Clinic Blog

for more information or
to schedule an appointment!
Beco Building West .  5410 Edson Lane . Suite 350 . Rockville, MD 20852 .  (301) 881-9313
Life Keeps Moving... Restore Motion
Hovering over the toilet is a common practice for many women who need to void (urinate) while away from home (Sapsford et. al, 1998).  Popular thought is that if contact with a public toilet seat is avoided germ contact will be decreased.  There are several flaws to this misconception and in fact this practice can be detrimental to your health and can alter bladder function.

Let’s first talk about the issue of “getting germs” from the “public seat.”  It is not uncommon to find an unflushed (or incompletely flushed) toilet in a public restroom.  While unpleasant –and inconsiderate, that alone is not necessarily a “germ factory.”  Flush the soiled toilet bowl.  Frequently that is all that is necessary.  Use toilet paper, paper towel (or your foot) to flush the toilet.  The most likely source of high germ contact is touching something someone has touched with unclean hands (door handle, faucet, soap dispenser).   You can decrease this germ contact by grasping the toilet handle with paper (or your foot).   Sometimes a toilet seat is damp.  Use toilet paper to dry it off –then flush.  Occasionally the seat is damp because the toilet bowl sprays onto the seat when flushed.  Granted this is unpleasant however it is less concerning than the thought of someone else urinating on the seat!  Use toilet seat covers.  If one is not available use folded toilet paper over the area you will use while sitting.

Why bother with sitting?  Why can’t I hover?

Your bladder empties more easily and completely when you void (urinate) in a relaxed seated position.  Buttock, leg and core muscle work is necessary to maintain a hovering squat position.  This muscle activity includes the pelvic floor muscles, which support the pelvic organs, and makes it hard for the bladder and urethra, the tube urine passes through when emptying the bladder, to fully relax.  When the pelvic floor muscles do not relax fully, some people feel it necessary to “push” to “get all the urine out.”  Pushing to get all the urine out is also done when in a hurry.  Pushing or “bearing down” puts stress on the pelvic floor and can contribute to pelvic organ prolapse— a condition where the pelvic organs descend out of the rectum or vagina, see “pelvic organ prolapse” post.  Voiding while in an un-relaxed position contributes to incomplete bladder emptying.  This is due to reduced urine flow secondary to increased muscle activity and resistance of the pelvic floor.  Incomplete bladder emptying or urinary retention, has two further complications.  First, it can lead to increased urinary frequency as  the bladder “sends the signal” that it is full more frequently—It didn’t empty fully previously so it takes less time to fill again.  Secondly, chronic urinary retention can lead to bladder infections.  Allow yourself to take the time to empty your bladder fully when you need to urinate!  Sitting on the toilet seat is good for your pelvic health.

Take home messages
•Relax your muscles to while urinating to void more completely.  Sit comfortably.
•Avoid bearing down to empty your bladder.
•Take the time to allow your bladder to empty fully.
•Use paper to grasp the toilet handle while flushing (or flush with your foot).
•Wash your hands after touching surfaces in the restroom.
•Use paper towel to turn off the water faucet and to open the door of the restroom—dispose of the                paper towel once you have opened the door.
•When in doubt--use hand sanitizer.
•If you have further concerns or questions discuss them with your doctor or a pelvic floor physical                 therapist www.womenshealthapta.org.

Sapsford R, Bullock-Saxton J, and Markwell S,  Women's Health:  A textbook for Physiotherapists.  Page 66, W.B. Saunders, 1998. 

©Miriam Graham, MSPT, MBA, Restore Motion, 2011.

January 20, 2011 Update