Coffee, foot stool, toilet positions: What are the most effective ways to ease constipation?

Even if you always manage to cruise through Number 2 in the bathroom, there will be occasions when your bowels pull a number on you in the form of constipation. You’ll be pushing and grunting as you’re scrolling through social media. And if luck would have it, you might come across a TikTok video or two about some rather unusual toilet positions like this one:

That video got us going like an enema – mentally, at least. How does doing “yoga” on the toilet (well, sort of) stack up against other pooping strategies? What’s the science behind each method? In no specific order of effectiveness, here’s a look at what you could try as you’re passing verdict on your porcelain throne.

1. TOILET POSITIONS AND TACTICS

Is it worth the effort to twist your body into a pretzel even as your colon is trying to squeeze out a chocolate eclair? What about leaning to the left and coughing while defecating? (We were told it's a thing.)

First, a lesson in biology. The rectoanal angle is found in the last portion of your anal canal and is about 90 degrees when you’re not swirling your soft serve into the toilet bowl. And rightly so as the acute angle closes the anal canal to keep things in. During defecation, the rectoanal angle extends to 110 to 130 degrees, so that stool can pass through.

If the position you adopt helps to straighten the rectoanal angle, you could make it easier to pass motion without straining, said Dr Kewin Siah, a senior consultant with National University Hospital’s Department of Medicine, Division of Gastroenterology and Hepatology.

What about the torso twist seen in the TikTok video? “While it may aim to leverage the benefits of squatting, it is not research-proven and may not be safe or effective for everyone,” said Dr Siah. 

Dr Wang Yu Tien, a consultant gastroenterologist from Nobel Gastroenterology Centre at Gleneagles Medical Centre, thinks it just might work. "The position in the video involved lifting the left thigh while pressing it against the lower abdomen, which may increase the abdominal pressure," he said. "Lifting the left thigh is also likely to open up the anus. Combined, the position may help open the bowels."

As for coughing and leaning, "coughing increases abdominal pressure, so it may also help with opening the bowels", said Dr Wang. "With regards to leaning to the left, I am uncertain of the physiology and efficacy of it."

2. FOOT STOOL

Speaking of the foot or toilet stool, it isn’t only Dr Siah who gave his approval; researchers from The Ohio State University Wexner Medical Center’s College of Medicine also gave their thumbs-up.

At the start of their study on 52 healthy participants, 44 per cent reported straining on the toilet, while nearly a third said they had trouble completely emptying their bowels. A month of using the stool later, 90 per cent reported less straining and two-thirds said they would continue to use a foot stool.

The science? Putting your feet on a stool while sitting on the toilet can help to straighten the rectoanal angle between the rectum and anus, said Dr Wang, and this helps to let stool pass through easier. You'll have to ensure your hips are flexed beyond 90 degrees, said Dr Siah, for the anal canal to straighten.

3. SQUAT VS SIT TOILET

While most of us would make a beeline for the stall with the toilet bowl, the squat toilet may be more conducive for the brown train to chug along easier. “Squatting is a more beneficial position for defecation than sitting as it straightens the rectoanal angle, making it easier to pass stool without straining,” said Dr Siah.

Conversely, “sitting on a standard toilet can lead to a sharper angle, requiring more effort and potentially causing issues like constipation and haemorrhoids”, he said.

4. PHYSICAL ACTIVITY

Here’s another benefit to tag to the long list of benefits that exercise delivers: Easing constipation. According to Dr Siah, the body movements you go through can stimulate your intestinal muscles. This increases blood flow to the intestinal tract and promote peristalsis – the involuntary muscle movement that occurs in the digestive system, he said.

You don’t have to book a yoga retreat or run a marathon but keeping your activity regular would help. Try core strengthening exercises, stretching and aerobic ones that work the cardiovascular system such as walking.

5. ABDOMINAL MASSAGE

Small studies suggest that massaging your abdomen can move things along in the colon. A 2020 study on 40 subjects, for instance, compared Thai massage with laxatives, and found that while both methods gave the subjects relief, researchers said the massage was a more effective one as it resulted in more solid, regular stools than the laxative.

“Abdominal massages can help relieve constipation by massaging the intestines and promoting regular bowel movements,” said Dr Siah. His suggestion: Daily abdominal massages for 10 to 15 minutes.

Such massage typically follows the directional flow in your colon. It often starts at the right hip bone, progresses upwards and across from right to left underneath the rib cage, before going down the left side of your abdomen. Here’s one to try:

6. CARBONATED WATER

Like a water slide without sufficient water, your poop won’t be having a splashing good time as it moves through your internal waterpark. But you already know that, don’t you? What you may not be aware of is that sparkling or carbonated water may do a better job at lubricating things.

It’s not known why but in a study of stroke patients, the group that drank bubbly water for two weeks nearly doubled the number of bowel movements than the control group. What’s more, participants reported a 58 per cent decrease in constipation symptoms.

But don’t confuse carbonated drinks for carbonated water. The former is often loaded with sugar, a FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) that can lead to changes in bowel habits such as constipation.

In diabetics, excessive levels of the sweet stuff may cause nerve damage. If the vagus nerve that controls the movement of food through the digestive tract is affected, it may lead to constipation.

7. COFFEE

The caffeine in coffee certainly revs your gastrointestinal engine. Almost 30 per cent of coffee drinkers report a desire to poop after a cuppa and it can happen in as little as four minutes.

Whether it’s regular or decaffeinated, each cup of joe contains acids that are known to boost levels of gastrin, a hormone that stimulates these involuntary muscle contractions in your stomach to get your bowels moving. Coffee also increases the release of cholecystokinin, a hormone that plays a key role in the digestive process.

8. FIBRE

You've probably heard about fibre easing constipation all the time, so why are we still talking about it? Because fibre may sometimes worsen symptoms of constipation instead such as stool consistency, pain, bloating and gas, even though fibre generally shortens your go-time in the bathroom. In a six-month study on 63 subjects with chronic idiopathic constipation, a low-fibre or even a no-fibre diet actually improved their symptoms.

But that's not to say you shouldn't take fibre. The Health Promotion Board recommends two servings of fruit and two servings of vegetables per day to help you meet your daily fibre requirement (20g for women and 26g for men). Otherwise, check with your doctor first before adopting any dietary changes for your constipation.