Toilet Heights and Chronic Constipation

Chronic constipation affects many Americans at some point in their lives.  “Chronic constipation can be caused by several conditions: colonic disorders, pelvic floor dysfunction or secondary constipation. Causes of secondary constipation include colon cancer, endocrine conditions (e.g., diabetes mellitus, an underactive thyroid gland), medications (e.g., narcotics) or neurological diseases (e.g., Parkinson’s diseasemultiple sclerosis). Colonic disorders cause constipation when the movement of contents through the colon and/or colonic sensation is disturbed. The colonic disorders include irritable bowel syndrome (IBS), which is often associated with constipation, and slow-transit constipation.” 1

It has been thought that poor dietary intake can also be a leading factor in chronic constipation.  It may import to monitor your fiber and liquid intake in order to eliminate the toxins and residuals of what we ingest.2However, who would think that your toilet height would be contributing to your chronic constipation?

Westernized seating has produced ill effects on evacuation.  The introduction of the toilet bowel is a necessary seat.  They are now indoors, come in several heights, colors and are surrounded by, at times, beautiful décor and tile.  However, it can prove a difficult place for elimination for shorter-stature people and children.  Proper bowel elimination seating can create appropriate relaxation of the pelvic floor muscles which can lead to successful defecation.  When you sit on the toilet, your knees may need to be higher than your hip bones.  There should be a greater than 90 degrees angle created at your hip that can help you relax your muscles enough so that you can have full pelvic floor muscle relaxation.


A pelvic floor physical therapist is able to help you to determine if your muscles are part of the problem of your chronic constipation problems.  While there are many facets to pelvic floor muscle problems relating to chronic constipation, a relatively quick muscle activity assessment in sitting, using computerized-biofeedback, with your hip and knees at different heights can help you determine the best position for muscle relaxation during defecation.

What is a quick solution to this problem if you can’t change the height of your toilet bowl?  Think about using a stool, or a large book you can place your feet upon to change your hip/knee angle.  Children should definitely be given a stool if their feet are dangling.  If this quick fix is not solving your problem and you have seen several doctors for chronic constipation, there may be a muscle dysfunction that can be the cause.   A physical therapy assessment could be just what the doctor ordered.

Lila Abbate PT, DPT, OCS, WCS


  1.  January 6, 2011.
  2. Annells M, Koch T. Constipation and the preached trio:  diet, fluid intake, exercise.  Int J Nurs Stud. 2003: Nov, 40 (8):  843 – 852.