Monday, August 24, 2009
I Stand by My Beliefs
Herein I shall bear my soul. It has been over a month of this “put-it-all-out-there” emotional “dear diary” confessional, and I do believe the time has come for the other Choo to drop… I do not pee standing up. This I now realize may come as a shock to many. Some of you have shut your browsers in horror or are now perusing E-Talk daily or checking what has been released this week on i-tunes. For my male readers you may sit in wonder that there are in fact women who can urinate in a vertical position to begin with.
Truth be told, and there is nothing stopping me now, in a café, at the movies, hell, even most gas stations, I do sit to pee. This is not always the case. Make no mistake, if the seat is covered in urine, I AM NOT sitting down. Furthermore I, like many of my soul sisters have mastered the art of vertical urination. If the seat is clean and the washroom does not look like a scene from Midnight Express (insert Turkish prison reference here) I will sit down to do my business. Furthermore, I don’t place toilet paper in neat little rows across it. I have many a time HAD to stand, in four inch heels hovered over the bowl with certain desperation reminiscent of childhood diving lessons. There, on the high board peering at the water below, wondering when to take the plunge. Such is the scene in a less than favorable washroom usually a gas station in one of the Prairie Provinces or Middle America; both of which can be avoided if you don’t drive very often.
I figure I am a busy girl. My day is filled with morning walks, daily bike rides, afternoon runs and a host of activities of regular living. Sitting to relieve myself is one of the few times I DO sit down in a day and why should my backside by denied? Now, women talk about many things when in the company of one another, but really, for all of our chatter, urinating practices are not a usual topic. I know this because in pursuit of research, I asked around. Sitting with girlfriends over coffee, or brunch, drinks or whatever girlfriends do, I have spent the last month inquiring into the positional practices of my fellow females while in the act of urinating. Firstly my question of “Do you sit to pee?” was met with considerable shock. Firstly, let me preface this by saying that as a physician I am quite used to asking people personal questions. More importantly, as a physician I am quite used to getting some pretty personal answers. So I was somewhat shocked by the common thread of surprise and even embarrassment that my “seating” question was often met with. Secondly, the question was usually asked of women I know well, some for years. I did not peruse coffee shops for strangers or survey a hotel bathroom taking an exit poll while unsuspecting patrons washed their hands. I asked GOOD girlfriends, many of whom had divulged to me their personal triumphs and heart breaks. But the “do you sit to pee?” was a question I soon realized that was as polarizing as one’s belief in God or political affiliation.
“It’s a question of cleanliness,” one of my “girls” claimed. “you can catch a hell of a lot from a seat, can’t you?”
And so I got to thinking, what can one catch, I mean really catch from sitting on a public toilet seat? In a world where we are almost to the point of conducting studies into the benefit of jumping out of a plane with or without a parachute, I had to know. What is the medical evidence behind sitting or standing to pee?
At first I turned to my patients’ favorite source for all thing medical…. GOOGLE. Make no mistake, I love GOOGLE. She’s like a personal assistant and a favorite aunt who has the answers to everything rolled into the perfect on line search tool. When I need to find directions to a restaurant or to settle an argument on movie trivia with my husband, GOOGLE is my goddess and I will worship her without shame. However, when a patient would rather search GOOGLE for answers about her blood pressure than talk to me (true story- happens all the time), well then, plain and simple, GOOGLE pisses me off. I am what you would call a fair weather GOOGLE. I search when it suits me. When it came to this particular search, GOOGLE was less than helpful. Sure there were 960,002 search items on “what can one catch from a toilet seat?” I made it through the first 32 pages of references to blogs and bullshit websites before declaring my search a bust. This was not before I found three websites selling a detachable female contraption that allows women to pee standing up. It is a cross between a plastic penis and a catheter and was featured on Good Morning America. This, like a terrible car crash, was too much to turn away from but eventually I decided to close the laptop and move on.
Next came Wikepedia to which I have a sincere emotional attachment. I will elaborate on this at another more appropriate time. Safe to say, I do love my Wiki. Solid, dependable and straight to the point, Wikipedia is like your best gay boyfriend who not let you leave the house in stirrup pants no matter what decade you are living in. But unfortunately on the topic of urination, Wikipedia left me somewhat smarter but still full of questions. I did learn that the toilet dated back to Roman times and that in many countries in West Africa women pee standing up. Hell, in some cases even in the streets. However, there was little to be found on the topic of the North American toilet seat as the next source of the plague.
And so there I was at the University of British Columbia Medical School Library doing one hell of a literature search on a perfectly sunny day that should have been spent at the beach. I had just used their facilities (it was only proper) and sat down again to examine the evidence. There is an overwhelming amount of data on what can grow on a toilet seat, but as for catching it, I am terribly reassured. Interestingly it is the flushing of a toilet that disperses the most bacteria and viruses into the air. In fact a landmark study published in 1975 by Gerba, et al. in the Journal of Applied Microbiology showed that the first flush of a toilet after urination or defection releases the most amount of bacteria into the surrounding air via droplet infection (just like when someone sneezes on you). The amount of pathogens (cooties) drops SIGNIFICANTLY with each empty bowl flush after that to the point that after 3 flushes you are dealing with a bowl that has a much bacteria as it did before anything or anyone went near it. The study went on to sample different locations within household and public bathrooms. They sampled 20 different bathrooms, public and private, and swabbed each sample onto agar plates (used to grow bacteria). They then let the plates grow and counted how many plates grew how many different types of bacteria. The study swabbed six different locations in the bathrooms:
3. toilet seat
4. toilet rim
5. flush handle
The study took into account which places had any bacteria at all and which had the most types of bacteria growing. The researchers found that the two places that grew the most types of bacteria were the rim of the toilet and the sink. Yes my sisters… the seat of the toilet grew less colonies of bacteria than did the floor but more than the flush handle and the walls.
Always one to give you both sides of the story, there is one case report in the literature of an eight year old girl allegedly catching Gonnorhea from an airport bathroom in Hong Kong, but she was from Texas and the parents could not be reached for comment according to the American Journal of Microbiology.
Finally, all my reading confirms that one should stand AWAY from the bowl during flushing (I love it when science confirms the obvious). It turns out that the flush of the toilet that is the “dirtiest” part of the act. Toilet paper should be covered, eyes shielded and children and handbags in a safe place! Stand AWAY from the bowl and hope for a good immune system.
Speaking of the immune system, let’s talk about hand washing. As someone who touches sick people for a living, I am a big fan of the hand wash. Hell, I’ll devote a whole blog entry to it in the next few months but for now let’s just say it is a good thing. The American Society of Microbiology conducted a Clean Hands Campaign in 2000 that showed that although 95% of Americans say they wash their hands after going to the washroom, only 67% actually did. Surveys of washrooms across major airports in the USA and Toronto (when will America realize Canada is more than just Toronto?) show that if the Olympics were held in an airport washroom, we’d bring home the gold.
Ninety-seven precent of women using Toronto Pearson’s washrooms are washing their hands versus only 59% in San Francisco. I love San Fran, fabulous city! I don’t care if you leave your heart there or your urine sample… wash your damn hands!
There you have it. Sit or squat, flush or not? Proper bathroom hygiene according to the evidence suggests we may have been doing it wrong all these years. We have long thought it was what we did during urination that matters most. Turns out like most things in life, it is about the end game. Be far from the flush and wash your hands!
Bottom line, there are many ways to do many things in this world. We all have our own paths and preferences in life. Mine is not to judge (at least not here, anyways). I’m just here to do my business, flush and leave. My hands are washed, my soul is clean.
With that said I wonder if I could ask the women before me who do stand to pee to abide by the golden rule I learned in grade school,
“If you sprinkle, when you tinkle, be a sweetie, wipe the seatie”.