Urinary Incontinence - A Silent Epidemic

Urinary incontinence, or bladder incontinence, is uncontrollable leaking of urine from the bladder.

It is a serious problem that has reached epidemic proportions.

The extent of the suffering and high cost of treatment is reflected in these statistics (from Medicinenet):

  • In the United States alone, more than 17 million people are incontinent

  • 1 in 4 women age 30 to 59 has experienced an episode of urinary incontinence

  • 50% or more of elderly persons living at home or in long-term care facilities are incontinent

  • $16.4 billion is spent every year on incontinence-related care

  • $1.1 billion is spent every year on disposable products (diapers) for adults

But these figures do not give the full picture. For less than 50% who have problems with bladder control are too embarrassed to talk about it. The tragedy of it all is that urinary incontinence can easily be prevented because it has an underlying cause: sitting toilets.

sitting toilets, water closet

Many doctors are still unaware of the connection between urinary incontinence and sitting toilets. This is due to cultural conditioning. It would be difficult for a doctor, living in a society where sitting toilets are the norm, to be able to accept it.

Also, somehow, the information has been suppressed and kept from the public, for a good reason. Medical practice for urinary incontinence is extremely lucrative and has become a multi-billion dollar industry.

The sale of adult disposable diapers alone is worth more than a billion dollars a year. Obviously, there are many companies which don't want this to change.

With sitting toilets making huge inroads in many parts of the world today, the problem of incontinence is going to get worse. One can only hope that more people would learn about the toilet connection, and take action to protect themselves.

There are three things about urinary incontinence which would have revealed its association with another serious ailment, pelvic organ prolapse.

  • It is prevalent in the Western countries, but rare in the developing world

  • Women are more susceptible, and are twice as likely as men to suffer from it.

  • Many women with pelvic floor prolapse invariably suffer from urinary incontinence as well.

A pelvic floor prolapse occurs when the pelvic floor, which supports the pelvic organs (bladder, uterus, vagina, rectum), weakens and descends, causing the pelvic organs to drop (prolapse).

Pelvic floor prolapse can be attributed to straining on a sitting toilet. The descent of the pelvic floor often results in urinary incontinence. (More on this later.)

Women are more susceptible to urinary incontinence simply because their pelvic floor is more flexible (to allow for childbirth). This also explain why many women develop incontinence during pregnancy and after childbirth.

(A detailed explanation on the connection between sitting toilets and pelvic floor prolapse is given in the Pelvic Floor Prolapse section.)

For a pregnant woman, straining during bowel movements adds on to the pressure exerted by the fetus on the pelvic floor. Giving birth in the reclining position also increases the risk of pelvic floor nerve stretch injury.

Squatting is the position designed by nature to protect the pelvic floor during delivery. Sadly, the long-term use of modern toilets has also rendered millions of women incapable of prolonged squatting. The explanation for this is given in the page on squatting facets.

Adelaide University researchers, in the first comprehensive study of its kind in the world, have found a remarkably high prevalence of incontinence and pelvic prolapse in the Western countries.

The results of the study were published in an article entitled The Descent of Women – A Silent Epidemic (23 Nov 2000).

This is an extract from the article:

"Pelvic floor disorders can be a serious cause of discomfort and even disease, especially among women. The disorders may prompt incontinence…

… (the researchers) have found a remarkably high prevalence of pelvic floor disorders in the general population… Most of these complaints were still common among women who had never had a vaginal birth…

It is a silent epidemic, as those with the problem are often embarrassed to talk about it."

Ajay Rane, Professor Ajay Rane

In an interview with the Australian Broadcasting Corporation (21 November 2005), Professor Ajay Rane, consultant urogynecologist and pelvic reconstructive surgeon from James Cook University also spoke about the prevalence of urinary incontinence and pelvic floor disorders:

"Quite basic statistics even from India are showing that their incidence of incontinence or genital prolapse is far less than our population.

Australia, like any Western culture at the moment, is going through what's called a silent epidemic of urinary incontinence and genital prolapse.

As high as one in three women will suffer from urinary incontinence during their lifetime - this increases to one in two after the age of seventy. One in eleven women will have an operation for genital (pelvic organ) prolapse in their lifetime.

Thirty percent of these women will have a repeat operation within two years, so it's a big problem that we are facing."

On two separate occasions, Professor Ajay Rane had highlighted the underlying cause of urinary incontinence:

The New Zealand Herald (28 Oct 2004)

"We were quite sure squatting would be far superior to the Western toilet position. However, we have a problem now ... one third of the population is unable to squat."

The Star, Malaysia (30 Mar 2003)

"Actually, your toileting technique may have an effect on urinary incontinence. There is a lot of evidence to show that the Asian technique of using the toilet goes a long way to maintaining better pelvic health than the Western technique.

A study done in Hong Kong showed that city-dwelling women had more urinary incontinence and bowel problems than country dwelling women.

The basic differences in these women were not their body weight, or how many children they had, but their toileting habit. In general, women in urban areas use the 'sit' method while the rural women use 'squat' toilets.

Basically, we believe that the study suggests squatting causes the angle of the pelvis to relax much better and give better pressure. When you are sitting, you do not have the right relaxation of the muscles and the angle of the pelvis. I strongly believe that the squatting technique has tremendous beneficial effects on the pelvis."

Professor Ajay Rane is not alone...

stuart stanton, professor Professor Stuart Stanton, Chairman of the Continence Foundation and Consultant Urogynaecologist at St George's Hospital, London is also strongly in favor of using squatting toilets:

" 'Squat' toilets are an excellent way for women to exercise their perineum and pelvic floor muscles and control their urinary stream from the age of 2½-3 years onwards. Reports from the developing world suggest that urinary incontinence is much less in women who squat."

Find Out More...

The Problem With Sitting Toilets

Sitting toilets increase the risk of urinary incontinence because users are forced to strain for waste evacuation.

The colon is designed with squatting in mind. The men who invented or promote the use of sitting toilets did not know about this. They do not know that in any other position, the colon is not properly prepared for waste elimination.

On a sitting toilet, with the colon in the continence mode, a person is forced to strain while holding the breath and bear downwards with the diaphragm in order to evacuate waste (the Valsalva Maneuver).

The effect of straining during bowel movements can be devastating on the pelvic floor. Each time a person strains, the pelvic floor is stretched and pushed downwards. Assuming that a person have to strain three times per day on a sitting toilet, by age 45, her pelvic floor would have been pushed and stretched 50,000 times.

The pelvic floor is simply not equipped to take this kind of abuse. Over time, its muscles weakened, it can give way and cause a prolapse (dropping) of the pelvic organs (bladder, uterus, rectum, vagina). This is when the problem of urinary incontinence can arise.

Passing through the pelvic floor, and connecting the bladder to the spinal cord, is the pudendal nerve which controls, among other things, bladder function.

With the descent of the pelvic floor, the pudendal nerve can suffer a stretch injury, and lose its ability to properly transmit brain signals to and from the bladder.

(More information on pudendal nerve.)

Further proof that using the correct toilet posture is the natural remedy for incontinence can be found in the article "My Child, My Teacher" that was published in the 1998 spring edition of the New Vegetarian and Natural Health magazine.

The article, which focused on the benefits of squatting for children, recorded numerous cases of bedwetting that was corrected by a simple change in their toilet posture (from sitting to squatting).


More than any other factor (pregnancy and childbirth, hormonal changes due to menopause, medications etc), the high incidence of urinary incontinence is caused by wrong toilet posture.

To quote Professor Ajay Rane...

"The Asian technique of using the toilet goes a long way to maintaining better pelvic health than the Western technique."

It is no wonder why there is a growing epidemic of urinary incontinence in Westernised countries.

The solution is actually very simple: to squat instead of sit for waste evacuation. In order to do this, you must be able to squat, and also have a squatting toilet.

For those want to switch from sitting to squatting, the most common problem they will have is the lack of a squatting toilet. In such a case, a practical solution is to use a toilet squatting platform or converter.

Find Out More...

Book Recommendation

book about squatting, Nature Knows Best
If you are keen to know more about the benefits of the natural squatting position and the health hazards of sitting toilets, I like to recommend that you read Nature Knows Best.

You can find out more about Nature Knows Best by visiting this page.

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Sitting toilets are not the primary cause of incontinence. The problem of incontinence stems mainly from a sexual deficiency mainly, with sitting toilets …

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