Highly recommended: a small survey among your circle of friends about the urination posture of male housemates. Woman 1: “Sitting. Apparently they prefer that, because I didn’t ask them.” Man 1: “Sitting is more relaxing. Although I have to be careful not to pee under the glasses.” Woman 2: “Sitting. Never having to ask, they do it on their own. But I don’t want it any other way.” Man 2: “I only do standing in the wild, because there it doesn’t matter whether you can aim well.”
Conclusion 1: it is often women who clean the toilets. Conclusion 2, at least in this bubble: men are completely okay with sitting. But what do the doctors say? It would be better to pee while sitting, you hear a lotbut is that really true, and what difference does it make?
First about the latter: it is really true that you are more likely to get bladder infections if you often do not urinate properly. That’s all kinds of things overview studies. Even though your urine flows continuously: there is still one strong connection between how much urine remains in your bladder after urination (always something; at one in twenty healthy adults is it more than 100 ml) and how many bacteria live in it.
It sounds logical: you can relax better while sitting. And one relaxed pelvic floor muscle is a prerequisite for being able to urinate properly. But no. The meta-study on standing versus sitting urination, a Leiden article PLOS One in 2014literally states: “In healthy men we found no difference (between standing and sitting urination) in urodynamic parameters.” These parameters are the maximum jet strength (in milliliters per second), the urination time and the amount of residual urine.
Sitting can help
What the authors did find is that men with ‘lower urinary tract symptoms’ have some benefit from urinating while sitting: about 25 ml less urine remains in the bladder. This lower urinary tract symptomsLUTS, or LUTS, are complaints that people experience when urinating or when holding in urine. They hang out with men often together with a benign prostate enlargement or prostate cancer. But sometimes it concerns bladder stones, cystitis or a narrowing of the urethra. Certain medications, alcohol or obesity can also cause LUTS.
A great study among tens of thousands of Americans, British and Swedes found that three-quarters of men and women ‘sometimes’ have LUTS, and half experience them ‘often’. Another big one, international study reports that one in five even has ‘severe’ LUTS complaints. For all these people, urinating while sitting could help, according to the Leiden study.
But wait, has there actually been research into urination positions in women? Of course! Women who urinate standing up, for example with a pee trough, urinate just as efficiently as when they sit. Useful for women with knee problems, the researchers saidand for women who find public toilets dirty. As for the latter: hanging over the glasses works just as well as urinating while sitting, but the urine flow starts later and is more irregular. This requires more research, according to the Chinese researchers. A Indian research shows that squatting works even better for women.
In short, for the general population, the urination position does not matter. The Dutch guidelines also say this general practitioners and urologists. Too bad for the toilet cleaners. But of course they can keep this information to themselves…
