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.
- 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.