Stool samples, Australian style

When I was in the hospital last week for recurring gall issues, I provided a stool sample to check for C. difficile.
Stool samples are the cornerstone of foodborne illness outbreak investigation.
This is what Chapman pooped in to about 8 years ago in Kansas.
Campylobacter and didn’t just hate my cooking.
I was curious about the Australian way, and followed the nurse around.
And took pictures.

Doctors fall ill in India as food safety ignored at hospital mess

Doctors at Gandhi Hospital and Osmania General Hospital are regularly falling ill thanks to the poor hygiene at the mess being run at the two hospitals.
Common complaints being made by the duty doctors after having their meals at the mess include vomiting sensation, stomach ache and low grade fever. In rare cases, a few have come down with typhoid too.

scrubs.foodIn fact, the situation is worse at the Gandhi Hospital mess above the emergency block, with the doctors claiming that it is infested with rodents.
“It’s the worst place to have food, but we are helpless as 70-80 duty doctors working for 24 hours at a stretch cannot bring food from home. I have an upset stomach now,” said a senior doctor at Gandhi Hospital on condition of anonymity.

The mess at the hospital neither has a fridge to store vegetables nor proper containers to store cooked food. One can see rotten tomatoes, chillies and other vegetables left to dry on pieces of paper and half-eaten food kept in dirty plastic containers without lids. Leftovers from lunch being served for dinner is also quite common. Adding to the troubles is the fact that the wash basin is situated in the common eating area itself.

However, when contacted, both OGH and Gandhi Hospital authorities denied the allegations. “The hospital food is served to both doctors and patients only after it passes quality tests every day. However, if any individual doctor has any issues, it can be brought to our notice,” said Dr G V S Murthy, superintendent, OGH.

Squatty potty: Too easy to be true

Thanks to an alert reader, I have the rebuttal to the Squatty Potty and its magical unicorn turds, via Because we all care about poop.

1223_squatty_potty_630x354The Squatty Potty is an invention by Robert Edwards; its express purpose to to improve the quality and ease of your bowel movements while on the toilet. It has a catchy name and is sold everywhere from Target to The squatty potty is a stool that is designed to fit around the front of a standard toilet bowl, providing lift to your legs and resulting in a squatting-type position rather than sitting position while moving your bowels.

Among the Squatty Potty’s claims are these:

The modern day toilet is convenient, but has one major fault; it requires us to sit. While sitting to do our business may be considered “civilized”, studies show the natural squat position improves our ability to eliminate.


The puborectalis muscle creates a natural kink to help maintain continence. Squatty Potty relaxes this muscle for fast, easy elimination.

The marketing declares that sitting on the toilet is not as beneficial or effective as squatting. Since this is an obvious naturalistic fallacy, we have the refreshing twist of a new device intended to make one more “natural.” This is common in marketing, where one often sees the equation of “natural=good,” with total disregard for reality. The Squatty Potty is a simple yet interesting device with a catchy name. The marketing is what draws my skeptical eye. They make very specific claims about the research and anatomical benefit—testable claims. Let’s take a close look at the research and find out if the claims are full of it.

The first thing any good skeptic should do when faced with a marketing claim is evaluate the plausibility of the claim. Low plausibility means that claims require more rigorous proof. The Squatty Potty actually scores pretty high on the plausibility scale. The position that the device places you in is a very plausible mechanism for easier stooling.

Raising your legs can be a mechanism to improve your bowel movements. This is irrelevant to the claimed colon-kinking anatomical issue. When you bear down on the toilet, you are performing what’s called a Valsalva maneuver. You are forcing expiration against either a closed glottis, or contracting strongly your thoracic and abdominal muscles increasing intra-abdominal pressure. Similar changes can also occur when a person lifts a heavy weight while holding their breath. Sitting in any squat-type position while bearing down is likely to increase that intra-abdominal pressure, resulting in a more effortless bowel movement. Although this is not the claim in the marketing, the Squatty Potty has a very plausible mechanism to improve the ease of bowel movements.

What about the other claims? Namely that it produces an anatomically improved position and produces a “cleaner colon.” These things are easy to claim and hard to prove. The Squatty Potty is not the first product to claim this benefit. It is a smaller and cheaper version of other squat-position devices, such as the Lilipad and the Nature’s Platform. There are others. Basically they all make the same claims. The Squatty potty claims that it has developed a sweet spot (pun intended) of not too much sitting, not to much squatting.

The website lists several research papers supporting their position:

The first is a Japanese study, “The Influence of Body Position on Defecation in Humans.” It is a small-scale, six-person, uncontrolled study. Sure, I buy it as research, but it is a index study. It limits include tiny non-heterogenous (one male, five female) cohort, with no controls and without blinding. Interestingly, full squat is considered the best, which is not the Squatty Potty position. It doesn’t support the claim that Squatty Potty’s squat is better than a full squat.

The next study has my favorite title of the the group: “Impact of Ethnic Habits on Defecographic Measurements.” (As an aside, I think I need to add “defecographic measurements,” which means “poop X-ray study,” to my medical lexicon… but I digress.) This was a small study that used barium enemas and radiography to evaluate the anorectic opening in defecation.Imaging revealed that the rectal opening was measurable larger in a squatting position. But this study has two major issues. If you use a population that squats to move their bowels and then place them on a first-world toilet bowl, as was done here, you are disrupting their accustomed maneuver. You would need a control group of Europeans to do the same tests to realistically support superior evacuation. Plus moving your bowels is an activity that has deep social and cultural taboos associated with it. Making major changes may cause the participants to rush or change their normal structure. Imaging revealed that the rectal opening was measurable larger in a squatting position. Any of these factors can have a major impact upon on bowel evacuation.

The third research paper posted was “Comparison of Straining During Defecation in Three Positions.” It’s a larger study than the first, but it’s still very small. Researchers used a subjective questionnaire to have subjects rate straining. The findings were similar to the other studies: full squat results in the lowest straining.

Overall the research is flawed and not very compelling. It does have the upside of replications of results. Interestingly, the results do not support the website’s assertion that the Squatty Potty is superior to squatting fully. So I’m not really sure why the website lists this research as scientific evidence for their modified toilet stool.

Based on my reading of the research offered I would say the squatting is the most beneficial for anatomical opening. That is about all the research says. How suboptimal sitting and partial squatting is remains unclear. The study related to straining is too qualitative and small to make that distinction.

Overall, the direct claims  The Squatty Potty specifically makes—such as “elevating your feet during elimination is healthier” and “primary (simple) constipation is a consequence of habitual bowel elimination on common toilet seats”—are unsupported by the research they provide.

This is where the Squatty claims are full of it, in my estimation. They cite figures such as these:

“4-10 million Americans have chronic constipation (defined as having a bowel movement less than three times per week), and as many as 63 million people are suffering at any time from occasional constipation.”

The real research is left out of the website’s facts page. Self-reported constipation in the United States and the United Kingdom is more prevalent in women, nonwhites, and those over age 60. And surveys of physician visits for constipation have also confirmed this, finding more visits by women, nonwhites, those with lower incomes, and patients with less than 12 years of education. After adjusting for these factors, it is more common in individuals with little daily physical activity, low income, and poor education.

The prevalence of chronic constipation rises with age, most dramatically in patients 65 years of age or older. In this older age group, approximately 26 percent of men and 34 percent of women complain of constipation. Constipation appears to correlate with decreased caloric intake in the elderly but not with either fluid or fiber intake.

The glaring omission by Squatty Potty here is the fact that constipation correlates with many issues. Yet none of them are position-related. So although the research they offer can suggest that squatting makes bowel movements easier it doesn’t automatically follow that sitting contributes to constipation.

Constipation is a complicated medical issue. There are a myriad of medical conditions, medications, and diseases that cause constipation. Constipation has too many variables to lock it down to a single vague, unproven supposition that your anatomy is interfering with your stooling. Your lower intestines are not a standpipe and fecal consistency is another variable. There is just no credible evidence that sitting is a problem. It may be dangerous to assume that sitting is a problem. Treating simple constipation with a stool may work but it could also be dangerous: you may miss a serious health issue early because you assume that your position is giving you constipation. That is not the only downside for using a toilet stool.

The Squatty Potty marketing gives the false impression that better bowel movements equates with better health. They are not alone; many alternative treatments tend to give the impression that our bowels are trying to kill us. Brian Dunning went over this in Skeptoid episode #83, “The Detoxification Myth.” There is no real evidence that better bowel movements equate with better health. There is no evidence that squatting produces a larger or more complete bowel movement. Even though the position may make an easier bowel movement, that doesn’t equate to bigger or healthier. Anyone who has had to undergo a colonoscopy will tell you that cleaning out your colon is fatiguing and undesirable. Medically speaking, bowel cleansing claims can be dangerous or nonsensical. Your colon is not the center of healthy living, and consequently cleansing is of marginal health benefit.

Overall I would say this about the Squatty Potty: on the positive side it almost certainly enhances your ability to bear down when you go. There is some replicated evidence that squatting does foster ease of going. As for the negatives, there is no evidence that it prevents or treats uncomplicated constipation. There’s no real evidence that anatomic position is a risk factor for constipation, and no real evidence that it is significantly different than other types of toilet squat devices. It leads you to believe that sitting is an impairment to normal bowel movements. That implied problem is not supported by the research and is unlikely, based on uneven distribution of constipation problems.

So why buy a Squatty Potty? I can’t say I think it’s worth it. Truthfully, it looks a little ridiculous, not that that means anything during a bowel movement. It really has no effect on other factors that impact constipation—diet, exercise, age and medical issues. I am uncertain that changing your position is enough of a benefit to help anyone suffering from chronic constipation. I can say that it is not dangerous and it may make it easier for you to bear down or reduce straining if you are constipated. It is just not reasonable to say that it has any significant effect on your overall bowel habits.

On the upside, Squatty Potty is relatively inexpensive, seems safe, and as long as you have a realistic view of the benefit I can see someone using it.

Everything comes down to poo

Many are uncomfortable talking about digestion, but changes in your bowel movements could mean something is wrong, so it’s important to understand and be candid about your digestive habits. Healthworks-Poop-Infographic (1)“The digestive tract contains more bacterial cells than there are cells in the entire body,” Dr. Jean-Pierre Raufman, a gastroenterologist at University of Maryland School of Medicine, told MyHealthNewsDaily last year. “It’s very important that our bowels work well to absorb necessary nutrients but also keep out any foods, chemicals and germs that could do us harm.”

Because poop is such a taboo subject, digestive issues are a bigger problem in our country than many realize. Up to 70 million people in the U.S. are affected by digestive diseases, with nearly 50 million needing ambulatory care visits as a result. Nearly 25,000 people get stomach cancer each year and more than 10,000 die from the condition annually.

Indicators to health problems can be found in your poop, so pay attention the next time you have a bowel movement. You maybe tempted to just flush everything down the toilet, but the chart below created by HealthWorks indicates when you should worry about your poop’s smell, frequency, or color.


Where does zoo poo go?

Steve Bircher, curator of mammals at the Saint Louis Zoo, told KSDK,

"It’s probably thousands of pounds that we collect and it’s recycled so we can use it as fertilizer and compost.”

Corrine Kozlowski, an endocrine lab technician, said,

"So we can determine whether an animal is pregnant or not from it’s poop. If it’s having regular reproductive cycles, so it allows us to time breeding appropriately for that animal. We can also look at whether an animal might be stressed based on hormones in the poop.”

Everything comes down to poo.

Should doctors’ scrubs be as clean as their hands?

The New York Times reports that,

“Amid growing concerns about hospital infections and a rise in drug-resistant bacteria, the attire of doctors, nurses and other health care workers — worn both inside and outside the hospital — is getting more attention. While infection control experts have published extensive research on the benefits of hand washing and equipment sterilization in hospitals, little is known about the role that ties, white coats, long sleeves and soiled scrubs play in the spread of bacteria.

“The discussion was reignited this year when the British National Health Service imposed a “bare below the elbows” rule barring doctors from wearing ties and long sleeves, both of which are known to accumulate germs as doctors move from patient to patient.

“But while some data suggest that doctors’ garments are crawling with germs, there’s no evidence that clothing plays a role in the spread of hospital infections.”

Apparently there are some textiles being manufactured with  antimicrobial components. I really have no opinion. But when it comes to Scrubs, Everything Comes Down to Poo.


Tellruide, Colorado, has a problem with poop.

Tellruide, Colorado, has a problem with poop.

Dog poop.

A local biologist, Ramona Gaylord, told city council that the impact of waste produced by 100 dogs located within a 20-mile radius of a watershed draining to a small coastal bay would contribute enough bacteria and nutrients to temporarily close it to swimming and shell fishing after two to three days, according to the U.S. Environmental Protection Agency.

A new form from the Marshal’s Office is due to come into circulation soon. It will enable passersby to document occasions on which they witness owners neglecting their doodie duties. By signing the form the complainant agrees to be called as a witness if a ticket is issued and the matter goes to trial.

So pick up your poop.

And if you find some old poop, send it to University of Oregon archeologist Dennis Jenkins.

Jenkins found 14 feces, or coprolites, in the Paisley caves in south-central Oregon. He reported in Science on Friday that the oldest piece of crap in the collection was 14,300 years old.

Eske Willerslev, a Danish expert in ancient DNA and one of the authors of the paper, said genetic material found in the ancient poop suggests the earliest known North Americans came from Asia and Siberia, and were the ancestors of modern native peoples

As they sing on Scrubs, Check the Poo.