• Paul Sebo, Cécile Quinio, Marion Viry, Dagmar M Haller, and Hubert Maisonneuve.
• From University Institute for Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Geneva, Switzerland (PS, DMH, HM), University College of General Medicine, University Claude Bernard Lyon 1, Lyon, France (CQ, MV), and Mermoz Primary Health Centre, Lyon, France (HM). paulsebo@hotmail.com.
• J Am Board Fam Med. 2022 Jul 1; 35 (4): 836-839.

IntroductionConstipation is a common complaint in the general population. Squatting (using a toilet stool) is associated with faster and more complete bowel emptying, and could therefore help prevent or treat constipation. We analyzed the reviews of online buyers of a toilet stool to assess perceived effectiveness, overall satisfaction and potential side effects.MethodsIn this exploratory mixed-method study, we collected all plain text reviews left between November 2013 and March 2020 by buyers of a toilet stool on Amazon. We adapted the Framework method to perform a seven-step process to analyze user reviews. We assigned numerical values from -5 (minimum) to +5 (maximum) to perceived effectiveness and overall satisfaction.ResultsWe included comments left by 10,027 customers who purchased 19 different types of toilet stools (79.1% seven-inch stools, 16.1% folding stools, 4.8% other stools). Perceived effectiveness and overall satisfaction were high (median = 5 and interquartile range = 0 for both variables). Eighty-one individuals reported adverse events related to toilet stool use, mainly musculoskeletal pain (N = 26), numbness in the lower limbs (N = 16), falls (n = 11), constipation (N = 9), anorectal symptom (N = 8), and cramps (N = 6).ConclusionPerceived effectiveness and overall satisfaction were rated high by those who purchased a toilet stool online. In addition, their use seems to be safe (<1% reported adverse effects). Our results suggest a good risk-benefit ratio. The device may offer an inexpensive option to treat or prevent constipation, and may reduce the frequency of medical visits and the risks associated with long-term use of laxatives.© Copyright 2022 by the American Board of Family Medicine.

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