Toilet-Related Health Problems and News

This page is devoted to reports on toilet-related health problems and news from around the world.


Toilets of The Future

New 2013 Toilet Law in Thailand

Squat Toilets in a UK Shopping Centre?

Dealing With Pelvic Floor Prolapse and Incontinence - The Most Effective Option

Beijing Olympics 2008 -- China's Toilet Dilemma

Pelvic Floor Problems: The Continuing Ignorance of The Root Cause

Colon Cancer - If Eating Lots of Fruits and Veggies Doesn't Cut The Risk, What Else Could?

Appendicitis - The One Thing That Should Be Made Known, But Isn't

What Crohn's Disease and Colitis Cost Australians Per Year

Pelvic Muscle Injury During Childbirth

Toilets in China - Lessons and Insights

The Annual Health Care Costs of Constipation

Erection, Urinary and Prostate Problems

Diverticulosis - Must One Avoid Nuts, Corn and Popcorn?

The Top Cancer Among Men and Women in Singapore

U interview News (Dec 9, 2013)

A Competition for Toilets of The Future Yields a 'Revolutionized' Design

In honour of World Toilet Day (every Nov 19), a 'Toilets of the Future' competition "to raise awareness on how we can upgrade the 130 year old flush toilet to one that benefits our health and the environment" was organised by UK's Dyno-Rod Drains in London.

Three students from the University of The Arts, London -- Victor Johansson, Pierre Papet and Samuel Sheard -- came up with the winning design.

What is most remarkable is that the Wellbeing Toilet they envisioned is quite different from sitting toilets that they are familiar with. The toilet of the future they had in mind requires users to fold their legs up and squat, rather than sit.

(Photo credit: Metro, UK)

"Essentially, this toilet is forcing a new way of 'sitting' (squatting) which to a large extent doesn't exist, culturally speaking, in the West yet," Johansson told NBC News. "But I think when people starting realising the benefits (of squatting) they might be tempted to switch."


The article continued that the benefits Johansson referred to include the reality that squatting provides a lesser likelihood of obstruction (colon)... which can lead to several health concerns, such as colon infections.

In truth, there is nothing 'revolutionary' about the design of the toilet of the future, for squatting is something that humans were designed to adopt for waste elimination in the first instance.

Nevertheless, the students have hit on something good for the Western world. May the day come, when all peoples in the West will be able to squat, just as many in Asian, African and Middle Eastern societies do!

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Bangkok Post (Apr 29, 2013)

New Toilet Law in Thailand?

Usnisa Sukhsvasti, the Features Editor of the Bangkok Post, wrote about a new Royal Decree that calls for the replacement of toilets of the squatting kind to sitting toilets within 120 days.

Although the capital of Thailand has gradually weaned itself off squat toilets over the past few decades, Ms Sukhsvasti noted that squat toilets still proliferate in the provinces as they are cheaper, much easier to clean (fewer nooks and crannies), take up less space and use less water to flush.

She is not certain about the rationale behind the Yingluck toilet scheme, as she had always thought that squat toilets are actually better than sitting toilets in terms of the (natural and correct) position the user is forced to take.


How right she is. If the Decree on toilets is true, then it spells trouble ahead, for it will deprive many Thais of the benefits of squatting.

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BBC News (Jul 15, 2010), ANI (Jul 22, 2010)

Ill-informed campaign against squat toilets installed in Rochdale Shopping Centre in Manchester, UK

A British shopping centre's decision to install "squat toilets" for Asian customers has come under intense criticism by outraged council chiefs.

According to reports by BBC News and ANI, two of the 200-pound loos, which users squat over rather than sit on, were put in alongside traditional (sitting) loos in a bid to raise cultural awareness. The hole-in-the-ground toilets, sometimes known as Nile pans, are installed in both the ladies' and gents' at the Exchange Center in Rochdale, Greater Manchester.

The squatting toilets were first installed after Exchange Center management attended a "cultural" training course with community activist Ghulam Rasul Shahzad.

Rochdale Borough Council has reiterated that they had nothing to do with the Exchange Shopping Centre’s decision to install Nile pan toilets.

The Deputy Leader of the Council, Councillor Ashley Dearnley said: "I hope that the Exchange sees sense quickly and the toilets are removed."


If the Council members -- and the British people -- know the truth and history about sitting toilets, they would not have acted in the way that they have. Squatting -- not sitting -- toilets are traditionally used by the vast majority of mankind, before sitting toilets first became widely used in Britain in the mid 19th century.

You can discover whether the outrage makes sense by reading about the benefits of squatting and the reasons why squatting toilets are better than sitting toilets.

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Democrat and Chronicle (Mar 18, 2009)

Women's Options for Dealing with Pelvic Floor Prolapse and Incontinence

"More than 50 percent of women have pelvic prolapse or incontinence, but not even 10 percent get treatment in their lifetime," says Dr. Rahul Laroia, attending physician of obstetrics and gynecology at Rochester General Hospital. "Women tend to ignore such problems."

"One in three women has urine leakage from stress, coughing, sneezing or an urge to void," says Dr. Gunhilde Buchsbaum, urogynecologist and director of Strong Memorial Hospital's Pelvic Health and Continence Specialties service.

Risk factors include obesity, smoking, advancing age and genetics. "If a family member has prolapse or incontinence, you're at higher risk for developing them," she says.

There are many options, says Buchsbaum — and there's no right choice for everyone. "The key is to consider each patient's needs," she says. "Treatment is very individualized. One woman might prefer a pessary (insert); another, a robot-assisted surgery."


Drs. Laroia and Buchsbaum would be able to give better advice if they knew about the link between sitting toilets and pelvic prolapse and urinary incontinence problems.

The reason why so many women in Western world -- more than 50% of women, according to the report -- suffer from pelvic floor prolapse and incontinence is the long term use of sitting toilets. The incidence is much lower in societies where squatting toilets are used.

It is a pity that the options recommended are so costly and not without risk, considering that all one needs to do is to switch from sitting to squatting for bodily functions. More details of the link between pelvic floor prolapse and incontinence and sitting toilets can be found in the section on pelvic floor prolapse.

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Associated Press (Mar 19, 2008)

Another Olympic 'Problem' -- Squat Toilets

It seems that China is not only having trouble with protests, pollution concerns and talk of boycotts surrounding the Olympics Games that would be held in Beijing from Aug 8 to 24.

With about 500,000 foreigners expected to attend the games, a more basic problem has arisen: the presence of squat toilets at many of the sporting venues has drawn frequent complaints.

"Many people have raised the question of toilets," said Yao Hui, deputy director of venue management for the Beijing organizers. "We have asked the venues to improve on this, to increase the number to sit-down toilets."

But Yao suggested it might be difficult to change every permanent toilet in the 37 venues:

"In my personal point of view, there are cultural differences between Chinese and Western people. Chinese are more used to squat toilets. Most of the Chinese people are used to the squat toilet, but nowadays more and more people demand sit-down toilets. It will take some time for this transition."


All parties concerned -- both Chinese and Westerners -- should approach the issue of toilets from a different angle. The question to ask is: Which toileting posture is better for humans: squatting or sitting?

Michael David Smith, writing in a related article for AOL Sports (China Promises to Install Sit-Down Toilets for Western Olympic Athletes, Spectators), was right, though he may not realised it, when he pointed out that:

"It's a nice gesture from China (to install more sit-down toilets), but I would hope that American visitors wouldn't expect the Chinese to bow to all of our whims. There are worse things than having to squat rather than sit."

The worse thing is the health risks associated with sitting toilets.

Those who attend the Beijing Olympics should be glad if more squat toilets are left in place. For then they would have more opportunities to learn from Shane Bauer's experience with squatting.

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HealthNews-Stats Press Release (Nov 21, 2007)

New Book Highlights Flawed Thinking on Pelvic Floor

Mary O'Dwyer, an Australian physiotherapist and female pelvic floor function and health expert, has written a book My Pelvic Flaw to help women to better understand their own pelvic floor.

What had driven Mary O'Dwyer to write the book is the plight of women who suffer from pelvic floor prolapse:

"Today, there is an epidemic of pelvic floor dysfunction that women generally accept as part of being female. Many women continue to suffer silently with problems causing loss of intimacy, decreased activity levels and a diminished quality of life."

Her book is also intended to put to rest many of the flawed thinking about pelvic floor problems, such as:

  • Accepting that pelvic floor problems are simply a part of being female and having babies

  • Continuing with habits that damage the pelvic floor -- such as heavy lifting and straining at bowel which promote (pelvic) prolapse

  • Continuing with incorrect exercises that damage the pelvic floor

  • Thinking that surgery will be a 'quick fix'

  • Thinking that a Cesarean delivery would protect a woman from pelvic floor damage

  • Accepting sexual dysfunction as a normal part of life

In the same article, Mary O'Dwyer was quoted as saying:

"Great emphasis is placed on training our bodies, while the pelvic floor is completely ignored. We have no information in our female culture to teach our daughters about preventing pelvic floor problems throughout their lives."


When it comes to pelvic floor problems, the one thing that has been utterly ignored is the question of toileting posture.

Although O'Dwyer noted that 'straining at bowel' promote pelvic floor prolapse, either she was not aware, or had chosen not to point out, that in the sitting posture (toilet), evacuation is difficult and can never be complete. In this position, one is forced to hold the breath and 'push downwards' in order to evacuate.

This kind of straining puts pressure on the pelvic floor, which, over time, can lead to the risk of a pelvic floor prolapse.

Mary was also right in the sense that it is a cultural issue. People in the West are brought up to sit for bowel movements, whereas in Asia, Africa, Middle East and the developing world, squatting -- for defecation and childbirth -- is a way of life. That explains why pelvic floor problems are rare in these areas.

[More information on the link between toileting posture and pelvic floor problems can be found on this page.]

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Science Daily (Sep 28, 2007)

Fruits And Veggies Not Likely Linked To Colon Cancer Risk

A Canadian study has found that although eating lots of fruits and vegetables is good for your health, doing so will not reduce your risk for colon cancer.

This was the conclusion of a team led by Dr Anita Koushik, from the University of Montreal, which had looked at the link between eating fruits and vegetables and the risk for colon cancer. The study involved more than 756,000 men and women over a period of 20 years.

In another report on the same study [CBS (Sep 26, 2007], Dr Marji McCullough, R.D., Sc.D., Strategic Director of Nutritional Epidemiology for the American Cancer Society in Atlanta and the Co-Author of the study, was quoted as saying that:

"Eating fruits and vegetables does not appear to be as protective as researchers thought."


An adequate amount of fruits and veggies is essential, but it will do not much good if a person cannot evacuate waste easily and completely -- a well-known side effect of using the sitting posture for emptying the colon.

Although there are many possible causes of colon cancer, increased toxicity in the body, as a result of stagnation of waste in the colon, is a major contributing cause.

The researchers should have done a similar study on a different group of people who - unlike the subjects in the Canadian study - uses the squatting position for waste elimination. They might be surprised at the results.

[More information on link between sitting toilets and colon cancer can be found on this page.]

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Nigerian Tribune (Aug 17, 2007)

Appendicitis: More Dangerous Than You Imagine

This Nigerian Tribune report on the causes, symptoms and treatment of appendicitis is unremarkable as well as remarkable for it does say, and what it doesn't.

Containing a mix of facts, opinions and conjectures, and omitting the one thing about appendicitis that should be known, the report does not offer real hope or answers for those who wants to know more about this painful disease.

These are the things that the report did say and/or theorise:

  1. Appendicitis usually begins with pains in the middle of the abdomen, followed by nausea, vomiting, and occasionally diarrhea.

  2. Appendicitis is said to be common in the southern part of the country (in this case, Nigeria) due to the kind of food being consumed there.

  3. However, patients experiencing it need to go for minor surgery to correct the "abnormal growth" in order to avoid any complication.

  4. Appendicitis can be described as a pain often at the left hand side of the lower abdomen as a result of indigestion arising from hard or improperly cooked foods. Guava seed may also cause it.

  5. The appendix serves no known major functions or purpose.

  6. The exact cause of appendicitis has not yet been discovered, but it appears that different factors can trigger the condition.

  7. It has also been suggested that infection in the digestive tracts may allow bacteria to invade the appendix causing inflammation and formation of pus.

  8. Genetics may also play a role as the ailment often times runs in families which can leave a person more vulnerable to it.

  9. Once an individual discovers that he or she has appendicitis, the only solution is surgery if such a person wants to remain alive.
And these are the things that the report did not cover:

  1. Has appendicitis been with us all the while? If not, when did appendicitis first appear?

  2. Who was the one who first recognised and named the disease?

  3. Who was the one who proposed treating appendicitis by removing the appendix (appendectomy)?

The most glaring omission, however, would be the connection between the sitting toilets and appendicitis.


Appendicitis is a disease of the modern world. It first appeared in the West toward the end of the 19th century, the period when sitting toilets were introduced in the West. The Medical Journal of Australia had this to say about appendicitis:

"The epidemiology of appendicitis poses many unanswered questions. Almost unknown before the 18th century, there was a striking increase in its prevalence from the end of the 19th century, with features suggesting it is a side effect of modern Western life."

Although the Journal did not identify or elaborate on the side effect, it is clear what it is: the long-term use of sitting toilets (more on this later).

Harvard Professor Reginald Heber Fitz was the first doctor to recognise the disease in 1886. He was also the one who called it appendicitis and proposed to treat it by removing the appendix.

This widely used surgical procedure was - and still is - based on the (erroneous) belief that "The appendix serves no known major functions or purpose." (Nothing could be further from the truth.)

Like many other serious colon, bladder and pelvic-related ailments, appendicitis is a sitting toilet-related health problem. It occurs when the appendix gets blocked with fecal matter. And it all has to do with the toileting posture a person uses for waste evacuation, as explained in this page on appendicitis.

[Back to Top] (Jun 19, 2007)

Inflamed Intestines Cost Australians Heavily

In an Access Economics study on the economic impact of Crohn's disease and ulcerative colitis, Australian researchers estimated the annual financial cost of these diseases at $0.5 billion - half for lost productivity, $79 million on the health system and the rest for absenteeism and informal care.

However, the biggest cost comes from lost wellbeing or 'burden of disease', which researchers valued at $2.2 billion.

Australian Crohn's and Colitis Association Chief Executive Francesca Manglaviti said the report reveals the enormous hidden cost of these debilitating conditions, and shows that more must be done.

"People with inflammatory bowel disease often feel invisible and vulnerable - it's a 'silent' disease," Ms Manglaviti said. "One of the main problems is the lack of knowledge in the community about Crohn's and colitis..."


Of course more must - and can - be done. But the report does not say how. There is a simple solution. However, based on the current state of affairs, it is unlikely that this problem will be solved.

Crohn's, ulcerative colitis and other inflammatory bowel diseases (IBD) are, in reality, sitting toilet-related health problems. One can lower the risk of contracting them simply by using the anatomically correct posture for waste elimination: squatting.

Ms Manglaviti's assertion that the lack of knowledge in the (Australian) community is not true.

Since 1987, Wallace Bowles of Australia has made it his life's work to educate his fellow countrymen on the danger of sitting toilets, and the importance and benefits of squatting.

The Access Economics researchers would do well to read this 1997 report on IBD in the British medical journal, The Lancet (Infant Mortality and The Incidence of Inflammatory Bowel Disease, Volume 349, Number 9050 DATUM: 1997-02-15):

"Inflammatory bowel disease is confined to countries of the Western World. The last half of this century has seen a rising incidence of inflammatory bowel disease in developed countries...  (But there is an) ...apparent absence of IBD in developing countries."

It has all got to do with the position (sitting or squatting) a person uses for emptying the colon.

[More about Crohn's Disease, Colitis and Wallace Bowles and his work...]

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Boston Globe (Jul 2, 2007)

Pelvic Muscle Injury During Childbirth

In her report, Judy Foreman wrote that that doctors, using MRI (magnetic resonance imaging), have just confirmed that vaginal deliveries (during childbirth) can severely tear muscles in the pelvis. These tears can lead later in life to uterine prolapse, in which the uterus bulges into and sometimes falls out of the vagina, and possibly to incontinence, or leakage of urine.

The study suggested that the use of forceps - large tweezer-like instruments used to pull babies that are stuck from the birth canal - raises the risk of injury to these pelvic muscles.

One take-home lesson, said Dr John DeLancey, the first author of the study and Director of Pelvic Floor Research at the University of Michigan Medical School, is for women and their doctors to "limit forceps to use only when necessary."


The problem is NOT with vaginal deliveries, but the posture used for childbirth. In most modern hospitals, women are only allowed to give birth in the semi-sitting position, which causes the birth canal to be closed by 20 - 30% (Journal of Obstetrics & Gynecology, 1969;76:817-20).

As a consequence, in an attempt to deliver their babies, women are forced to hold their breath and push with all their might (the Valsalva Maneuver). This straining and pushing put enormous strain on the pelvic floor muscles.

In a sense, damage to pelvic muscles during childbirth is akin to other toilet-related health problems. They can all be prevented by correct posture. This explains why women who use the squatting position for bodily functions and childbirth "are relatively unaffected by pelvic floor problems" [Schulz, J.A. (2001). Assessing and treating pelvic organ prolapse. Ostomy Wound Management, 4 (5), 54-56, 58-60].

[More about Childbirth and Pelvic Floor Prolapse...]

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Chicago Tribune and (Jun 10, 2007)

Toilets in China -- Lessons and Insights

In a report from Beijing, Alan Solomon of Chicago Tribune described, among other things, the kind of toilets one can expect:

"...Women especially should know that "squat" toilets outnumber 'western' ones."

Also, in her despatch from China, Lin Acacio-Flores of the Philippine Daily Inquirer/ANN) talked about the 'plight' of women using toilets in Shanghai and Hanzhou:

"In women's public toilets, almost all cubicles have the toilet bowl built into the tile floor, its edges flush with the floor. In other words, females squat to use them. There may be only one western toilet in an aisle of 12 toilets, so there's usually a long queue of foreign women in front of the western toilet.

My friend (had) taught me how to use the Chinese toilet when we were in Beijing two years ago. On the way to Hangzhou, I decided to avoid the waiting line and do it the Chinese way.

Well, I did, but while rising, my legs threatened to do a ballet split because the floor was wet and slippery. Fortunately... I got my old knees to work and stood up. From here on, don't persuade me to try it again."


Women in China and Western countries do it differently (squatting vs sitting). This, more than any other factor, explains why African and Asian women are relatively unaffected by pelvic floor prolapse and other (sitting) toilet-related health problems.

[More about sitting toilets and pelvic floor prolapse...]

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MedPage Today (May 24, 2007)

Patients with constipation may be costing the health care system thousands of extra dollars per person each year. The average annual health care costs for California patients with chronic constipation climbed from about $14,500 in 1997 to just under $23,000 in 2002.

Drug costs for the constipation group also increased substantially, from an annual average of about $2,000 in 1997 to more than $5,000 in 2003.


As long as the main underlying cause of constipation is not revealed and made known, there will be no end to the suffering and spiraling costs.

Those who suffer from constipation accept without question when told that the most common causes of constipation are insufficient intake of fiber and liquids, lack of exercise, medications, older age or abuse of laxatives. Few, if any, would be told that a natural remedy for constipation is to squat -- not sit -- when answering the call of nature.

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CBS News (May 23, 2007)

Researchers have found that erection problems and urinary symptoms associated with an enlarged prostate gland may be linked.

"Before, we looked at these two conditions as two different diseases," says Dr Kevin McVary, Professor of Urology at Northwestern University Feinberg School of Medicine in Chicago. But in the past three or four years, he says, the thinking among urologists has changed.

Experts have noticed that sexual performance in men seems to decline as their prostate enlargement becomes more severe. Also, men with milder prostate problems often have less erectile dysfunction than do those with moderate or severely enlarged prostates and urinary symptoms.

"These two diseases -- erectile dysfunction and the lower urinary tract symptoms associated with benign prostatic hyperplasia," says Dr McVary, "are probably linked."


These two problems have a common underlying cause. The pudendal nerve, located deep within the pelvic region, controls the function of the bladder and sexual organs in both males and females. As it passes through the pelvic floor, the pudendal nerve can suffer a stretch injury when the pelvic floor is repeatedly and forcefully pressed downwards whenever one strains to evacuate waste in the sitting toilet position.

In many cases, prostate enlargement, sexual dysfunction and urinary incontinence can be attributed to injured pudendal nerve. In reality, they are toilet-related health problems which could be prevented with the use of the correct toileting posture (squatting).

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MedPage Today (May 21, 2007)

Popcorn and Nuts Exonerated in Diverticulosis

To avoid the risk of complications like infection, inflammation, and bleeding, those who suffer from diverticulosis are often advised to stay away from nuts, corn and popcorn.

However, based on a long-running study, researchers have confirmed that this time-honored advice can be ignored. The study showed that there was no association between any of the three foods (nuts, corn and popcorn) and diverticular bleeding.

"The recommendation has evolved over the past 60 or 70 years," Dr Lisa Strate of the University of Washington said. "It simply stems from a theory that trauma was one of the causes of diverticular complications, and that these foods would be more likely to traumatize the colon wall."


Must it take another 60 to 70 years before researchers would recognise the truth about diverticulosis?

Like many other colon and pelvic ailments, diverticulosis is a toilet-related health problem. The underlying cause is the Western habit of using the sitting posture for defecation. The researchers could have saved all their trouble by reading the work of Dr B.A. Sikirov, the Israeli physician who conducted successful clinical research on the use of squatting to treat hemorrhoids:

Colonic diverticulosis develops as a result of excessive straining at defecation due to habitual bowel emptying in a sitting posture... The bowels of Western man are subjected to lifelong excessive pressures which result in protrusions of mucosa through the bowel wall (diverticulosis).

[More about diverticulosis...]

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The Straits Times (May 20, 2007)

Colorectal or colon cancer is the top cancer among men and women in Singapore. Between 1,300 and 1,400 new cases of are detected each year. The report also noted the worry trend that more young Singaporeans are being diagnosed with colorectal cancer, a disease usually associated with older people. One in five sufferers is below 50 years old.

According to Associate Professor KW Eu, Head of Singapore General Hospital's Colorectal Surgery Department, the likely cause of the big jump in the number of young people with colorectal cancer is "likely caused by diet".


Prof Eu might want to focus on toileting posture factor. There is strong anecdoctal evidence that colorectal (colon) cancer is a (sitting) toilet-related health problem. The rise in the incidence of the disease in not surprising; an increasing number of homes in Singapore do not come with squat toilets any more.

[More about sitting toilets and colon cancer...]

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