If I had to guess, in order of importance: - Americans don’t use bidets, largely. Simple water use cuts down on toilet paper significantly - SAD (standard Ame

If I had to guess, in order of importance: - Americans don’t use bidets, largely. Simple water use cuts down on toilet paper significantly - SAD (standard American diet) is awful for digestive quality. Little to no fiber = using the toilet will not be pretty - healthcare costs. Americans with digestive issues probably just put up with it most of the time. Nobody is out here seeing a gastroenterologist because they poop more than average