Have you ever thought about how you sit on the toilet? Most people haven’t! But the way you position your body when using the bathroom can make a surprising difference in how easily you poop and pee.
If you struggle with constipation, straining, incomplete bowel movements, or difficulty emptying your bladder, something as simple as putting your feet on a small stool may help. As pelvic floor physical therapists, we often recommend using a toilet footstool, commonly known by the brand name of Squatty Potty, to help improve bathroom habits and reduce unnecessary strain on the pelvic floor.
Why Sitting on a Regular Toilet Isn’t Always Ideal
Modern toilets are designed for convenience, but the traditional seated position isn’t necessarily the most efficient position for having a bowel movement.
When you sit on a standard toilet with your feet flat on the floor, your hips are typically positioned around 90 degrees. In this position, a muscle called the puborectalis helps maintain a bend at the junction between your rectum and anal canal. Or, if you are shorter in height, your feet might not touch the floor, meaning your lower extremity muscles and pelvic floor are not relaxed.
The puborectalis is part of your pelvic floor muscle group. It forms a sling around the rectum and helps maintain bowel continence by supporting the anorectal angle. When it’s time to have a bowel movement, this muscle needs to relax to allow stool to pass more easily.
However, if your pelvic floor muscles aren’t relaxing properly, or your toilet position makes relaxation more difficult, you may find yourself pushing and straining to empty your bowels. This is where a toilet footstool can help!
How Does a Toilet Footstool Help You Poop?
A toilet footstool is a small footstool designed to elevate your knees while you’re sitting on the toilet. By raising your knees above your hips, you create a more squat-like position that changes the angle of your hips and pelvis. This position can help:
- Improve the anorectal angle: Bringing your knees toward your chest can help straighten the pathway for stool to exit.
- Reduce straining: Better positioning may make it easier to pass stool without excessive pushing.
- Encourage pelvic floor relaxation: A supported squat-like position can make it easier to release tension in the muscles surrounding the rectum.
- Improve bowel emptying: Some people experience more complete bowel movements and less time spent sitting on the toilet.
- Decrease pressure on the pelvic floor: Reducing repeated straining can help limit unnecessary stress on the pelvic floor muscles and surrounding tissues.
While a footstool won’t fix every cause of constipation, it can be an incredibly useful tool for improving your bowel habits.
Why Is Straining So Bad for Your Pelvic Floor?
When you repeatedly bear down or hold your breath while trying to poop, you increase pressure inside your abdomen.
Over time, excessive straining can contribute to or aggravate problems such as:
- Hemorrhoids
- Pelvic organ prolapse symptoms
- Pelvic floor muscle dysfunction
- Rectal discomfort
- Difficulty coordinating your pelvic floor muscles during bowel movements
Your pelvic floor is designed to support your pelvic organs while also allowing you to empty your bowel and bladder. When these muscles are constantly exposed to excessive pressure, or don’t coordinate appropriately, bathroom habits can become more difficult. The goal isn’t to push harder. It’s to position your body so you don’t have to.
But Did You Know a Toilet Footstool Can Help You Pee, Too?
Most people associate the toilet footstool with constipation, but proper toilet positioning can also be beneficial for bladder emptying. When you urinate, your bladder muscle contracts while your pelvic floor muscles and urinary sphincter relax to allow urine to flow.
If your pelvic floor muscles remain tense, or you’re hovering over the toilet rather than sitting comfortably, it can become harder to relax and empty your bladder. A footstool may help by providing better support for your legs and allowing you to find a more comfortable, relaxed position.
It Can Help Your Pelvic Floor Relax
Your pelvic floor muscles play an important role in controlling urination. When these muscles are overactive or have difficulty relaxing, you might experience:
- Difficulty starting your urine stream
- A weak or interrupted stream
- Feeling like you haven’t completely emptied your bladder
- The urge to push or strain to urinate
- Frequent trips to the bathroom
Sitting with your feet supported, your knees comfortably apart, and your body relaxed can help encourage pelvic floor relaxation. For some people, using a footstool makes this position easier to achieve.
It May Help With Incomplete Bladder Emptying
Do you ever finish peeing, stand up, and immediately feel like you need to go again? Sometimes this sensation is related to pelvic floor muscles that aren’t fully relaxing during urination. Using a footstool may make it easier to relax and allow urine to flow without pushing.
However, it’s important to understand that a footstool does not guarantee complete bladder emptying. Persistent difficulty emptying your bladder should be evaluated by a healthcare professional.
It Encourages Better Bathroom Habits
Many people develop habits that make bladder emptying more difficult without realizing it.
These include:
- Hovering over public toilets
- Holding their breath while peeing
- Pushing to make urine come out faster
- Rushing through bathroom trips
- Keeping their abdominal and pelvic floor muscles tense
Using a footstool can serve as a reminder to slow down, sit comfortably, breathe, and let your body do the work.
Remember: You should not have to push to pee. Urination should happen through coordinated bladder contraction and pelvic floor relaxation, not forceful abdominal straining.
How to Use a Toilet Footstool Correctly
Using a footstool is simple, but your positioning matters!
Step 1: Elevate Your Feet
Place both feet on a stable footstool while sitting fully on the toilet. For bowel movements, aim to position your knees slightly higher than your hips. You don’t need a specific brand. A sturdy bathroom stool can work just as well (or a garbage can on its side, especially in a hotel!)
Step 2: Lean Forward Slightly
Rest your elbows or forearms on your thighs and gently lean your torso forward. Keep your back comfortable rather than excessively rounding or stiffening.
Step 3: Relax Your Belly and Pelvic Floor
Take slow, relaxed breaths. As you inhale, allow your belly to expand naturally and imagine your pelvic floor gently softening or releasing. Avoid clenching your buttocks or holding your breath.
Step 4: Avoid Forceful Pushing
For bowel movements, gently exhale as if you’re fogging up a mirror or softly blowing out a candle. If you need to assist a bowel movement, use gentle abdominal pressure rather than forceful bearing down. For urination, avoid pushing altogether. Let your bladder empty naturally.
Step 5: Don’t Sit for Too Long
If nothing is happening after approximately 5 minutes, get up, walk around, and try again when you feel the urge.
Spending long periods sitting and straining on the toilet can contribute to hemorrhoids and other pelvic floor problems.
Should You Use a Toilet Footstool Every Time You Go to the Bathroom?
For bowel movements, using a footstool regularly can be a helpful habit, especially if you experience constipation or frequent straining.
For urination, it’s a little different. You don’t necessarily need your knees above your hips to pee effectively. The most important factors are sitting comfortably, having your feet supported, and allowing your pelvic floor muscles to relax. Some people find that elevating their feet helps them relax, while others empty their bladder perfectly well with their feet flat on the floor.
The goal is to find a comfortable position that allows you to empty without straining.
What If a Toilet Footstool Doesn’t Help?
Although toilet positioning can make a significant difference, it isn’t a cure for every bowel or bladder problem.
If you continue to experience constipation, difficulty passing stool, or trouble emptying your bladder, there may be other factors involved. For example, some people have a condition called dyssynergic defecation, which occurs when the pelvic floor muscles and abdominal muscles don’t coordinate properly during a bowel movement. Instead of relaxing when you try to poop, the pelvic floor muscles may tighten or fail to release adequately.
Similarly, people with overactive pelvic floor muscles may experience urinary hesitancy, interrupted urine flow, or sensations of incomplete bladder emptying.
In these situations, changing your toilet position may help, but additional treatment may be necessary.
How Can Pelvic Floor Physical Therapy Help?
Pelvic floor physical therapy focuses on improving the strength, flexibility, relaxation, and coordination of the muscles responsible for bowel and bladder function.
Depending on your symptoms, treatment may include:
- Pelvic floor relaxation techniques: Learning how to release muscle tension rather than constantly tightening or performing Kegels.
- Bowel and bladder retraining: Improving bathroom habits, timing, and toileting mechanics.
- Diaphragmatic breathing: Learning how to coordinate your breathing, abdominal muscles, and pelvic floor.
- Manual therapy: Addressing muscle tension and restrictions when appropriate.
- Biofeedback and coordination training: Helping you recognize when your pelvic floor muscles are contracting versus relaxing.
- Individualized exercises: Improving mobility and muscle coordination to support easier bowel and bladder emptying.
The goal is to help your body work more efficiently so that using the bathroom becomes easier and more comfortable.
The Bottom Line: Small Changes Can Make a Big Difference
Something as simple as changing your toilet position can have a meaningful impact on your pelvic floor health.
Using a toilet footstool or another stable footstool may help you:
- Have bowel movements with less straining
- Improve comfort during bowel movements
- Reduce unnecessary pressure on your pelvic floor
- Relax more effectively while using the bathroom
- Develop healthier bowel and bladder habits
While the benefits are generally more established for bowel movements than for urination, proper positioning and pelvic floor relaxation are important for both.
Your bathroom routine shouldn’t feel like a workout. If you’re constantly pushing, straining, or feeling like you can’t fully empty your bowel or bladder, your pelvic floor may need some extra attention.
Looking to optimize your well being with pelvic floor physical therapy? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at [email protected]. We are in-network with several insurance plans and can help you confirm your benefits before your evaluation.