#078 Squat Toilets, Hemorrhoid Prevention, and Longevity

Squat Toilets, Hemorrhoid Prevention, and Longevity

Are you like 50% of Americans who have developed hemorrhoids by age 50?  Do you worry about your parents or grandparents falling in their homes?  Are you losing leg muscle strength as you are getting older?

If you answered yes to any of these questions then perhaps the answer just might be a squat toilet.  This article is just for you.

My First Experience with a Squat Toilet

At the age of 21 I was on a plane to Taiwan.  I had just completed 2 years of volunteer church service helping the Chinese immigrant population in New York City and I was eager to try out my new Chinese language skills and immerse myself in the culture by living in Asia for the first time.

I still remember the first time I went out with my Chinese friends in Taiwan.  We were busy enjoying the exciting night markets of Taipei, Taiwan when I suddenly needed to find a bathroom.

Perhaps it was travelers diarrhea.  Perhaps it was because I was not yet used to the food.  After finally finding a public bathroom, I was devastated to see that the only option available was a squat toilet.

How do you use this thing I thought?  There was no one else in the bathroom that I could ask.  As I was desperate I thought I would give it a try.

At first I thought “this isn’t so hard.”  Then my legs got wobbly, I lost my balance, and fell backwards.  It was gross.  Fortunately, no one saw me.

From then on I was always careful whenever I went out in public and did everything possible to avoid another encounter with a squat toilet.  I, like most Americans, lacked the lower extremity muscle strength, balance, and flexibility to use a squat toilet.

Is the key to longevity a squat toilet?

Would you believe it if I told you that 97% of the centenarians in the Bama County of China’s Guangxi Province are still able to independently use a squat toilet while in their 100s?  China’s Longevity Village is part of Bama, County in Southwest China near the Vietnam border.  Could this be the real reason for their longevity?

Depending on how long and how many times you use the bathroom, using a squat toilet could be the equivalent of doing about 10 squats each day.  This could be an incredible work out throughout the day for every day of your life.

Could this be an additional reason why obesity is rarely, if ever seen, in rural Asia where squat toilets are still common?  Could this answer why falls are rarely seen in rural China among China’s elderly?

The Dangers of Falling

Every day in my cardiology clinic I see older patients who are at risk of falling.  Many of these patients are also on blood thinners.  For anyone with aging parents or grandparents this is a real concern.

In fact, 90% of all hip fractures come from falls.  Of those who do fall and break a hip, the vast majority of them are either dead or still in a nursing home 1 year later.  This is definitely not how we want to spend our last days on Earth!

Falls are a very rare event in China’s Longevity Village.  Even the centenarians have excellent balance as they take their daily walks on the Village streets.  I suspect their great balance comes from being lean, not taking any medications, and from having excellent lower extremity strength from a lifetime of squatting.

Could falls in the elderly be just another manifestation of the American lifestyle?

Hemorrhoids Are Completely Preventable

Did you know that the word “hemorrhoid” was the number 1 searched for topic on Google in 2012?  Could this be because we are too embarrassed to bring this topic up with our doctor?

Hemorrhoids are definitely painful and embarrassing.  They are also totally unnecessary.  Once again, could hemorrhoids be yet another manifestation of our American lifestyle?  Once again, we could not find any cases of hemorrhoids in China’s Longevity Village and studies have shown that hemorrhoids are indeed rare in rural China.

What Causes Hemorrhoids?

If we know what causes hemorrhoids then we can take measures to prevent them.  According to medical studies, here are the big 4 causes of hemorrhoids.

1. Sitting and straining on the toilet

2. Not enough dietary fiber and water (constipation)

3. Not enough physical activity

4. Obesity

As you can see from the list, these are all easily preventable.  By simply tweaking our lifestyles, hemorrhoids never need to occur again.

The 3 Benefits of Using a Squat Toilet

1. We Were Not Meant to Sit

Sitting is indeed the new smoking.  While sitting is dangerous at home or at the office, could the same also be true in the bathroom?

Studies show that our body position is important when we have a bowel movement.  For example, squatting improves the anorectal angle allowing for better emptying of our colons and decreased intraabdominal pressure.  The end result of a better body angle during bowel movements is a lower risk of hemorrhoids.

2. Saves Time

Is there just not enough time in the day to get everything done that you need to get done?  Studies show that you can cut the amount of time you use the bathroom by 61% with a squat toilet.  The amount of saved time could really add up over the course of a lifetime!

3. A Daily Work-Out

Is it hard to find time to get to the gym?  Depending on how often you typically sit to use the bathroom you could potentially get your daily work-out just from using a squat toilet.

This is a great way to multitask.  You could get your work out done while using the bathroom.  This is so much healthier than reading a magazine or playing on your phone for 20 minutes while using the bathroom.

The list of benefits from doing squats as part of your daily work-out routine is endless.  In addition to strengthening your legs, it strengthens  your core muscles, improves balance, and improves flexibility.  If you suffer from knee pain it could just be because you have inadequate leg strength, balance, or flexibility.

My Confession

I need to make a confession.  Despite knowing the benefits of using a squat toilet, on our first two visits to China’s Longevity Village I did not use one.

While our room had a squat toilet I did not use it.  Instead, I used a chair with a hole cut out in the bottom and positioned it over the hole in the ground where the squat toilet was.

Interestingly, our children did not have any problems at all using a squat toilet.  Perhaps I was still too fearful from my first encounter with a squat toilet.

Action Items

1. Daily Squats

Even if you have no intention of ever using a squat toilet, doing squats daily can strengthen your legs as well as improve your balance and flexibility.  To learn how to do squats here is a great resource with an explanation and video.

Got bad knees or you are too big to do squats?  Here is a short video showing how you can still enjoy the benefits of squats even if you have bad knees or you are too big to do a traditional squat.

2. Don’t Read or Play on Your Phone While Using the Toilet

Sitting too long on the toilet can increase your risk of hemorrhoids.  If you like to read or play on your phone while using the toilet then you will probably sit longer.

While sitting in any form is not good for our health, there is an additional health concern with reading or using the phone while sitting on the toilet.  According to this BBC report, fecal material was found on 1 in 6 iPhones.  This is clearly not a healthy practice.

3. Increase Your Fiber, Water, and Physical Activity

To minimize your risk of hemorrhoids, increase your fiber, water, and physical activity.  Our bodies were designed to get more fiber, water, and physical activity than we typically get in the U.S.  This will also help to decrease the amount of time and straining required while on the toilet.

4. Convert Your Western Toilet to a Squat ToiletIMG_8894

For $25 you can easily convert your Western toilet to a squat toilet.  Basically, this is just placing a stool next to your toilet that allows you to squat.  There are a number of different manufacturers, such as Squatty Potty, and you can buy this on Amazon.

Even better would be to build your own squatting platform for free.  This is what I have done.  With some bricks we had laying around our house I was able to build this squat toilet.

If you do choose to build your own please make sure it is very stable to reduce your risk of falling.  Mine is definitely not stable at all.

Now with this unstable squat toilet I will definitely never be able to use my iPhone again while on the toilet.  Perhaps this will help me in my training to use a squat toilet before we return to China’s Longevity Village again in the fall.

With a squat toilet now you can do as they do in rural Asia and get in your daily squats without even having to schedule a time to work out.  Have you ever tried a squat toilet?  What was your experience?


If you do not typically do squats or use a squat toilet please discuss this with your doctor first before trying.  Also, depending on your level of physical conditioning, squats could result in significant injury.  If you are not used to using a squat toilet then you may also fall and get seriously injured while trying to use one.

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Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.

  1. Squat toilets really work. It is the correct toilet bowl as squatting is the right position when you do a bowel movements. When you are experiencing hemorrhoids, it is better that squatting is your position when you’re doing a bowel movements to decrease the pain. For a faster relief, better apply some over-the-counter remedies.

  2. Dr. Day, regarding squat toilets, I have worked outdoors for 40 plus years, often in very remote areas. SO yes, squat toilets are no stranger to me and I agree that it is a strenuous experience, we often remark that “it” is the hardest thing we have done all day! Carrying paper is a hard learned lesson, on one particular job in Montana, at the end of the project none of us had tails on our flannel work shirts 🙂 Thanks for these news letters, I enjoy them greatly!

  3. I smiled all the way through the article. I have been to Taiwan and China and had a similar experience. Fortunately I found a handicapped toilet in the train station. I also lived in Iran as a boy. Most of the toilets there are squatters without any flushing capability. They are called moosterahs. (Phonetic spelling)