Like religion and politics, toilet etiquette is a touchy subject. The latest proof is the debate on the future of traditional squat toilets in Thailand after a new law on the manufacturing standard of toilet seats came into effect on April 23. The law has provoked discussion and even fear that the state will ban the use of squat toilets, archaic but cheap household facilities that are still used in rural areas, as well as many houses and buildings.
Thailand is one of the few countries in the world where people in many areas still sit in a Gollum-seque position while answering the call of nature -- and some people in the city still prefer the good old squat toilet to the modern flush counterpart. The squat toilet can still be seen in Africa, and in Asian countries such as India, China or even technologically advanced Japan, which exports advanced sitting toilets with seat-heating functions, water spray for cleansing and ambient sounds. Still, the Japanese keep traditional squat toilets, known as washiki, with the belief that squatting will make knees stronger and help smooth out bowel movements.
The hullabaloo over Thai toilets came after the media saw the new law published in the Royal Gazette, and jumped to the conclusion that the authorities are trying to phase out traditional squats. But the fact is the announcement is a revised industrial ministerial order that requires manufacturers of toilet bowls to follow the rules of the Thailand Industrial Standard Institute (TISI) 792-2554 to make sure the products are manufactured in line with good sanitary and environmental standards.
"The law is not a ban on squat toilets. It is an industrial order that calls for sitting toilet seat manufacturers to follow production standards," said Dr Vachira Pengchan, director-general of the Department of Health.
Squat toilets have been the subject of curiosity -- and ridicule -- among some Westerners, who see it as a sign of backwardness. In China, Western-style sitting toilets are a sign of modernity. Japanese public toilets, meanwhile, usually have options for users, either the old way or the new method.
But in Thailand, the question whether to squat or sit has been framed in the health and social dimension, mainly the approach of our status as an ageing society. The state is not banning squat toilets but it does not want them either.
Dr Vachira said the Health Ministry tries to promote buildings to install modern sitting toilets for health reasons. The ministry has actually come up with the national public toilet master plan, which aims to see the number of modern toilets in Thailand reach 90%.
"Thailand is transforming into an ageing society where elders' health problems, mainly with knees and joints, are important health concerns," said Dr Vachira.
The master plan only targets 12 types of public buildings, not individual homes. So it will pay attention to tourist areas, food shops and restaurants, fresh markets, public transportation stations, petrol stations, schools, hospitals, government buildings, public parks, religious sites, public toilets and department stores. The master plan generally requires at least one modern seated toilet in one public bathroom.
But the debate over our positions on toilet seats has been simmering for a while. Indeed, there are reports of Western health experts raising questions that sitting toilet positions might be the cause of haemorrhoids and constipation. On the other hand, there are squat-toilet converts who preach about the benefits of the squatting position. In the US, there is a budding business called "Squatty Potty", founded by contractor Bobby Edward and his mother Judy Edward, who suffered from chronic constipation and was recommended by medical doctors to "relax the colon" by changing from sitting to squatting. Edward invented the U-shape stool, to place around Western toilet seats for his mother to raise her knees up.
"The squatting position has its pros and cons," said Asst Prof Dr Yudhtana Sattawatthamrong, gastroenterologist at Bumrungrad International Hospital. "The squatting position might be good for bowel movements, yet it might be bad for knees and joints, especially among elders, pregnant women or people who are overweight.
"Squatting will add weight and pressure to bones; it forces tiny bones to rub together and that will lead to knee problems. Furthermore, squatting too long might affect blood circulation," added Dr Yudhtana.
While sitting toilets might save our joint and knees, the knee-lowering posture impedes the opening of the puborectalis muscle and can hold back bowel movement function.
Knee raising is better because it will create an angle that helps relax the puborectalis muscle, and make the pathway to the anus straighter, and that will make our movement flow easily.
The important question, according to Dr Yudhtana, is how to combine the good aspects from the two positions. For him, it is possible for us to save our knees and have healthy and easy bowel movements without paying a lot of money. For homes with squatting toilets, all that is needed is an affordable raised toilet seat, available in medical supply stores, to be placed above squat toilets. The kit allows elders to sit with knees raised at the same time.
And owners of homes with modern sitting toilets do not need to make drastic adjustments.
"All you need are stools as high as 15cm to raise your feet and knees up. It is that simple."
