You walk into a public bathroom stall and you see pee on the seat, maybe it’s not been flushed properly, or there is toilet paper strewn everywhere. So you go in search of an alternative. But despite trying to find a suitable toilet you’ll feel comfortable with, most have ‘something wrong’ with them. But you have to go…. so, you opt for the hovering manoeuvre, you don’t want to touch that toilet, after all. Hovering to go to the toilet is a common tactic for women. Anywhere between 25-85% of women hover to use a toilet. Sure, it seems like an easy way to avoid any contaminants or having to deal with an unsanitary toilet, but could hovering be causing more harm than good? We consulted Dr Kate Lough, CSP registered Pelvic Health Physiotherapist and recent Chair of POGP (Pelvic Obstetric and Gynaecological Physiotherapy) to understand the problems with hovering on your pelvic floor. We also suggest some ways you can feel more comfortable using a public bathroom below, without the need to hover!
This interview has been edited for length and clarity.
1. Why is hovering over a toilet problematic for your pelvic floor?
Studies suggest and common thinking is if you hover over the toilet, you create tension between your abdominal and pelvic muscles and pelvic floor muscles and you can’t fully relax your bladder. Interestingly, from various studies, it’s a chicken and egg situation; there is a greater likelihood of those with existing bladder problems making things more difficult by not adopting best practise.
The question is, why are you squatting? If it’s because of hygiene, or because you don’t want to touch the seat, it is understandable, but if its habit or a rule, then [you’re] potentially not relaxing, and not peeing fully.
When you are young you may have been told “don’t sit, it’s dirty” – which is largely an old wives tale. Additional rules created such as “have a pee before you leave”, “wait until you’re home”, or “I never go to the toilet when at school”, or simply not responding to bladder [or bodily signals]. Under drinking, or ‘holding on’ until they get home, is not good for bladder health. Unhealthy relationships with your bladder mean you may be forcing your time scales on it and not letting normal bladder function occur.
In 2023, Diane Newman, an Australian Incontinence Specialist, ran a seminar that discussed behaviours for toileting, managing urinary incontinence and good toileting practices. Normal behaviour, which does depend on age – as you get older you may go to the loo more at night as increased frequency is common when you’re post menopausal, you should be going to the toilet anywhere between 4-6 times a day, with an urge to pee felt when the bladder has 300mls upwards inside.
Some people hold on and pass bigger quantities, others pee smaller volumes, sometimes out of convenience, others for a fear of bladder leakage (for example, an anxiety when sneezing will make it empty). Some people don’t sit, or don’t have enough for a good natural habit and too often individuals with small bladder volume may slightly push to pee with the thought of “if I empty my bladder, that’s me done”, but that’s not ideal – any kind of pushing. The bladder drip fills in an ongoing process, so it’s never really empty.
Then there is the difference between sitting and squatting positions to use the bathroom. This varies from person-to-person, some may find that squatting, or mimicking a squatting position will give the best release of the pelvic floor and therefore better for bladder and bowel emptying. It’s worth trying to see what is best for you.
2. What is the best position to comfortably, and fully empty your bladder and bowels?
Sit, relax, don’t push to pee, don’t hold on too long, and don’t go too often.
3. What other toilet tactics promote a healthier pelvic floor?
It’s important to get a sense of the bladder filling up (4-6 times per day).
To re-train your bladder, feel for a full bladder and take the full bladder to the toilet; when you’re on it, take your time. Sit down on the seat, breathe naturally, let your tummy relax and the bladder will do the work. Overworking and underworking the pelvic floor, for example, stopping the flow mid stream is not good for the pelvic floor because the bladder works with those muscles to coordiate emptying.
The risk factor to hovering and improper toileting habits, though not many studies conducted on this yet, is most likely causing an increased residual volume of urine, so you don’t fully empty your bladder. Additionally pressure changes, the urethral pressures, means it doesn’t come out efficiently.
The key takeaways? You don’t need to go often (4-6 times a day) and we need the bladder to feel full to go. Healthy output of the bladder, over 24 hours, on average is 1.5-1.8L output (not input!). It is important to drink because you’re thirsty or because the urine is indicative; so measure output rather than what or how much you drink.
How to get over ‘gross’ toilets:
It’s understandable you may want to avoid sitting on a public toilet for hygiene reasons. After all, bathrooms can harbour common bacterias and viruses that can spread when the toilet is flushed with the lid open, or through contact with touchpoint surfaces such as the flush handle and cubicle door lock. However, the risk of contamination in public bathrooms remains low.
Follow these steps to use a public toilet more confidently:
- If it is a state – absolutely look for an alternative toilet.
- If there is urine on the seat, wipe with a clean piece of toilet paper. As an extra step, you could apply a drop or two of hand sanitizer on a clean piece of toilet paper and wipe the seat with that.
- If you need to avoid touching surfaces, such as the flush, or door handle, use a clean piece of toilet paper and throw it in a bin outside of the cubicle.
- Exit the toilet promptly after flushing.
- But, ultimately, washing your hands thoroughly with soap for 20 seconds does kill the common bacterias and viruses found on these surfaces.
Observationally, hovering to use the toilet has become a bit of a cycle: Women end up hovering and peeing on the seats because they think it’s unhygienic and the next person comes along, sees pee and hovers to avoid it. The cycle perpetuates. The more women that become aware of the hygiene-factors of public bathrooms and the best practise for toileting on your bladder, the more likely (we hope) we’ll find sanitary toilets!
Featured image: Prostock-Studio, Getty Images, Canva
