Monday, October 11, 2010

Is Squatting When Urinating Bad for Women?

It’s not uncommon to hear from patients that in public restrooms they will squat or hover above the toilet during urination in order to avoid contact with the toilet seat for hygiene reasons. This may still be better than holding it in all day and becoming uncomfortable and then only urinating once at home. Nevertheless, there are different postures that women adopt when urinating, whether sitting, hovering above the toilet (“semi-squatting”), or actually crouching/squatting on the toilet seat itself. In certain cultures in Asia, women are accustomed to squatting over a floor drain in public restrooms. In the West women will sit of course, but evidence shows that the best overall posture is sitting on the toilet edge, legs separated but supported, leaning forward a little, to help open and relax the pelvic floor.

If women hover above the toilet or do not relax completely to urinate, does this affect their ability to empty the bladder? Is it detrimental to not sit to urinate?

A group of 45 university students was asked to participate in a survey of how they posture themselves during urination, as well as measuring residual urine and urine flow rate. They were also asked why they do this. What was found?

When voiding in the semi-squatting posture (hovering), women had a longer delay time to initiate voiding than in either the sitting or crouching (squatting on the toilet seat) posture. This is likely explained due to better relaxation of the pelvic floor which occurs with sitting. Forward bending helps to relax the pelvic floor, especially with the legs supported, and thighs spread apart. It was found that sitting allowed a smoother void pattern than either semi-squatting or crouching, but residual urine volume and maximum flow rate were no different among the three postures in these young women.

In order to squat or hover over a toilet, women have to contract their gluteus maximus and adductor femoris muscles, which when the latter is contracted, has been associated with failure of the pelvic floor to relax, impeding urination.

Crouching or squatting on the toilet seat itself may seem like it would open the pelvis more, but if the woman is unsure of her balance and therefore not relaxed, voiding will not be as smooth. With older women, or those after child birth, bladder function may be diminished and may lead to residual urine or lower flow rates.

Women’s reasons for adopting non-sitting postures in this survey were:

Toilet seat not clean- 97.8%

Space limited- 82.2%

Toilet height – 66.7%

Of the 45 participants, 40 (88.9%) preferred to not sit in public restrooms, even though 80% felt that it would be more comfortable, and very few felt comfortable when squatting or hovering. Among the women who did not sit to void, 39.5% reported that they began using such postures since junior high school. It may be therefore be interesting to consider a brief mention of the “right way” to urinate to young girls by their mothers, or even during health class at school.

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