Non-fiction Book of the Month - Gut
In an extract from this fascinating look at our own digestive system, Giulia Enders tackles an important question about bathroom etiquette.
It’s a good idea to question your own habits from time to time. Are you really taking the shortest and most interesting route to the bus stop? Is that comb-over to hide your increasing bald patch effective and chic? Or, indeed, are you sitting properly when you go to the toilet?
There will not always be a clear, unambiguous answer to every question, but a little experimentation can sometimes open up whole new vistas. That is probably what was going through the mind of Dov Sikirov when the Israeli doctor asked 28 test subjects to do their daily business in three alternative positions: enthroned on a normal toilet; half-sitting, half-squatting on an unusually low toilet; and squatting with no seat beneath them at all. He recorded the time they took in each position, and asked the volunteers to assess the degree of straining that their bowel movements had required. The results were clear: in a squatting position, the subjects took an average of 50 seconds, and reported a feeling of full, satisfactory bowel emptying. The average time when seated was 130 seconds, and the resulting feeling was not deemed to be quite so satisfactory. (Anyway, tiny little toilets look kind of cute, whatever you do on them.)
Why is this? The closure mechanism of our gut is not designed in such a way that it can open the hatch completely when we are seated. There is a muscle that encircles the gut like a lasso when we are sitting or, indeed, standing, and pulls it in one direction, creating a kink in the tube. This mechanism is a kind of extra insurance policy, in addition to our old friends, the sphincters. Some people will be familiar with this ‘kinky’ closing mechanism from their garden hose. You ask your sister to check why there’s no water coming out of the hose. When she peers down the end, you quickly unbend the kink, and it’s just a few minutes till your parents ground you for a week.
But back to our ‘kinky’ rectal-closure mechanism: it means our faeces hit a corner. Just like a car on the highway, turning a corner means it has to put on the brakes. So, when we are sitting or standing, our sphincters have to expend much less energy keeping everything in. If the lasso muscle relaxes, the kink straightens. The road ahead is straight, and the faeces are free to ‘step on the gas’.
Squatting has been the natural pooing position for humans since time immemorial. The modern sitting toilet has existed only since indoor sanitation became common, in the late eighteenth century. But such ‘cavemen did it that way’ arguments are often met with distain by the medical profession. Who says that squatting helps the muscle relax better and straightens the faeces highway? Japanese researchers fed volunteers luminescent substances and X-rayed them while doing their business in various positions. They found out two interesting things. First, squatting does indeed lead to a nice, straight intestinal tract, allowing for a direct, easy exit. Second, some people are nice enough to let researchers feed them luminous substances and X-ray them while they poo, all in the name of science. Both findings are pretty impressive, I think.
Haemorrhoids, digestive diseases like diverticulitis, and even constipation are common only in countries where people generally sit on some kind of chair to pass their stool. This is not due to lack of tissue strength, especially in young people, but to the fact that there is too much pressure on the end of the gut. Some people tend to tense up their entire belly muscles when they are stressed. Often, they don’t even realise they are doing it. Haemorrhoids prefer to avoid internal pressure like that, by dangling loosely out of the anus. Diverticula are small, light-bulb-shaped pouches in the bowel wall, resulting from the tissue in the gut bulging outwards under pressure.
Of course, the way we go to the toilet is not the only cause of haemorrhoids and diverticula. However, it remains a fact that the 1.2 billion people in this world who squat have almost no incidence of diverticulosis, and far fewer problems with haemorrhoids. We in the West, on the other hand, squeeze our gut tissue till it comes out of our bottoms and we have to have it removed by a doctor. Do we put ourselves through all this just because sitting on a throne is more ‘civilised’ than silly squatting? Doctors believe that straining too much or too often on the toilet can also seriously increase the risk of varicose veins, a stroke, or defecation syncope — fainting on the toilet.
A text message I received from a friend who was on holiday in France read, ‘The French are crazy! Someone’s stolen the toilets from the last three service stations we stopped at!’ I had to laugh: first, because I suspected my friend was actually being serious, and second, because it reminded me of my first experience of French squat toilets. Why am I being forced to squat here when you could just have easily put in a proper toilet? I mournfully complained to myself as I recovered from the shock of the emptiness I saw before me. Throughout much of Asia, Africa, and southern Europe, people squat briefly over such toilets in a kind of martial arts or downhill skiing pose to poo. We, by contrast, take so long, we have to while away the time till we’ve finished our business with reading the paper, carefully pre-folding pieces of toilet paper for imminent use, scanning the corners of the bathroom to see if they could do with a clean, or staring patiently at the opposite wall.
When I read this chapter out to my family in our living room, I looked up to see disconcerted faces…