says.
Sydney colorectal surgeon and director of anorectal physiology at St George Hospital, Dr David Lubowski, disputes that squatting has a beneficial effect. He says the true incidence of haemorrhoids in developing countries, where people squat, is entirely unknown. Even if it were known, there would be other factors, such as diet, to consider.
Further, he says the methodology in the Sikirov trial was problematic and its conclusions are not scientifically valid Lubowski says the relationship between straining at stool and haemorrhoids lies in the downward movement of the pelvic-floor muscles.
It used to be thought that haemorrhoids were simply due to varicose veins of the anal canal but this theory is known to be incorrect. It’s now accepted that haemorrhoids are caused by the prolapse of the three little cushions of tissue which are found immediately inside the anus. These are sometimes referred to as anal lips. These cushions can prolapse if the muscles which normally support them are damaged as a result of chronic excessive straining at stool. Such muscle damage is brought about by a stretch-induced injury of the pudendal nerves. Injury to these nerves is central to the development of haemorrhoids.
Avoiding straining is an essential part of the treatment for haemorrhoids since this avoidance prevents abnormal pelvic-floor descent and pudendal nerve damage. If squatting were to have an effect, it would have to reduce the amount of pelvic-floor descent during straining compared with straining in the conventional sitting position. Lubowski and colleagues tested this and found no difference in the amount of downward movement.
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Tags: Women’s Health