In the larger cities of Asia, many residents have abandoned their traditional customs, believing that the West is more progressive and somehow “superior.” By adopting western toilets, they have unwittingly introduced new diseases into their society. A recent article in the Malaysian newspaper, The Star, (March 30, 2003) discusses one such ailment:

 

To squat or not to squat? That is the question. 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, says Professor Ajay Rane, James Cook University of Medicine (Australia) consultant urogynecologist and pelvic reconstructive surgeon.

 

According to Rane, 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 habits,” he says.

 

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,” he says. “I strongly believe that the squatting technique has tremendous beneficial effect on the pelvis.”

 

Dr. Rane’s view is shared by Dr Stuart Stanton, Chairman of the Continence Foundation and Consultant Urogynecologist at St. George’s Hospital, London:

 

“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 2 ½ - 3 years onwards. Reports from the developing world suggest that urinary incontinence is much less in women who squat.

 

Here is a brief explanation of why sitting toilets increase the risk of incontinence: The pelvic floor is a hammock of muscles that supports the intestines, the bladder and the uterus. Western toilets force the user to strain for evacuation, repeatedly subjecting the pelvic floor to unnatural stress. The downward pressure stretches and weakens the pudendal nerve, responsible for bladder control.

 

To maintain continence, the brain needs to constantly monitor the pressure within the bladder and issue commands to the urethral sphincter muscle. Both functions are impaired when the pudendal nerve is weakened by the descent of the pelvic floor. The following statistics from FocusOnUrology.com show how frequently this occurs.

FocusOnUrology.com attributes incontinence mainly to childbirth, weakened pelvic muscles, hormonal changes associated with menopause, and (in men) prostate surgery. Due to their cultural conditioning, they do not mention the use of the reclining posture for childbirth. The modern commode has made women incapable of prolonged squatting, the position designed by nature to protect the pelvic floor during delivery.

 

Nor do they mention the direct effect of using a sitting toilet, which causes the pelvic floor to be pushed downwards each time one strains to evacuate. Based on a conservative estimate that the average person strains four times for each daily evacuation, by the age of 50 the unsupported pelvic floor has been stretched 73,000 times.

 

An unnatural manoeuvre repeated so many times inevitably causes a “repetitive stress injury.” The pudendal nerve is the main casualty of this unintentional abuse, which renders incontinent over 50% of elderly Americans (statistics above.)

 

Other westernized countries face a similar problem. Researchers at Adelaide University in Australia recently reported that incontinence and other pelvic floor disorders are much more prevalent than previously believed. The article is entitled “The Descent of Women – a Silent Epidemic” (23 November 2000):

 

Adelaide University researchers, in the first comprehensive study of its kind in the world, 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...... “The survey highlights the high prevalence and major social impact of pelvic floor prolapsed and incontinence in our society,” said Professor MacLennan. “It is a silent epidemic, as those with the problem are often embarrassed to talk about it,” he said.

 

 

Until recently, the cause of this epidemic has been a mystery. But research by Mr. Wallace Bowles on the relevance of the squatting posture has brought a new understanding of how to prevent (and in many cases correct) these disorders: