Medical Examiner

The Curious Irony of Avoiding Icky Public Bathrooms

A common infection could be caused by our habits—not dirty toilet seats.

A woman in a dress and boots sitting on the tank of a toilet with her legs crossed. One foot is on the toilet seat. It's a weird place to sit!
Photo by Gabe Pierce on Unsplash

It’s been 11 years since 33-year-old Erica started suffering from urinary tract infections, or UTIs. Every time her doctors put her on antibiotics, she gets better—only to have the infection strike once again.

Doctors aren’t sure why Erica has a recurrent UTI, she says (we’re referring to her by her first name to protect her privacy). But she attributes her first go around with the infection—which caused burning sensation while peeing, abdominal cramps, and frequent urination—to the fact that she was living in an unclean house with someone who was a hoarder.

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To this day, dirty bathrooms make her pretty squeamish. “If there’s a bit of pee on the toilet, and I don’t notice and then I sit on the toilet, I have to jump straight in the shower afterwards to wash it off,” says Erica who lives in Lincolnshire, UK. Whenever she travels or stays out for a long time, she’s inclined to hold pee for hours.

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A lot of women I know—including me—would rather squeeze in the urge to pee than use a dirty toilet seat. But experts are adamant that any connection between UTIs—one of the most common bacterial infections—and icky toilet seats is a myth. “Just literally sitting on a toilet public toilet seat? I mean, it doesn’t really work that way,” says Jennifer Rohn, a cell biologist who researches chronic UTI at the University College London. Germs don’t magically jump from the toilet seat to the urinary tract, she explains.

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Maybe we should even embrace less-than-clean public toilets. Not only do they not cause UTIs, holding pee itself may actually be associated with an increased chance of getting an infection, recent research suggests.

UTIs are commonly caused when germs that live in your own gut enter the urethra, the opening to the urinary tract. This is the reason doctors recommend wiping your butt from front to back. Sex acts can also cause the bacteria living around the anus to shift to the urethra. Additionally, the vagina also can harbor UTI-causing bacteria. The issue here is really your own germs, not someone else’s that they left behind after doing their business.

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There is evidence that holding pee for long periods could cause UTIs, perhaps by allowing bacteria in the urinary tract to multiply. A study published in the journal BMC Infectious Diseases in June this year describes a survey of 778 students staying in a hostel in Southern India’s Puducherry. Researchers found that a tendency to hold it was correlated with developing the infection. The study excluded participants with known risk factors for UTIs, such as previous urinary tract infection. Students who were on antibiotics for any other disease were also not included in the study. The study found that symptoms of a UTI were correlated with a tendency to hold urine.

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The most common reason why women in the study were holding their pee was the fear of acquiring infection from public toilets that are not clean, says Sharmili Jagtap, the study’s lead author and an assistant professor of microbiology at Pondicherry University in India. Jagtap acknowledges that this study was done only based on a questionnaire, and the results were based on the information that the participants provided, rather than an objective test.

But the evidence suggests “it’s your habit that causes the infection,” says Jagtap. And definitely not the toilet seat.

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What could make holding pee lead to a UTI? Microbes in the urethra get flushed when we urinate, says Jagtap. If holding pee becomes a habit, perhaps the bacteria in the urethra get established there, proliferate, and ascend to the bladder. This fits with health advice I’ve gotten in the past: when I was a teenager, I was diagnosed with a UTI. I was advised by my doctor to urinate when my brain signals my bladder to pee, so that I flush out the bacteria, and get rid of the infection.

It’s not easy for everyone to be comfortable using unclean toilets at all times. If you have a vagina, there are urination devices, which are basically funnels that allow you to stand and pee without having to squat down or sit on a toilet seat. No matter what, holding your pee is definitely not good for you.

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