The Household Physician


Prostate Problems: Why Is It Rare Among Chinese, Indian and Japanese Men?

Prostate problems and disorders are more prevalent in Western countries than in other parts of the world.

Take, for example, the situation with prostate cancer.

International Agency for Research on Cancer:

"The highest prostate cancer incidence rates are in the developed world and the lowest rates in Africa and Asia."

National Cancer Institute, US National Institutes of Health:

"Prostate cancer...is the most commonly diagnosed cancer among men in the United States...the incidence rates for clinical prostate cancer in Western men are 30 to 50 times higher than those for Asian men..."

USA Today:

"African Americans have the highest prostate cancer risk in the world .... And despite high rates among African Americans, prostate cancer is very low in Africa."


"A 200-fold difference in incidence exists between African American men, who represent the group with the highest incidence of the disease, and Chinese men living in Asia, in whom the incidence of prostate cancer is among the lowest in the world."

Aside from the US, prostate cancer is also prevalent in many Western countries - Sweden, Canada, Switzerland, Australia, UK and Denmark;

Along with China, there are two other Asian countries with very low rates of prostate cancer - India and Japan;

Compared with Africans who live in the US, Zimbabwe men (in Africa) have significantly lower rates of prostate cancer.

1) What could be the reason for the very different rates of prostate cancer in the world?

2) Why are men in the Western countries so susceptible to prostate problems?

3) What is the 'secret factor' that had protected Chinese, Indian and Japanese men from prostate problems and cancer?

For decades, many Western researchers have been trying to find the answers. They have not find much success, as reflected in the words they use to describe prostate cancer, eg:

"Little is known about the etiology of prostate cancer, although it is the most commonly diagnosed cancer among men in the United States.

Prostate cancer is more common in black men than it is in white or Asian men. This is probably due to a mixture of inherited genes and environmental factors but we don't really know the full story as yet."

-- National Cancer Institute, US National Institutes of Health

A common explanation given for the low incidence of prostate cancer in non-Westernised countries is a diet low in fat and high in fiber. However, the problem with this theory is that any association between diet and prostate problems and cancer has not been proven.

A recent major study by researchers at Memorial Sloan-Kettering Cancer Center, the National Cancer Institute and seven other centers had dismissed this theory. The researchers reported their findings in the American Society of Clinical Oncology (August 30, 2002):

"A low-fat, high-fiber diet heavy in fruits and vegetables has NO impact on PSA levels in men over a four-year period, and does not affect the incidence of prostate cancer."

The prostate-specific antigen (PSA) test is used to to detect the risk of prostate cancer and other prostate problems in men. A high PSA level is associated with a greater chance of developing prostate cancer.

The low fat, high fiber diet theory also doesn't  make sense based on migration studies. One such study found that within one generation, the incidence of prostate cancer among Japanese immigrants increased 4 to 9 fold, even though their diet remain largely unchanged. [Something else did changed for these Japanese immigrants. In Japan, they use squat toilets like the ones pictured here.]

What Western Researchers Had Missed...And Why

As a result of growing up in a society where sitting toilets are a part of life, it is very difficult for a Western researcher to recognise and accept that the sitting toilet is the root cause of prostate problems.

Yet, this is the case. It all has to do with the pudendal nerve which control prostate and bladder functions, and the descent of the pelvic floor (more on this later).

The pudendal nerve emerges from the base of the spinal cord, runs through the perineum (in men, the area between the anus and penis), and passes through the pelvic floor before connecting to the prostate and bladder.

The pelvic floor is a hammock of muscles which supports the bladder, intestines and (in women) the uterus and vagina.
In the sitting position, the colon is not properly prepared for waste evacuation. It is in the continence mode.

On a conventional (sitting) toilet, a person is forced to strain, while holding the breath, and pushing downwards with the diaphragm, in order to evacuate. This action is called the Valsalva Maneuver.

In the sitting position, the pelvic floor is also unsupported by the thighs. As a result, each time one strains on the sitting toilet, it is repeatedly forced downwards.

The pelvic floor is simply not designed to cope with this sort of stress and abuse. Each time it is depressed, the pudendal nerve which runs through the pelvic floor is stretched at the same time.

Nerves are not elastic, and studies have shown that a 12% stretch destroys a nerve. This goes for the pudendal nerve, which cannot be stretched very far without being damaged.

It doesn't happen right away. But slowly but surely, as the pelvic floor sags lower and lower, there comes a day when the tipping point will occur.

The pudendal nerve is stretched beyond its capacity, and can no longer transmit brain signals to and from the prostate and other pelvic organs properly.

This explains why prostate problems manifest itself from the age of 40 onwards. Because the stretch injury happens gradually over a long time, the underlying cause of prostate problems and disorders has escaped detection by Western researchers.

As mentioned, another reason is cultural insularity. Sitting toilets are "normal and natural" and therefore "above suspicion."

This breakdown in nervous control is the root cause of prostate problems and other pelvic-related ailments (eg: urinary incontinence).

Every gland in the body requires constant feedback from the brain to maintain normal functioning. As the pudendal nerve deteriorates, the prostate gland becomes increasingly isolated from the central nervous system, and could become dysfunctional in one or many forms. The three most common prostate problems we see today are:

1) Benign prostatic hyperplasia (BPH)

2) Prostatitis

3) Prostate cancer

What Can Be Done?

Getting everyone to squat for waste elimination. The truth is that human beings are designed to eliminate waste in the squatting position. It is only in this posture that you can completely empty your colon without excessive straining or imposing any stress on the pelvic floor.

Instead of pushing downwards with the diaphragm, squatting pushes upwards with the thighs. This increases the intra-abdominal pressure, which naturally compresses the colon and make it easier for waste to be emptied.

Squatting also relaxes the final pathway between the rectum and anus.
The net effect of squatting is easier evacuation, without exertion and stress on the pelvic floor and pudendal nerve.


By forcing users to sit, the sitting toilet does not fulfill the natural requirements of waste elimination. It is responsible for the growing epidemic of colon, bladder, pelvic and prostate problems in Westernised countries.

Worldwide, more than 650,000 men are diagnosed with prostate cancer every year. Almost 30 million men suffer from enlargement of their prostate gland (benign prostatic hypertrophy, BPH).

Each year, the United States alone, over 400,000 men undergo prostate surgery each year. Over a billion dollars is spent on treating prostate problems.

It is no secret why Chinese, Indian and Japanese do not have so much prostate problems as compared with Western men. They use squatting toilets instead of sitting toilets.

One will give protection against prostate problems; the other can increase your risk of prostate problems by 200 fold.

But act quickly. The longer you continue to use the sitting position for waste elimination, you might lose your ability to squat, as explained on this page about squatting facets.

Your ability to squat is important because if you can't, you won't be able to change your toileting posture from sitting to squatting, using one of the options described on this page.

If you want to squat, the best option is to install a squatting toilet. However, for many people, this may not be a viable option. In which case, a simple yet practical solution is to use a toilet squatting platform.

We Ignore Squatting
At Our Peril...

The best posture for passing stools is squatting. In this position, waste elimination is easier, faster and complete.

Sitting, on the other hand, obstructs the passage of waste through the colon. Elimination is difficult, requires straining and can never be complete...

Many people today remain unaware that their sitting toilet pose a danger to their health and well-being.

In his book, A Guide to Better Bowel Care: A Complete Program for Tissue Cleansing Through Bowel Management, chiropractic physician and nutritionist Dr Bernard Jensen identified the sitting toilet as a health threat to mankind:

"It is my sincere belief that one of the bowel's greatest enemies in civilized society is the ergonomic nightmare known as the toilet or john."

To understand why squatting is better than sitting, one just need to have a basic understanding of how the colon works...from the point where food leaves the stomach...

Colon, Colon System

From the stomach, food (all mixed and ready) goes into the small intestine where nutrients are absorbed. The food wastes then goes into the large intestine or colon. When it enters the colon, it is in a liquid state.

However, as it moves through the colon, water is continuously extracted, and it turns into solid waste (stools) by the time it reaches the rectum. It is then passed out through the anus.

It is crucial that the colon can perform its role efficiently and effectively. All waste must be evacuated on a regular basis to avoid the build up of toxins. For this to happen, one must adopt the squatting position.

1) Increased Abdominal Pressure

In the natural squatting position, the entire weight of the body rests on the feet, and the thighs are pressed against the abdomen.


This creates a beneficial pressure in the abdominal cavity, which compresses the colon, creates a natural urge to evacuate and helps force waste out of the body.

But there is more...

2) Protection of Appendix and Small Intestine

The colon - which comprises the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum and anus - is connected to the small intestine through the ileocecal valve.

The ileocecal valve acts as a one-way valve. It allows food wastes in the small intestine to enter the colon, but prevents fecal waste in the colon from leaking into the small intestine.

In the squatting position, the right thigh – pressing on the right side of the abdomen – squeezes the pouch-like cecum and force liquid waste upwards into the ascending colon and away from the appendix.

Hence, in the squatting position, the ileocecal valve is sealed securely, and both the appendix and small intestine are kept clean.

3) Release of Bend in Sigmoid Colon

Sigmoid Colon

There is also a kink or bend where the sigmoid colon joins to the rectum.

In the squatting position, the left thigh – pressing on the left side of the abdomen – supports and lifts up the sigmoid colon. This raising of the sigmoid colon opens up the kink to allow waste to flow easily into the rectum.

4) Straightening of Final Pathway

Just as there is an inlet valve (the ileocecal valve), there is also an outlet valve in the colon: the puborectalis muscle.

In the sitting position, the puborectalis muscle grips the rectum in a 'choked' position to maintain continence (prevent accidental release of stools from the anus).

In the squatting position, it relaxes its grip so that the pathway to the anus is straightened, to allow waste to pass out freely and easily.

Sitting vs Squatting
Truly, our colon is a marvel of nature!

The Case Against Sitting Toilets

By forcing users to sit instead of squat, the sitting toilet ignores ALL the natural requirements for effective waste evacuation:

1) Without pressure from the right and left thighs, no intra-abdominal pressure is created to facilitate expulsion of waste...

2) Without the action of the right thigh, there is no squeezing action to direct waste upwards and away from the appendix and small intestine...

3) Without the action of the left thigh, the natural bend between the sigmoid colon and rectum is not released...

4) The pathway between the rectum and anus is not straightened...

The outcome is obvious: difficult in passing stools. In frustration, one has to strain while holding the breath in order to 'push' downwards with the diaphragm (Valsalva Maneuver) in order to evacuate waste.

Yet, in spite of all the straining, the colon cannot be emptied completely.

Sadly, the impact of sitting toilets on young children is more serious.

When a tall adult uses a sitting toilet, his feet rest on the floor and his thighs are raised upwards at a slight angle and brought nearer to his abdomen and chest. He can also easily bend his chest forward to bring it closer to his thighs.

(Comment: This action to close the distance between the abdomen and thighs is not the same - or does not bring the benefits - as the full natural squatting position. But it is not as bad as the totally upright sitting position.)

But for young children who have shorter legs, the story is different. With their legs hanging over the toilet bowl and feet not touching the floor, they don't have any leverage to raise their thighs or bend their chest forward easily.

As a result, their colon is left totally unsupported.

It is worth noting that toddlers would instinctively squat, if sitting potties/toilets and well-meaning adults don't come into the picture.

What You Can Do... If You Want To Squat?

The best way, if you want to adopting the squatting position for your bowel movements, is to install a squat toilet. But check with your plumber if this can be done.

If installing a squatting toilet is not feasible, you could consider 'converting' your sitting toilet into a squatting type, i.e. use  a few paper towels or sheets of copy paper and disposing of the waste by burning or flushing (sans paper). The benefit here is one can inspect one's stool for shape, color etc.

The Best Toilet of All...
The best toilet for you - based on the design of the human body - is the Asian or Indian toilet, which requires you to squat for waste evacuation.

In your search for the best toilet, it may never occur to you to think in terms of the correct toilet posture to adopt, ie: squatting or sitting.

Nature has intended that human beings evacuate waste in the squatting position. In the sitting position, it is physically impossible for one to evacuate easily.

The long-term use of the sitting posture for defecation can cause fecal stagnation, and has been linked to many serious colon ailments and diseases.

The Best Toilet - Squatting or Sitting?

Squatting toilets are usually associated with non-Western cultures. This is why they are also known as Eastern, Indian or traditional toilets. But the truth is that squat toilets were used in all cultures in the past.

Long before sitting toilets even existed, human beings have always squatted whenever they need to relieve themselves..... including infants of every culture who instinctively adopt this posture to answer the call of nature... We know that sitting is an unnatural toilet posture because the earliest toilets do not come with seats. Everyone had to squat when the urge to evacuate comes... Here's one piece of evidence:

"Designate a place outside the camp where you can go to relieve yourself... as part of your equipment have something to dig with, and when you (want to) relieve yourself, dig a hole (in the ground)... and cover up your excrement" (Deuteronomy 23:12-13).

(Comment: No one would want to sit on a hole in the ground. The best way is to squat over it.)

In contrast to the early origins of squatting toilets, the Western toilet (water closet) is a relatively recent invention. Its origin can be traced back to the 19th century, when it was adopted in England, before spreading to other Western countries.

If you live in the West, you probably have never used or even seen a squat toilet. The idea that the best toilet being a squatting one might seem absurd at first...but it is true.

It really is a cultural issue. The sitting toilet was an effect of the increasing class and racial stratification of the Victorian Era in England (1837-1901).

The porcelain throne was justified by the idea that sitting was more dignified than squatting which was the 'habit' of natives in the English colonies. Sitting on this "throne" was seen to be more dignified, and hence more suited for aristocrats.

In short order, this new toilet took root and spread. Yet, the design of the new toilet had always been a bone of contention.

For many decades, virtually every physician and physiologist who has ever troubled to write on the subject agrees that squatting is the most natural and sound posture for emptying the bowels.

They have blamed the sitting toilet for the high incidence of serious ailments and diseases, such as appendicitis, constipation and colon cancer.

These ailments and diseases were rare before the mid 19th century, when the majority have always used the squatting position (except for royalty and the disabled).

Compared with the rest of the world, people in the Westernised countries where sitting toilets are well-entrenched have much higher rates of appendicitis, hemorrhoids, colon cancer, and other bowel diseases…

Consider this Apr 1979 report published in the Israel Journal of Medical Science:

"The prevalences of bowel diseases (hemorrhoids, appendicitis, polyps, ulcerative colitis, irritable bowel syndrome, diverticular disease, and colon cancer) are similar in South African whites and in populations of prosperous western countries. Among rural South African blacks with a traditional life style, these diseases are very uncommon or almost unknown."

If Squatting is Better, Why Didn't Anyone Speak Up?

In those days, no one could have knew about the impact of the water closet on the health of the population... As mentioned earlier, those who were uncomfortable with this new invention were compelled to keep silent.

In Victorian England, bodily functions were considered unmentionable. Also, how could a citizen openly criticise a toilet that was used by Queen Victoria herself? (Hers was a gold plated one.)

So, like the Emperor’s New Clothes, the sitting toilet was tacitly accepted…

An indication that all was not right was the immense popularity of "squatting stools" sold by the famous Harrods of London. Buyers used these foot stools to raise their feet and bring the knees closer to the chest – a crude attempt to imitate the squatting position.


We don't really know why or what had caused the Western world to go for sitting toilets and not squatting ones. After all, both could have the same flushing capabilities.

It could be that the early toilet inventors found the sitting posture to be more "dignified", and hence more suited to kings, queens, aristocrats than the traditional squatting position used by natives in the colonies. And so they go out to create what they think is the best toilet, not knowing the terrible consequences.


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