Sitting on the toilet!! Actually sitting, skin to porcelain. No more hovering! Even in public restrooms. I know, it’s going to be a tough paradigm shift since this issue is ubiquitous; one study, done in the UK, surveyed 528 women at a gynecology clinic and found that 85% reported that they crouched over public toilets while urinating. 12% said that they used a paper toilet seat cover and 2% reported that they sat all the way down1. Only 2%! So, I decided to make a point to ask every woman that I’ve seen recently in my office what their preference is regarding toilet seats.The answer: overwhelmingly in favor of squatting over the pot (especially when in public).
This week, my goal is to try to dispel some of the myths about public toilet seats and try to convince you, the readers, that sitting on the toilet is more important to urinary/bowel function and health than the germs you might find hanging out on the john.
First, let me back up and explain how our urinary and bowel systems work from a musculoskeletal standpoint. A typical urinary system works like this: liquid waste (urine) that has already been filtered by the kidneys, empties into the bladder. As the bladder fills, it stretches to accommodate the extra volume. Once it starts getting somewhat close to full, (about 300 cc or about 1 ¼ cup) it sends a message to the brain, which then sends a message to the pelvic floor muscles to say “Hey, we need to pee, let’s get to an appropriate place (in this case we are going to call ‘that place’ the toilet).” We get to the toilet, we sit, our brain tells our pelvic floor muscles and the urinary sphincters to relax and we empty our bladder. In an adult with typical or “normal” urinary function, we expect close to full emptying of the urine in the bladder.
The bowel system works similarly: The colon fills with solid waste, it moves by peristalsis through the ascending, transverse, and descending colon. Once it arrives in the rectum, a signal is sent to the brain, that says it’s time to go. We get to a toilet, we sit, the sphincters relax, we empty. Voila.
Hovering over a toilet seat can become seriously problematic, especially if it is a habit that you have been practicing for many years. Even if all of the events leading up to voiding may be normal,when we hover, we are engaging so many muscle groups to support us in that position! Think about doing a squat and holding it for 45 seconds. Better yet-try it. If you do, you can feel the core engage, as well as the quadriceps, hamstrings, gluteals, and pelvic floor muscles. They are all on! So the mechanisms to empty the bladder/bowel engage, but the sphincters CANNOT fully relax here. It becomes an uphill battle.
The sphincters cannot fully relax, which means that the bladder and/or rectum could not fully empty, meaning that now we are getting a backup of residual waste left in the body. If this becomes a regular occurrence we can begin to see issues arise within the bowel/bladder systems. We can begin to see increased risk for bladder stones, infections, hesitancy, urgency and frequency, constipation, prolapse, and incontinence.
In the same study that I mentioned above, the researchers found that there was a 21% decrease in average urine flow rate and a 149% increase in residual urine volume in women that voided in a crouching position. They went on to conclude that women found with any abnormal bladder voiding/retention symptoms may benefit from being encouraged to sit comfortably on the toilet whenever possible1.
Still not convinced? Ok let me try a different route. In 2014, an article came out in the journal of Applied and Environmental Microbiology. In this study researchers found that “while enteric bacteria would be dispersed rapidly due to toilet flushing, they would not survive long, as most are not good competitors in cold, dry, oxygen-rich environments.”2 In other words, although germs are present in and on all toilets, they don’t last long. In an interview for The Huffington Post, Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University Medical Center commented, “toilet seats are not a vehicle for the transmission of any infectious agents — you won’t catch anything.”3
Intact skin is generally thought of as an effective germ barrier, and the skin of the buttocks and legs is relatively thick. If you have very thin or cracked skin on the buttock or thigh, or have any open wounds in that area consider wiping the seat down. The American Society for Microbiology (ASM) published a study which found that after a porcelain surface had been wiped one time with either water, liquid soap, or an antibacterial wipe,* the amount of germs was decreased 10,000 times. A second wipe further reduced any remaining germs 1,000 times.4
A study published by the Public Library of Science swabbed flushers, door latches, faucet handles, and towel dispensers and found they are as dirty as, or dirtier, than the toilet seats themselves.5 In fact, many other places far from toilets are colonized by microbes. The main culprits include kitchen sponges, playground equipment, gym mats, and computer keyboards.5 And don’t get me started on your cell phone; cell phones carry 10 times more bacteria than most toilet seats, according to Charles Gerba, a microbiologist at the University of Arizona.6
Have I totally freaked you out? Don’t worry! Germs ARE everywhere. But if your immune system is healthy, and if you adopt simple hygienic measures like hand washing, you should have no problem kicking those pathogens to the curb. So let’s do it! Let’s all just start wiping the toilet seat off with a preliminary toilet paper wipe and sit yourself right down. And enjoy the full pee/poop that comes to follow**. Get the word out-let’s make 2016 the year we start sitting down on those seats and put our “germ-phobia” to rest!
*Remember not to flush antiseptic wipes because they are detrimental to our oceans. Instead, throw them in the trash.
**That being said, we have found that it is also important to increase the hip flexion angle for best pee/poop success. See this blog for more info.
References:
- Moore KH, Richmond DH, et al. Crouching over the toilet seat: prevalence among British gynaecological outpatients and its effect upon micturition. Br J Obstet Gynaecol. 1991 Jun;98(6):569-72.
- Gibbons S. M., Schwartz T., et al. Ecological succession and viability of human-associated microbiota on restroom surfaces. Appl. Environ. Microbiol. Online. Ahead of print 14 November 2014; doi:10.1128/AEM.03117-14 .
- “Why Using Toilet Seat Liners Is Basically Pointless.” Interview by Amanda L. Chan. Huffington Post 17 June 2014: n. pag. Web.
- Tuladhar, E, Hazeleger, W, et al. Residual Viral and Bacterial Contamination of Surfaces after Cleaning and Disinfection. Appl. Environ. Microbiol. November 2012 vol. 78 no. 217769-7775.
- Flores GE, Bates ST, Knights D, Lauber CL, Stombaugh J, Knight R, et al. (2011) Microbial Biogeography of Public Restroom Surfaces. PLoS ONE 6(11): e28132. doi:10.1371/journal.pone.0028132
- Gerba, Charles. “Why Your Cellphone Has More Germs than a Toilet.” Interview. Https://cals.arizona.edu/spotlight/why-your-cellphone-has-more-germs-toilet. The University of Arizona, College of Agriculture and Life Sciences, 15 Sept. 2012. Web. 29 Mar. 2016.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
This article is excellent!
I would like to share this on my blog… MomTrainer.com if that’s okay. I think it’s really important for pregnant women to sit as they’re at higher risks for kidney infections, incontinence, and pelvic prolapse.
Thank you for posting!
Great post, and to follow up: Researchers found that free weights at the gym had 362 times more bacteria than a toilet seat http://nyp.st/1N9aS59
I certainly agree with you that sitting down to pee is the only way. I have been doing that for years.
Thanks all of you for the fabulous posts.
Michael
It’s get me much pleasure when I peed sitting down. But I have a problem with public toilet and most of the time I peed there by standing. I am not aware of all of this and after reading this article I searched for google and I found something want share here. goo.gl/RFONW8
Hopefully you will appreciate that as well. Anyway thanks for the post.
This is really a helpful tip. Every bathroom must need sitting place. When i sitting down for pee then i feel good without sitting do pee it’s very bad feel. Thank you for share great article.
This is a great advice. The significance of sitting around the toilet is vital topic also. Your thought is need to help me in addition to my family. Giving you thanks for revealing great hints.
Wonderful tips. Everyone must know about proper sitting positions in the toilet. I would suggest high quality heated toilet sit for pooping and also adding a shower chair will be wiser.
This is a tremendous recommendation. The significance of sitting spherical the bathroom is crucial concern depend moreover. Your concept is want to assist me further to my circle of relatives. Giving you thanks for revealing super tips.
its very informative article for all readers including me….
Wonderful this article is very amazing!
I would like to share this on all of my contacts, I have to assume that it’s clearly important for pregnant ladies to take a seat as they’re at higher dangers for kidney infections, incontinence, and pelvic prolapse.
Thank you for sharing this article to us
You are so kind! We are happy to be able to provide this information to you. Please feel free to share with anyone and everyone!