The best toilet position for constipation: what a footstool actually fixes

The best toilet position for constipation: feet on a footstool so your knees sit above your hips, leaning forward with your elbows on your knees, back straight, belly relaxed. That shape partially recreates a squat, which imaging studies show straightens the anorectal angle (the bend your body maintains between rectum and anal canal) from about 100° to about 126°, so stool needs less force to leave. The studies behind this are small, but they point the same way: less straining, less time, more complete emptying. Plus an added benefit: a footstool costs almost nothing to try.

Written by Mike, Poopaya’s founder. I’ve lived with constipation for 13 years and built an app to finally get on top of it (here’s that story). The footstool was one of the first cheap experiments I ever ran on myself. I’m not a doctor, and this article is educational, not medical advice.

Why the angle matters

Your body is designed to make pooping difficult most of the time. That’s a feature: a muscle called the puborectalis wraps around your lower rectum like a sling and pulls it forward, creating a kink (the anorectal angle) that helps keep everything in until you decide otherwise. When you relax that muscle and the kink straightens, things can leave. When it stays kinked, you’re pushing around a bend.

Sitting on a modern toilet only partially unkinks it. A Japanese videomanometry study measured this directly, with simultaneous X-ray imaging and pressure sensors while volunteers actually defecated in three positions. Sitting produced an anorectal angle of about 100°. A full squat, hips deeply flexed, opened it to about 126°. Squatting also started from lower abdominal pressure before the pushing even began. The researchers’ conclusion was pretty plain: the greater the hip flexion, the straighter the canal, the less strain required.

That’s the entire theory of the footstool: you keep your toilet and borrow the hip flexion. Raising your feet and leaning forward moves your thighs toward your chest, which is most of what a squat does to your anorectal angle anyway.

That imaging study measured just six volunteers, though. Small studies are a recurring theme in this corner of medicine, so let’s look at the rest of the evidence with sample sizes attached.

What the footstool studies actually found

Start with full squatting. In a 2003 study in Digestive Diseases and Sciences, 28 healthy adults timed six of their own bowel movements in each of three setups: a standard-height toilet, a lower toilet, and a full squat. Squatting won decisively. Both time-to-done and self-rated straining dropped sharply in every single volunteer compared with either sitting height, and the author concluded that satisfactory emptying while sitting demands “excessive expulsive effort” compared with squatting.

Full squatting is a hard sell for most Western bathrooms (and most Western knees), so the practical question is whether a footstool captures enough of the same effect. In a 2019 Ohio State crossover study, 52 healthy adults logged every bowel movement for four weeks: two weeks on their normal toilet setup, then two weeks with a defecation posture modification device, which is the academic name for a footstool. Across 1,119 logged bowel movements, the footstool weeks looked meaningfully better. Complete-feeling emptying was about 3.6x more likely, straining fell to roughly a quarter of the odds, and movements without the stool took about 25% longer.

What’s still missing is a large randomized trial of footstools in people with diagnosed chronic constipation. The Ohio State participants were healthy volunteers, even if many of them reported straining and incomplete emptying at baseline. So the evidence tier here is “small studies, consistent direction, plausible mechanism” rather than guideline-grade proof, and I’d love to see a 300-person trial. But given that the intervention costs about as much as a pizza and has essentially no downside, the bar for trying it on your own gut is a lot lower than the bar for calling it a proven therapy.

How to actually sit

Continence physiotherapists have been teaching this position for years, and the UK’s Bladder & Bowel Community publishes the standard version:

1. Feet on the stool, knees above your hips. The standard stool is about 7 inches (18cm) tall; the right height is whatever clearly gets your knees higher than your hips. Shorter people and taller toilets need higher stools.
2. Lean forward, elbows on your knees. This is the half of the position people skip. The lean is what deepens the hip flexion. Feet up while sitting bolt upright negates most of the benefit.
3. Straight back, relaxed belly. Let your abdomen bulge out. Sucking it in works against you.
4. Breathe instead of straining. Slow, deep breaths, letting pressure build gently toward your bottom, mouth open rather than breath held. Straining against a held breath what this whole setup is trying to replace.
5. Give it a few tries, then leave. If nothing happens, get up, walk around, and come back when the urge does. Sitting there waiting mostly just leaves you sore and frustrated.

Two habits can multiply the squatting position’s effect: go when the urge arrives instead of postponing it (if you ignore an urge, it can be a while before the next one shows up), and give yourself an unhurried window. For many people that means 20-40 minutes after breakfast or coffee, when the colon is naturally most active.

And no, you don’t need the brand-name stool. Books, a crate, a yoga block, the kids’ step stool: anything that holds your knees above your hips does the same job.

One variable, two weeks

A footstool is about as clean as a single-variable experiment gets: it costs nothing and it doesn’t interact with anything else you’re taking. The only way to waste it is to change everything at once, feet up and more water and magnesium and a new fiber gummy, all in the same week, and then nobody knows what worked.

So run it clean: change the position, keep everything else steady, and track each movement for a couple of weeks: Bristol type, strain, how complete it felt. Poopaya makes that a two-tap habit and shows you the before/after pattern, which beats trying to remember whether last Tuesday felt easier than this one.

When position isn’t the problem

A footstool fixes geometry but it doesn’t fix everything else that causes constipation. Knowing which problem you have saves a lot of frustrated pushing.

If your stool comes out as hard little pellets, position probably wasn’t the bottleneck. Softness was. That’s a job for water, fiber, prune juice, and osmotic laxatives like MiraLAX, which has its own timing rules.

If stool is soft but still won’t come out, and every remedy seems to “fail” the same way, you may be in different territory: about one-third of people with chronic constipation have an evacuation disorder such as dyssynergic defecation, where the pelvic floor muscles stop coordinating and effectively push against a closed door. A footstool can’t teach muscles to cooperate. Biofeedback therapy with a pelvic floor specialist can, and it has a strong track record. This is definitely worth a conversation with a gastroenterologist.

If a medication is slowing your colon (GLP-1 drugs like Ozempic, opioids, iron, Zofran), the position still helps at the margin. But the driver is chemical, so the fix usually involves more steps of the relief ladder plus a chat with your prescriber.

While you’re collecting cheap, drug-free tools, abdominal massage pairs naturally with the footstool, since massage works on what’s moving through the colon while the footstool works on the exit.

And if you’re reading this in the first week after giving birth, the footstool is one of the things maternity guidance specifically recommends. The postpartum first poop has the rest of that picture.

When to see a doctor

Position is a low-stakes experiment, but constipation itself isn’t always. See a doctor promptly if you have:

• Blood in your stool, or black tarry stools
• Severe or worsening abdominal pain, or a swollen, hard belly
• Vomiting alongside the constipation, or you can’t pass gas
• Unexplained weight loss
• Constipation that’s new and persistent, especially after 50
• Weeks of reasonable home measures (position included) with nothing to show for it

A footstool is never the answer to any of these potentially serious issues.

FAQ

Does a footstool like the Squatty Potty really work? The best study so far says yes, with caveats. In a 4-week crossover study of 52 healthy adults covering 1,119 bowel movements, using a footstool made complete-feeling emptying about 3.6x more likely, cut straining sharply, and shortened time on the toilet. The caveat is that the participants were healthy volunteers, not people with diagnosed chronic constipation, and there’s no large randomized trial in constipated patients yet. Since a footstool is cheap and essentially risk-free, most clinicians file it under “worth trying”.

How high should a footstool for the toilet be? High enough that your knees sit clearly above your hips. The standard commercial stool is about 7 in / 18cm, which works for most people on a standard toilet. If you’re shorter or your toilet is tall, you may need more height. The stool itself is not magic: a stack of books or an upturned crate that gets your knees above your hips does the same job.

What is the best position to poop? Feet on a stool with knees above hips, leaning forward with your elbows on your knees, back straight, belly relaxed and bulged out rather than sucked in. Then breathe instead of straining: slow, deep breaths, letting the pressure build gently. If nothing happens after a few tries, get up and come back later rather than camping there.

Why is squatting better than sitting for bowel movements? Because of the anorectal angle, the bend between your rectum and anal canal that a sling-shaped muscle maintains to keep you continent. Sitting keeps that bend at roughly 100 degrees; a full squat opens it to about 126 degrees in imaging studies. A straighter path means less pushing force is needed. A footstool on a normal toilet is a practical way to move your body toward the squat shape without giving up the toilet.

The cheapest experiment in this whole category

Most constipation remedies ask for weeks of patience or a run to the pharmacy. This one asks you to put your feet on a box. The studies are small, but they all agree, and the mechanism shows up on an actual X-ray. If it does nothing for you, you’ve lost nothing.

Download Poopaya on the App Store, log two weeks with the footstool, and find out whether the oldest posture in human history deserves a permanent spot in your bathroom.

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This article is for educational purposes only and is not medical advice. Poopaya is a tracking and pattern-spotting tool, not a medical device, and it does not diagnose or treat any condition. If you have a condition affecting your pelvic floor, mobility, or balance, check with your doctor or physiotherapist before changing your toilet setup, and see a doctor promptly for any of the warning signs above.