This study investigates the relationship between different toilet sitting styles (squat vs. western) and their effects on ankle range of motion (ROM), constipation symptoms, and lower limb strength in school-going children aged 6-12 years. With increasing urbanization, the shift from traditional squat toilets to sitting toilets may influence children's musculoskeletal development and bowel health. Squatting involves greater ankle dorsiflexion and muscle activation, which may contribute to better lower limb strength and improved bowel function compared to sitting postures.

A comparative cross-sectional design will be used, including participants from public and private schools. Data on toilet usage habits will be collected along with demographic information. Ankle ROM will be measured using a goniometer, lower limb strength will be assessed through the 1-minute sit-to-stand test and standing long jump, and constipation symptoms will be evaluated using the PAC-SYM questionnaire. Data analysis will be conducted using SPSS version 26. Ethical approval will be obtained from the Research Ethics Committee of Riphah International University, Lahore.

This study aims to explore the correlation between different toilet sitting styles and their effects on ankle range of motion (ROM), constipation symptoms, and lower limb strength in school going children. With modernization and urbanization, there has been a significant shift from traditional squat toilets to western-style sitting toilets, especially in schools and households.This change in toileting posture may have a direct impact on musculoskeletal development and gastrointestinal health in growing children. Prolonged use of sitting toilets might limit the natural ankle dorsiflexion used during squatting and reduce muscle activation in the lower limbs, potentially contributing to strength limitations and altered bowel habits. The study intends to investigate whether habitual use of squat toilets promotes better ankle flexibility, stronger lower limbs, and fewer constipation-related symptoms in comparison to sitting toilet users.

A comparative cross-sectional study design will be employed, targeting children aged 6 to 12 years from selected public and private schools. After obtaining informed consent from guardians and assent from children, demographic data will be collected along with their toilet usage history. Ankle ROM will be measured using a goniometer, while lower limb strengthwill be assessed using the 1 minute sit-to-stand test and estimated long standing jump testing.Constipation symptoms will be evaluated using the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Data will be analyzed through SPSS version26.0.Descriptive statistics will be used to determine the association between toilet type and the selected outcome variables. The synopsis will be presented to the Research Ethical committee of Riphah International University, Lahore, for ethical approval to conduct this study.

Inclusion Criteria:

• Students age group: 6-12 year.
• Both male and female groups
• Normal developing children
• Children who have been using either sitting or squatting toilet type .
• Children's who are willing to participate and perform functional tasks.

Exclusion Criteria:

Children with abdominal surgery

• Children with lower limb surgery
• Children with acute or chronic disease like irritable bowel syndrome
• Children using both toilet postures
• Children with neurological or developmental delays affecting toilet independence like Cerebral Palsy and autism.
• Children on medications that affect bowel movement (e.g., laxatives, opioid)

The study population will consist of school-going children aged 6 to 12 years enrolled in selected public schools. Both boys and girls will be included. Participants will be grouped based on their habitual toilet usage (squat toilet users and western-style sitting toilet users).Only children who are healthy, ambulatory, and able to perform physical tests will be included. Children with neurological conditions, musculoskeletal deformities, recent lower limb injuries, congenital abnormalities, or known gastrointestinal disorders (other than functional constipation) will be excluded.

Informed consent will be obtained from parents or guardians, along with assent from the children before participation.