Is It Worse to Sit or Squat on a Public Toilet?

When nature calls, your bladder doesn't care that the only stall looks like a neglected stable.

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Aug 30 2017, 12:00pm

Gabor Monori 

The Scenario:
Peeing in public is nobody's favorite activity, but when nature calls, your bladder doesn't care that the only bathroom is a public stall that smells like a neglected stable and looks like the aftermath of sewer explosion. You've got to make a tough call: Pee in a slight squat, which might increase your risk of a urinary tract infection, or sit your booty down on that germ-laden surface. What do you do?

The Facts:
Perhaps the most important thing to know when you head into the germ-infested sphere of a public restroom is that your butt naturally keeps microbes at bay. Okay, maybe not your butt, but the skin on your butt—assuming you have no open wounds—is incredibly impervious to even the scariest of microbes. "Intact skin is a major component of your immune system and very hard for any microorganism to traverse," says Amesh Adalja, an infectious disease physician at Johns Hopkins Center for Health Security. "The likelihood of someone catching a disease by sitting on a toilet is very low."

The second most important thing to know is that the public bathroom is no more germy than most other surfaces you're likely to encounter. "It's an artificial distinction to say the bathroom is dirtier than other [places]," Adalja says. Unless you're immune-compromised to begin with, you have just as much chance of catching a virus from a door knob, an office desk, or your friend's hand, as a public restroom. He points out that there are more bacteria in a patch of grass and in one scoop of ocean water than in your average public bathroom.

"I think people get neurotic about public bathrooms, not realizing they have an artificial view of the sterility of everything else outside of the bathroom," he says. In fact, your home bathroom is probably no better, and you're far more likely to brush your teeth, put on your makeup, and drink water in a place where plumes of bacteria sprayed up from every open-toilet flush have coated all surfaces. When in doubt, he advises washing your hands thoroughly with water and soap—but avoid antibacterial soaps and gels, which could be fueling the growth of antibiotic resistant bacteria.


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But What About My Bladder?
Say your fears about sitting have not yet been allayed. Or you decide to squat over the toilet because someone before you rudely failed to wipe down their own backsplash. What about the risks to your bladder that come from not emptying yourself out completely? Your bladder is essentially a muscle. When it becomes full, you constrict the muscle to push the urine out and release the muscle when you're done, says Alex Shteynshlyuger, director of Urology at New York Urology Specialists. When you squat or hover over a toilet you compress the muscles of the bladder and perineum into an unnatural position, which can potentially lead to problems such as backed up urine and muscle issues.

The Worst That Can Happen:
Because you're partially using your bladder muscles to hold yourself in that hovering position, you indeed may not fully empty your bladder in a squat. "If the bladder is forced to be distended for a long period, over time the bladder muscles become less functional, less able to squeeze [out urine] and more fibrous," Shteynshlyuger says. Bladders that don't empty fully are also at increased risk of urinary tract infection (UTI). But unless you want to start getting into some pretty absurd hypotheticals involving freshly-spilled bodily fluids and gaping wounds, the risk of picking up an STD or a virus is minimal.

What Will Probably Happen?
Go ahead and plop your parts on down on that seat; you'll more likely catch your next infection from your sick work neighbor with an aversion to hand washing or a snotty child who slicked up the grocery cart before you touched it. "We live in a world dominated by bacteria, and it's foolish to think you can live a sterile life, nor would you want to," Adalja says. Microbes do more for the good of our health than they do to make us sick.

And so long as you don't make a regular habit of squatting over the toilet seat, or holding your urine in for long periods of time on a regular basis, your bladder muscles should be just fine for the occasional squat over the seat. "In general, the human bladder is very resilient. For you to damage it you need to do something very consistently for a very long time," Shteynshlyuger says.

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