An ergonomic approach to public squatting-type toilet design

Optimal Span between Feet of Public Squat Toilet Based on Anthropometric Data and Squatting Stability Assessment

Sitting toilets are preferred globally because they afford a relatively comfortable posture. However, squat toilets are among the most common toilets in numerous public areas because of their advantages, including personal hygiene, easy cleaning, and health benefits. This study attempted to determine optimal toilet design parameters and recruited 50 Taiwanese and 50 Southeast Asian women and collected span between feet (SBF) data for participants squatting in their most comfortable posture, and also surveyed maximum outer width (MOW) data of 28 public squat toilets in Taipei. Finally, we compared the squatting stability levels of 40 female participants (20 Taiwanese and 20 Southeast Asians) who squatted for 2 min at comfortable SBF and MOW-based SBF values. The results revealed that the minimum and maximum SBFs of Taiwanese were 14.52 cm and 18.40 cm, and that of Southeast Asians were 15.64 cm and 20.40 cm, respectively. No significant difference was observed in the SBFs between the two groups was observed. The mean (range) MOW of the surveyed toilets was 27.7 (27–29) cm. Analysis of variance results showed no difference in stability between the two SBFs. This implies that the comfortable SBF (i.e., 16 cm between the participants’ heels) was narrower than the MOW, as commonly used, indicating that the comfortable SBF can be considered as an optimal toilet width parameter because of its constant stability.

Toileting Behaviors of Women-What is Healthy?

PURPOSE

The objective of this study was to assess toileting behaviors in community dwelling women.

MATERIALS AND METHODS

Women 18 years old or older were recruited through a national registry of research volunteers. They were asked to complete validated questionnaires assessing urinary symptoms and toileting behaviors, specifically place preference for voiding, convenience voiding, delayed voiding, straining during voiding and position preference for voiding. The PPBC (patient perception of bladder condition) was administered to assess the participant impression of bladder health. Analyses were done to determine the prevalence of each toileting behavior reported to occur sometimes or more often as well as differences in toileting behaviors in women with vs without self-perceived bladder problems based on the PPBC response.

RESULTS

The 6,695 women who completed the questionnaires were 18 to 89 years old (mean ± SD age 41.4 ± 15). Of the women 79.9% identified as white and 71.0% were college educated. Of the women 6,613 (98.8%) reported a place preference for voiding. The 3,552 women (53.1%) who reported a bladder problem were more likely to report convenience voiding, delayed voiding and strained voiding behaviors. While 6,657 women (99.4%) reported sitting to void at home only 5,108 (76.2%) reported sitting when using public toilets.

CONCLUSIONS

Certain toileting behaviors, of which some may be considered unhealthy, were common in this sample of women and most were associated with a perception of bladder problems. Voiding positions other than sitting were frequently used when away from home. These data have important implications for defining bladder health and implementing behavior based interventions for women with lower urinary tract symptoms.

Perspective on Physical Therapist Management of Functional Constipation

Functional constipation is a common bowel disorder leading to activity restrictions and reduced health-related quality of life. Typically, this condition is initially managed with prescription of laxatives or fiber supplementation, or both. However, these interventions are often ineffective and fail to address the underlying pathophysiology and impairments contributing to this condition. Physical therapists possess the knowledge and skills to diagnose and manage a wide range of musculoskeletal and motor coordination impairments that may contribute to functional constipation. Relevant anatomic, physiologic, and behavioral contributors to functional constipation are discussed with regard to specific constipation diagnoses. A framework for physical therapist examination of impairments that can affect gastrointestinal function, including postural, respiratory, musculoskeletal, neuromuscular, and behavioral impairments, is offered. Within the context of diagnosis-specific patient cases, multifaceted interventions are described as they relate to impairments underlying functional constipation type. The current state of evidence to support these interventions and patient recommendations is summarized. This perspective article aims not only to heighten physical therapists' awareness and management of this condition, but also to stimulate clinical questioning that will open avenues for future research to improve patient care.

Impact of behaviour and lifestyle on bladder health

Bladder conditions, including UTI, UI, and bladder cancer, are highly prevalent and affect a wide range of populations. There are a variety of modifiable behavioral and lifestyle factors that influence bladder health. Some factors, such as smoking and obesity, increase the risk or severity of bladder conditions, whereas other factors, such as pelvic floor muscle exercise, are protective. Although clinical practice may be assumed to be the most appropriate ground for education on behavioral and lifestyle factors that influence bladder health, it is also crucial to extend these messages into the general population through public health interventions to reach those who have not yet developed bladder conditions and to maximize the prevention impact of these behaviors. Appropriate changes in these factors have the potential for an enormous impact on bladder health if implemented on a population-based level.

Evaluation of proper height for squatting stool

Many jobs and activities in people's daily lives have them in squatting postures. Jobs such as housekeeping, farming and welding require various squatting activities. It is speculated that prolonged squatting without any type of supporting stool would gradually and eventually impose musculoskeletal injuries on workers. This study aims to examine the proper height of the stool according to the position of working materials for the squatting worker. A total of 40 male and female college students and 10 female farmers participated in the experiment to find the proper stool height. Student participants were asked to sit and work in three different positions: floor level of 50 mm; ankle level of 200 mm; and knee level of 400 mm. They were then provided with stools of various heights and asked to maintain a squatting work posture. For each working position, they were asked to write down their thoughts on a preferred stool height. A Likert summated rating method as well as pairwise ranking test was applied to evaluate user preference for provided stools under conditions of different working positions. Under a similar experimental procedure, female farmers were asked to indicate their body part discomfort (BPD) on a body chart before and after performing the work. Statistical analysis showed that comparable results were found from both evaluation measures. When working position is below 50 mm, the proper stool height is 100 or should not be higher than 150 mm. When working position is 200 mm, the proper stool height is 150 mm. When working position is 400 mm, the proper stool height is 200 mm. Thus, it is strongly recommended to use proper height of stools with corresponding working position. Moreover, a wearable chair prototype was designed so that workers in a squatting posture do not have to carry and move the stool from one place to another. This stool should ultimately help to relieve physical stress and hence promote the health of squatting workers. This study sought to evaluate and make suggestions on user preference and BPD of proper stool height, at which work can be done comfortably, according to squatting work position. In short, results showed that proper stool height differed according to working position, even with similar squatting tasks.

The relation between the changes of postural achievement, lower limb muscle activities, and balance stability in three different deep-squatting postures

Deep squatting places a burden on the lower limb muscles and influences postural balance. We attempted to determine the effects of postural changes on the rectus femoris, tibialis anterior, gastrocnemius, soleus, and extensor digitorum brevis muscles during squatting in 8 healthy male subjects. Three squatting conditions were involved: full squatting (FS), tiptoe squatting (TT), and tiptoe squatting on a 15 degrees slope (TTS), performed randomly and recorded in a period of 4 min for each task. The influence of the squatting condition on electromyography and vertical ground reaction force parameters was examined in order to observe the effect of postural alteration on muscle activity and balance control. The results showed that the change of squatting posture from FS to TT decreased the activity of the rectus femoris and tibialis anterior muscles. FS has been suspected as a main cause of musculoskeletal complaint during prolonged squatting. In contrast, as the heel was lifted, the extensor digitorum brevis muscle increased to 39% of maximum activation. On the other hand, sway analysis at TT showed balance instability regarding the large area occupation of the center of pressure displacement. The presence of a 15 degrees slope significantly reduced the muscular load. This simple study suggests that the inclusion of a sloping surface in daily activities that requires a squatting posture would be an effective means to reduce muscular load.

Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: the Beijing Osteoarthritis Study

OBJECTIVE

To examine the association between squatting, a common daily posture in China, and the prevalence of radiographic osteoarthritis (OA) in different knee compartments among Chinese subjects from Beijing, and to estimate how much of the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in Framingham, Massachusetts is accounted for by the impact of squatting.

METHODS

We recruited a random sample of Beijing residents age > or =60 years. Subjects answered questions on joint symptoms, and knee radiographs were obtained. Subjects were also asked to recall the average amount of time spent squatting each day at age 25 years. Radiographic films (weight-bearing anteroposterior and skyline views) were read for Kellgren/Lawrence (K/L) grade and individual radiographic features. Medial disease was defined when radiographs showed a K/L grade of > or =2 at the tibiofemoral joint and a medial joint space narrowing score of > or =1, and lateral disease was assessed in a comparable manner in the lateral compartments. We examined the association of squatting with the prevalence of tibiofemoral OA as well as with the prevalence of patellofemoral knee OA, while adjusting for age and other potential confounding factors. We used the same approach to assess the relationship between squatting and tibiofemoral OA in the medial compartment and in the lateral compartment. Finally, we estimated the impact of squatting at age 25 on the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in the Framingham OA Study.

RESULTS

Squatting was very common among the Chinese subjects: approximately 40% of men and approximately 68% of women reported squatting > or =1 hour per day at age 25. The prevalence of tibiofemoral OA increased as the time spent squatting at age 25 increased in both the men and the women. Compared with subjects who squatted <30 minutes per day at age 25, the multivariable-adjusted prevalence odds ratios of tibiofemoral OA were 1.1 for time spent squatting of 30-59 minutes/day, 1.0 for 60-119 minutes/day, 1.7 for 120-179 minutes/day, and 2.0 for > or =120 minutes/day among the men (P for trend = 0.074), and the respective odds ratios among the women were 1.4, 1.3, 1.2, and 2.4 (P for trend = 0.077). A weaker association with patellofemoral OA was found. Prolonged squatting in daily life was more strongly associated with medial knee OA than with lateral disease in the men, but had a similar effect on both knee compartments in the women. After adjusting for the impact of squatting, the age-adjusted difference in prevalence of tibiofemoral OA was reduced from an excess of 14.4% to 9.5% in the Chinese women, but the difference in prevalence of tibiofemoral OA in the Chinese men increased after adjustment for age and squatting, from 2.9% lower to 7.0% lower as compared with their white counterparts.

CONCLUSION

Prolonged squatting is a strong risk factor for tibiofemoral knee OA among elderly Chinese subjects in Beijing, and accounts for a substantial proportion of the difference in prevalence of tibiofemoral OA between Chinese subjects in Beijing and white subjects in Framingham.