Sitting vs. squatting: a scoping review of toilet postures and associated health outcomes.

BACKGROUND/OBJECTIVE: The comparison between squatting and sitting toilets involves complex health, ergonomic, and design considerations. This scoping review aims to synthesize evidence on the digestive, musculoskeletal, and ergonomic health outcomes associated with squatting and sitting toilet postures, while also exploring related health impacts (e.g., urinary and cardiovascular) and design considerations.

METHODS

This scoping review was conducted on January 1, 2024, searching Scopus, PubMed, and Web of Science, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Inclusion criteria were defined using the patient/population, intervention, comparison and outcomes (PICO) framework. Two reviewers independently screened titles, abstracts, and full texts, supplemented by hand searches in Google Scholar and Science Direct, and snowballing. Methodological quality was appraised using Joanna Briggs Institute (JBI) checklists.

RESULTS

Forty-two studies were analyzed. Squatting may reduce digestive strain and enhance bowel evacuation, potentially benefiting constipation, while sitting toilets may increase bowel-related issues but provide comfort for specific populations, such as older adults. Musculoskeletal outcomes vary, with squatting linked to strain in vulnerable groups and sitting toilets reducing joint stress when ergonomically designed. Ergonomic innovations, such as adjustable seats and non-slip surfaces, show promise in improving comfort and minimizing health risks. Methodological limitations, including small sample sizes and inadequate control of confounders, preclude definitive conclusions.

CONCLUSION

Squatting and sitting toilet postures differentially influence digestive health, musculoskeletal strain, and sanitation, shaped by individual needs, cultural practices, and environmental factors. Practical implications include developing adjustable, hygiene-focused, culturally sensitive toilet designs to enhance public health. Longitudinal studies with robust methodologies are needed to clarify chronic health impacts and optimize user-centered toilet design solutions.