How to use a squat toilet safely and hygienically: 5 steps for public restrooms

If you've ever been hesitant to sit on a public toilet due to a cold, dirty, or unhygienic seat, you might have considered hovering over the toilet or standing to defecate. However, improper posture can cause feces or water to splash out, leading to unsanitary conditions and discomfort.

Physiologically, a squatting posture or a posture close to squatting often provides a more favorable angle between the rectum and anus for bowel movements. Therefore, instead of attempting to defecate while standing in a completely upright position, experts recommend understanding how to properly shift your weight into a squatting position for bowel movements, while maintaining body stability to minimize messes.

In this article, Tiptory will help you understand how to hover over the toilet more safely, why some people choose this posture in public restrooms, what is the easiest posture for defecation, and simple ways to make bowel movements quicker, easier, and with less straining.

Is it possible to hover over the toilet?

It is possible to hover over the toilet, but it's not the optimal posture.

• Mechanically, you can defecate while standing or without directly sitting on the toilet. However, standing completely upright makes the defecation posture less natural and increases the likelihood of feces falling or splashing out.

• If you're in a public restroom and don't want to touch the toilet seat, a more appropriate approach is to transition to a squatting posture for defecation, rather than trying to keep your body fully upright.

• Research on the physiology of defecation shows that a squatting posture widens the anorectal angle compared to a conventional sitting posture, which can lead to a straighter path for stool and reduce the need to strain.

How to squat more safely when using the toilet

1. Place both feet firmly on the floor.

   • Stand facing the toilet, with your feet spread comfortably wide, and maintain a stable center of gravity.

   • Avoid attempting to maintain an unstable posture or standing only on your tiptoes, as this can lead to loss of balance.

2. Lower yourself into a near-squatting position.

   • Bend your knees and hips to lower your body, while avoiding direct contact between your buttocks and the toilet seat.

   • If necessary, you can lean your torso slightly forward to maintain balance.

   • This posture is similar to the mechanics of squatting for defecation, which helps increase hip flexion and change the anorectal angle.

3. Relax your abdomen and anal muscles.

   • Breathe normally, allowing your abdomen to relax naturally instead of constantly tensing your abdominal muscles.

   • Relax your anal area and pelvic floor, avoiding holding your breath or straining too hard.

   • The goal of a correct defecation posture is to facilitate the passage of stool with moderate straining, not to force it out quickly.

4. You can rest your elbows on your thighs.

   • Once you've lowered yourself, gently resting your elbows on your thighs can help stabilize your body.

   • Do not put your full weight on your knees or try to maintain the posture if you feel pain, dizziness, or lose your balance.

A squatting posture is generally more favorable than standing upright.

• Studies on defecation posture show that greater hip flexion when squatting is associated with a wider anorectal angle and can reduce the force needed to strain.

• However, the evidence does not mean everyone must defecate while standing or squatting. A recent pilot study showed that changing posture with a footstool does not always significantly improve stool evacuation in people with constipation.

• Therefore, if the toilet is clean and suitable, sitting on the toilet in a comfortable position is still a simple and safe option for most people.

If you have difficulty defecating, don't just change your posture.

• Constipation or the feeling of incomplete evacuation can be related to various causes, not just posture.

• If you frequently have to strain hard, experience pain during bowel movements, have blood in your stool, or prolonged constipation, you should consult a doctor instead of relying on hovering over the toilet.

• Some studies suggest that a forward-leaning posture can also aid defecation in people who have difficulty expelling stool.

Part 1: How to Hover Over the Toilet Correctly

Step 1: Choose an appropriate toilet stall for defecation.

Prioritize stalls with functional locks and sufficient privacy.

• When you need to hover over the toilet, stand to defecate, or have a bowel movement in a public restroom, choose a stall with a working lock. This helps prevent others from opening the door or interrupting you while you're using the restroom.

• If there are multiple stalls to choose from, prioritize one that is clean, dry, has toilet paper, and a sturdy door lock. Research shows that cleanliness and privacy are important factors influencing how people use public restrooms.

Choose a suitable location if you want to limit contact with others.

• If you are self-conscious about people passing by or find it difficult to defecate in public, you might choose a restroom located further from the lobby, entrance, or crowded areas.

• However, you shouldn't assume that stalls closer to the door are always cleaner than others. There isn't enough scientific evidence to confirm that this rule applies to all restrooms. Hygiene depends more on the number of users, cleaning schedule, and management quality.

• A study evaluating public restroom hygiene found that contamination levels can vary significantly between areas and times of day. Therefore, direct observation before choosing a stall is still a simpler and more reliable method.

If you don't want to sit directly on the toilet seat:

• For those who need to hover over the toilet due to concerns about the toilet surface, quickly inspect the seat before use.

• If the seat is clean and you feel safe, sitting in the correct posture is usually more stable than trying to hold your body in a standing or squatting position over the toilet.

• If you still want to avoid contact with the seat, keep both feet firmly on the floor and lower yourself into a near-squatting position, rather than standing completely upright. This method helps you control your body better when defecating in a standing posture.

Don't hold in your bowel movements just because the restroom is uncomfortable.

• Feeling concerned about cleanliness, lack of privacy, or fear of others hearing sounds can lead some people to avoid using public restrooms. A study of 6,004 women showed that 26% limited public restroom use frequently or almost always; this group also tended to use non-sitting postures and hold their urine more often.

• Therefore, if you need to defecate, prioritize finding a clean, private, and safe restroom instead of holding it in for too long.

Create a sense of privacy when using the restroom.

• If you're at a friend's house and are worried about others hearing sounds from the restroom, you don't need to be overly stressed. Sounds during defecation are completely normal.

• You can close the door, check the lock, and perform your personal hygiene routine as usual. Do not try to strain or prolong the time you defecate standing just to cover up sounds.

• If necessary, turning on the faucet for a short time can provide some background noise, but this is just a tip to help you feel more comfortable, not a necessary health requirement.

Prioritize hand hygiene after defecation.

• Whether you choose to hover over the toilet, stand to defecate, or sit on the toilet, the most important step after using the restroom is to wash your hands thoroughly with soap and water.

• Studies on public restrooms show that many surfaces, such as door handles, faucets, and frequently touched areas, can be recontaminated with microorganisms. Therefore, avoiding unnecessary contact with dirty surfaces and washing your hands after using the restroom is a more practical measure than solely focusing on the posture of standing defecation.

Step 2: Prepare toilet paper before defecating.

Check the toilet paper before use.

• Before you hover over the toilet, stand to defecate, or have a bowel movement in a public restroom, check if the stall has enough toilet paper and if it's within reach.

• If the toilet paper is out or too far away, you should switch to another stall to avoid an awkward situation while you are defecating.

You can line the bowl with a thin layer of paper to reduce splashing.

• If you are using a toilet and are concerned about water splashing back when stool drops into the bowl, you can place a few layers of toilet paper on the water surface before defecating.

• This method can help reduce noise and the sensation of splashing, but you shouldn't use too much paper as it can increase the risk of clogging the toilet.

• For those who defecate standing, maintaining body stability and controlling the defecation position is still more important than relying on a layer of paper in the toilet bowl.

Carry tissues or wet wipes when needed.

• A small pack of wet wipes can be useful when you need to clean up quickly after standing to defecate or if waste accidentally spills outside the toilet bowl.

• If using wet wipes, prioritize those that are fragrance-free and do not flush them directly down the toilet, unless the product is confirmed by the manufacturer to be flushable.

• You can carry extra tissues or dry paper towels to clean soiled surfaces. Afterward, dispose of them properly.

Choose easy-to-manage clothing.

• If you know in advance that you might have to hover over the toilet in a public restroom, you should choose clothing that is easy to pull up or adjust without losing your balance.

• With skirts or loose-fitting clothing, keep the fabric neat to avoid contact with the toilet or floor.

• With trousers, pull them down just enough and keep the pant legs neat to avoid touching the floor or getting dirty.

• Do not wear overly tight or difficult-to-adjust clothing if you anticipate having to use a non-sitting defecation posture.

Prioritize safety over trying to maintain a standing posture.

• If the restroom floor is wet, slippery, or you feel unsteady, dizzy, or unable to maintain a stable body position, stop.

• In particular, do not try to defecate while standing by squatting on the rim or seat of the toilet. The risk of falling in this case is more concerning than the benefit of avoiding contact with the seat.

• If the toilet is clean and safe, sitting directly on the seat is still the more stable and appropriate option for most people.

Step 3: Squatting helps make defecation easier.

Lower yourself into a squatting position, instead of standing upright.

• If you absolutely have to hover over the toilet or stand to defecate in a public restroom, you should actually lower yourself into a near-squatting position, rather than standing completely upright.

• This posture helps stabilize your body and allows for better control of the direction of defecation, thereby reducing the risk of waste falling outside the toilet bowl.

• A study on the physiology of defecation showed that a squatting posture widens the anorectal angle compared to a conventional sitting posture. However, this study was only conducted on 6 healthy individuals, so it should not be taken as evidence that squatting is always better for everyone.

Take small steps to keep your body stable.

1. Place both feet firmly on the floor.

   • Stand in an appropriate position in front of the toilet, with your feet spread comfortably apart.

   • Keep your entire foot in contact with the floor to create a stable base.

   • Do not stand on the rim or seat of the toilet, as there is a risk of slipping and causing injury.

2. Bend your knees and lean slightly forward.

   • From a standing position, slowly lower your body by bending your knees and hips.

   • Leaning your torso slightly forward helps stabilize your center of gravity.

   • If necessary, you can gently rest your elbows on your thighs for balance support.

3. Lower your hips into a near-squatting position.

   • The goal is to lower your hips while keeping your feet firmly on the floor.

   • If you can bring your knees slightly higher than your hips and still feel comfortable, this posture can create greater hip flexion.

   • Do not force your body down too far if your knees, hips, or back hurt.

Relax instead of straining forcefully.

• When you start to defecate, breathe normally and try to relax your abdomen, anus, and pelvic floor.

• As you exhale, allow your abdomen to relax naturally and apply gentle pressure from your abdominal muscles to assist with stool expulsion. Do not hold your breath or strain continuously and forcefully.

• The squatting posture can change the anorectal angle in a more favorable direction for stool expulsion. Some physiological studies have noted that this posture may help reduce the need to strain, but the existing evidence is not yet sufficient to conclude that it is the optimal posture for everyone.

Do not try to maintain the posture if you feel off-balance.

• If the restroom floor is wet, slippery, or you feel shaky, dizzy, or unable to keep your body stable, stop.

• In particular, you should not try to defecate while standing by squatting on the rim or seat of the toilet. The risk of falling in this situation is more concerning than the benefit of avoiding contact with the seat.

• If the toilet is clean and safe, sitting directly on the seat is still a more stable and appropriate option for most people.

If you frequently have difficulty with bowel movements, find the cause.

• Posture is only one part of the defecation process. Constipation can also be related to hard stools, low fiber intake, dehydration, lack of physical activity, or pelvic floor dysfunction.

• If you frequently have to strain hard, experience pain during bowel movements, feel like you haven't fully emptied your bowels, or have blood in your stool, you should not rely solely on standing to defecate to solve the problem. These could be signs that require medical evaluation.

• For people with constipation, experts often recommend drinking enough water, increasing appropriate fiber intake, exercising regularly, and not delaying bowel movements when the body has the urge.

Step 4: Proper Hygiene After Defecation

Wipe gently after using the toilet.

• After you hover over the toilet, stand to defecate, or squat, you might have less precise control over stool placement. Therefore, take your time to clean the anal area instead of just a quick wipe.

• Use soft toilet paper and wipe gently until clean. There's no need to rub hard or wipe too many times, as friction can irritate the skin around the anus. Anal skin care recommendations also emphasize gentle cleaning and avoiding excessive wiping.

Wipe from front to back when appropriate.

• For women, it is recommended to wipe from front to back, meaning from the genital area towards the anus. This method helps prevent bacteria from feces from reaching the urethra and vagina and is recommended by the NHS to reduce the risk of urinary tract infections.

• For men, the wiping direction can be more flexible depending on location and hygiene practices. The important thing is to avoid spreading fecal matter from the anal area to clean skin.

Use water or wet wipes when dry paper isn't enough for cleaning.

• If toilet paper doesn't clean completely, you can slightly dampen a small amount of paper or use a suitable moist wipe for a final clean.

• After cleaning with water or moist paper, gently pat dry instead of rubbing. Keeping the perianal area clean and dry helps reduce irritation.

• If you frequently experience itching, burning, or irritation around the anus, avoid increasing the number of wipes or using too many cleaning products. Excessive cleaning can damage the skin's protective barrier.

Caution when using wet wipes

• If you carry wet wipes when standing to defecate, prioritize gentle, unscented products or those without easily irritating ingredients.

Avoid using wet wipes with alcohol or strong detergents on the anal area unless necessary. The skin in this area is quite sensitive, and repeated exposure to harsh cleaning agents can cause dryness or irritation.

• Wet wipes are only for cleaning support; they do not completely replace washing with water when conditions allow.

If stool gets on your skin, clean it promptly

• In cases where standing to defecate causes stool to get on the skin around the anus or other areas, clean it as soon as possible.

• You can use water to wash it off first, then gently wipe or pat dry. There's no need to use strong disinfectants directly on this skin area.

• If stool getting on your skin happens frequently, re-evaluate your defecation posture, distance from the toilet, and body control rather than just increasing the amount of toilet paper used.

Wash hands after cleaning

• After wiping and adjusting your clothes, wash your hands with soap under running water for at least 20 seconds. This is an important step to remove bacteria and pathogens that can transfer from stool to hands.

• If soap and water are not available, you can use an alcohol-based hand sanitizer with at least 60% alcohol. However, when hands are visibly dirty, washing with soap and water is still the more appropriate choice.

No need to wipe to the point of pain or irritation

• The goal of cleaning after defecation is cleanliness without skin damage. If the anal area is frequently painful, burning, itchy, bleeding, or experiences prolonged discomfort, you should stop using potentially irritating products and consult a healthcare professional.

• A simple routine is: defecate → wipe gently → clean further with water or moist paper if needed → pat dry → wash hands. This is a more practical and safer approach than trying to wipe many times.

Step 5: Clean up and wash hands after using the toilet

Check and clean the area around the toilet bowl

• After standing to poop, standing to pee, or squatting, quickly check the toilet bowl and surrounding area for any splashed water or waste.

• If there are stains, use toilet paper, tissue, or a suitable wipe to clean them immediately. This helps keep the restroom clean and reduces the chance of the next user coming into contact with waste.

• If the toilet seat is dirty, wipe it clean before leaving the stall. Do not leave waste on the seat or floor.

Dispose of paper and sanitary items correctly

• Toilet paper can be flushed down the toilet if the restroom's drainage system allows it.

• For wet wipes, sanitary wipes, or thick paper, follow the instructions on the packaging. If they are not designed to be flushed, dispose of them in a trash can.

• If using a toilet seat cover, dispose of it according to the restroom's instructions instead of trying to flush a large amount of paper at once.

Wash hands with soap after defecating

• After defecating, whether you sit, squat, or stand to defecate, wash your hands with soap and clean water for at least 20 seconds. The CDC recommends washing hands after using the toilet as this is when hands are most likely to come into contact with microorganisms from feces.

• Follow these steps:

  1. Wet your hands under clean running water.

  2. Apply enough soap and rub all over your palms, backs of hands, between fingers, and under nails.

  3. Scrub hands for at least 20 seconds.

  4. Rinse thoroughly under running water.

  5. Dry with a clean, single-use towel or hand dryer.

Use hand sanitizer when water and soap are unavailable

• If the restroom does not have a sink or soap, you can use an alcohol-based hand sanitizer containing at least 60% alcohol.

• However, if hands are visibly dirty or have feces on them after standing to pee, it is best to find a place with water and soap to wash your hands. Hand sanitizer does not fully replace handwashing when hands are clearly soiled.

Last check before leaving the restroom

• After cleaning yourself, quickly check the toilet seat, floor, and area around the toilet bowl.

• Ensure no paper or waste is left outside the toilet and that trash has been disposed of correctly.

• A simple routine to remember is: defecate → check and clean up → dispose of trash correctly → wash hands for at least 20 seconds. Whether you choose to stand to poop for privacy or hygiene reasons, the cleaning step afterward is just as important as the defecation posture.

Part 2: Reasons to stand to defecate

Reason 1: Don't over-worry about toilet germs

Public restrooms have germs, but there's no need to be overly scared

• Worrying about germs when standing to pee, standing to poop, or using public restrooms is quite common. However, the presence of germs on surfaces does not mean you will definitely get sick.

• Studies show that public restrooms can contain various bacteria and viruses on surfaces, especially in high-touch areas. Nevertheless, a systematic review of 38 studies found that the actual number of illness cases with a confirmed source from public restrooms was quite low. Hand hygiene, surface cleaning, and good restroom maintenance can help reduce the risk of infection.

Focus on what truly helps reduce risk

• Instead of over-worrying about standing to defecate and potentially coming into contact with germs, focus on simple yet effective hygiene measures:

  1. Wash hands with soap and water after using the restroom.

  2. Avoid touching your face, eyes, nose, and mouth before washing your hands.

  3. Clean up any waste or splashes before leaving the stall.

  4. Keep your phone, wallet, and personal items away from potentially contaminated surfaces.

• The CDC recommends washing hands after using the toilet as it is one of the crucial times to help limit the spread of bacteria and viruses.

No need to be obsessed with avoiding every surface

• Germs don't just appear in restrooms. They also exist on many frequently touched surfaces in daily life.

• Research on the microbiome in public restrooms shows that surfaces can contain various microbial groups originating from human skin, soil, and the digestive tract. This indicates that contact with microorganisms in the environment is almost impossible to avoid completely.

• Therefore, if you choose to stand to pee because you don't want to sit directly on the toilet seat, consider this a personal choice for cleanliness, rather than thinking it completely eliminates the risk of germ exposure.

Don't hold stool just because you're afraid of public restrooms

• If you need to defecate, finding a clean, lockable stall and using it properly is often more practical than holding it in just because of fear of infection.

• If you need to stand to poop because you don't want to touch the toilet seat, prioritize maintaining a stable body, avoid skin or clothing contact with dirty surfaces, and wash your hands afterward.

• The goal is not to create a completely sterile environment, which is almost impossible in daily life, but to reduce unnecessary contact and maintain proper hygiene.

If anxiety about restrooms is stressing you out, adjust your body's response

• When feeling stressed before or during standing to pee, try inhaling slowly through your nose, exhaling slowly, and relaxing your shoulders and abdomen.

• You can do a few cycles of slow breathing before using the restroom. The goal is to reduce immediate tension, not to completely control anxiety.

• If fear of germs or public restrooms frequently causes you to hold stool, avoid going out, or significantly impacts your daily life, you should consult a doctor or mental health professional for assessment and appropriate guidance.

Remember that hand hygiene is more important than obsessing over defecation posture

• Whether you stand to poop, squat, or sit on the toilet, the risk of microbial exposure is not zero.

• The most important thing after defecating is proper handwashing. If water and soap are unavailable, you can use an alcohol-based hand sanitizer with at least 60% alcohol; however, soap and water are still the appropriate choice when hands are visibly dirty.

• Simply put: don't turn the restroom into a "danger zone," but don't underestimate hand hygiene either. A few correct habits will protect you better than over-worrying about every germ on the toilet seat.

Reason 2: Standing does not make defecation faster

Standing has not been proven to help defecate faster

• Some people believe that standing to poop or standing to pee stretches the digestive tract and stimulates bowel movements. However, current scientific evidence does not support this claim.

• A study on body posture showed that changing posture between sitting, standing, and lying down can stimulate colon motility better than maintaining a single posture. This suggests that movement and changing positions may be more important than remaining fixed in a standing position.

• Another study also did not find that standing posture accelerated the onset of defecation. Therefore, there is no basis to assert that standing to defecate helps stool pass faster.

Sitting or squatting postures are generally more suitable for defecation

• During defecation, posture can affect the angle between the rectum and the anus. A squatting posture increases hip flexion and can facilitate easier stool passage.

• However, this doesn't mean you have to stand to pee or squat every time you defecate. If the toilet is clean and safe, a comfortable sitting posture is often simpler and more stable.

• Some studies show that changing posture with a footstool can help some people reduce the sensation of difficult stool expulsion, but the effectiveness is not consistent across all individuals with constipation.

If you have difficulty defecating, consider the cause rather than just changing posture

• If you frequently strain, spend a long time in the restroom, or feel like stool remains even after defecating, the problem may not be with your posture.

• Constipation can be related to hard stools, a low-fiber diet, insufficient water intake, lack of physical activity, or certain medications and medical conditions.

• Some cases may involve obstructed defecation, where patients have difficulty expelling stool despite the urge to defecate. The cause may be related to pelvic floor dysfunction or structural issues.

When to seek medical attention?

• Consult a doctor if difficult defecation is prolonged, recurrent, or affects daily life.

• Specifically, medical evaluation is recommended if you have symptoms such as:

  1. Blood in stool or rectal bleeding.

  2. Persistent abdominal pain or significant anal pain.

  3. Vomiting, fever, or unusual abdominal distension.

  4. Unintended weight loss.

  5. Significant changes in bowel habits without clear cause.

If you simply want to defecate easier, start with the basics

• Don't force yourself to stand to defecate solely to make stool pass faster. Instead:

  1. Go to the toilet as soon as you feel the urge, avoiding frequent holding.

  2. Maintain sufficient fiber and drink enough water appropriate for your body's needs.

     Mia Taylor Doctor of Medicine, General Practitioner

     Graduated from Northwestern University Feinberg School of Medicine, with over 16 years of experience in primary care and metabolic disease management. Currently works at Northwestern Memorial Hospital, prioritizing safe, evidence-based medical treatment.