public toilet

Did you know that there is a medical condition called TP (toilet phobia). An article in the German medical journal Klinische Pediatrie (Jan. 2017) notes that “…toilet phobia (TP) is a rare disorder in which toilets are avoided completely.” The pediatricians who describe TP and its cousin TRS (toilet refusal syndrome) are referring to childhood conditions. But judging from our inbox, a lot of adults are fearful of toilet seats. Updated 12/27/18

TP is a Real Thing:

We had no idea Americans have such a fear and loathing of toilet seats. We discovered that when we received a letter from a reader of our syndicated newspaper column. She wanted to know a quick way to sterilize the seat in public restrooms. She complained that back pain had made it more difficult to crouch over grungy seats in movie theaters, gas stations and fast food restaurants.

We tried to be reassuring, pointing out that people don’t catch horrible diseases from sitting on the toilet. A search of the medical literature turned up no cases and dermatologists we consulted knew of no instances of venereal diseases transmitted in such a casual manner.

Cleaning Toilet Seats?

Although sterilizing a toilet seat in a public rest room is virtually impossible, we offered her two suggestions. One was to carry alcohol wipes to clean the seat. Another option was a dilute bleach solution that would probably kill most organisms. This might be rather inconvenient to carry around, however.

Then the mail started pouring in and it became clear that our answer was inadequate. Disposable paper seat covers were the most popular solution by far. One writer told us:

“Like the people who have American Express cards, I don’t leave home without it.”

Many of our readers pack disposable seat covers whenever they travel. According to one:

“I travel by car a great deal and am often forced to visit rest stops. In California the bathrooms are notoriously filthy and quite often have no seat covers or even toilet paper. I always carry both in my car and put some in my purse before using the facilities. It’s a very simple and relatively inexpensive solution to the problem.”

Is Hovering Over Toilet Seats Unhealthy?

Clearly, people prefer not to let their skin come into contact with seats where others have rested their naked derrieres. Without benefit of a paper seat protector, many people tend to crouch or hover rather than to perch.

Urologists tell us that this is not a good practice. They have found that women who stand over the seat instead of sitting have a slower release of urine and more residual urine left after emptying the bladder (British Journal of Obstetrics and Gynecology, June, 1991). This could increase the risk of a urinary tract infection. They had found that many of the women they were treating for incontinence did not sit.

Beware Sprinkling on Toilet Seats:

Then there is the issue of sprinkling. When someone crouches over the toilet there is a strong likelihood the seat will get wet. Many people do not have the courtesy to dry off the seat afterwards. Hence this famous ditty:

“If you sprinkle when you tinkle, please be neat and wipe the seat.”

Another variation:

“If you sprinkle when you tinkle, be a sweetie and wipe the seatie.”

Sadly, though, a lot of folks do not follow this advice.

Squatting vs. Sitting?

One listener to our radio show reminded us that this issue is extremely culture-bound. He pointed out that in much of the world people crouch low out of necessity, as the “throne” is unknown. He added that hemorrhoids are far less common in such cultures, but we have no studies on the urological consequences.

Bacteria in the Bathroom!

Our hunt through the medical literature did turn up one disquieting fact. Public restroom surfaces are commonly contaminated with invisible bacteria, usually those carried in the intestine. Microbiologists recovered these not only from toilet seats, but also from flush and tap handles and doorknobs, which is quite a bit more disconcerting since you have to touch them to get out of the restroom.

Chinese researchers have noted that (Indoor Air, Jan. 2018):

When people flush:

“toilets generate contaminated aerosols, the transmission of which may cause the spread of disease, particularly in the immunocompromised or the elderly.”

American researchers appear to agree with their Chinese colleagues. They came up with a cute title: “Lifting the lid on toilet plume aerosol.” It was published in the American Journal of Infection Control, March, 2013.

The authors note that researchers detected bacterial spread after flushing as far back as the 1950s. The greater the “flush energy” the greater the “bioaerosol.” Public toilets often tend to have impressive flush energy.

Shut The Lid on Toilet Seats BEFORE Flushing:

The American investigators cited above report this interesting observation:

“Recently, Best et al, flushed a toilet seeded with fecal suspensions of Clostridium difficile. Settle plates were placed near the toilet and air was sampled at seat height, flush handle height, and midway in-between, with the toilet lid both up and down. Settle plates showed widespread dissemination of large droplets with the lid up but not with the lid down. C difficile was recovered from air sampled at heights up to 25 cm above the toilet seat and up to 90 minutes after flushing, at concentrations 12-fold greater with the lid up than with the lid down. They concluded that lidless conventional toilets increase the risk of C difficile environmental contamination and thus discouraged their use.”

Here’s another thought. You may not want to lift toilet seats with your fingers. Just imagine the accumulation of bacteria, viruses, fungi and other microorganisms on the underside of toilet seats.

Speaking of viruses!

One of the nastiest gastrointestinal infections known to man is human norovirus (HuNoV). When you hear about a cruise ship that has to make an emergency trip to port because of an outbreak of vomiting and diarrhea among passengers, norovirus is almost always the culprit.

Researchers shared this disquieting observation (International Journal of Environmental Health Research, Aug. 2016):

“We systematically reviewed the literature to determine the presence of HuNoV on bathroom surfaces. Our review included 22 eligible studies conducted in commercial and institutional settings. Under outbreak conditions, 11 studies reported detection rates of 20-100 %…Our review suggests bathrooms could be vehicles that transmit HuNoV under both outbreak and non-outbreak conditions.”

Readers Speak Out About Toilet Seats:

We heard from one visitor:

“I have NEVER understood why people get so distressed about germs that might land on the back of their thighs. Seriously… are you going to serve a meal there later or something? Just sit down and get it over with. The REST of us do not like sitting in YOUR pee on the seat after you’ve done that whole “hover” thing.

“If you’re in a disgusting bathroom and you just can’t live with the fact that you might have a germ or two on your thighs, then why aren’t you carrying wet wipes in your purse so you can wash your backside when you’re done? That would seem more logical to me.

“But then again, I’ve never understood the whole worry about a dirty toilet seat. It’s dirty even if it looks clean; fecal microbes get into the air and land on everything when the toilet gets flushed. It’s common. There was even a Mythbusters episode about it. Did you know the floors and counters in your KITCHEN have more germs and more potential to do you harm than what is on a toilet seat?” M.O.

Should we advise people to use alcohol wipes on the tap handles? Should you use a clean paper towel to open the door after washing your hands? We don’t have the answers to these questions, but we also don’t have documented epidemics of diarrhea from public restroom contamination.

Naomi offered this comment:

“Getting wet from sitting on a wet seat is an inconvenience and nothing more. If your skin gets wet, dry it. No other part of you is apt to get wet.

“The reminder about faucet handles, door handles, soap dispensers, etc. is much more important – and you’re NOT in a hurry on the way out.
 LEAVE with clean hands, that’s what counts.”

We were set straight on one issue in this letter from a reader:

“Your dermatologists are wrong when they say you can’t get anything from a toilet seat. During World War II I worked in the office of the camp where my husband was stationed. We shared a rest room with the Motor Pool–some of the biggest roughest, toughest females I’ve ever seen.

“All the females in our office got those ‘little creepy crawly’ things. It was very embarrassing to go to the clinic and be examined for treatment. Needless to say, after that experience I do not ever sit on a public toilet. I am 82 and it is not an easy task!”

Many readers have shared their own fears about toilet seats below in the comment section. Why not participate? Share your own bathroom experiences and solutions below in the comment section below.

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  1. WK
    Raleigh
    Reply

    Funny, I usually put paper on the toilet seat at public
    facilities. I failed to do so recently. Just now I realized THAT is why I developed “acne” on my bottom for the first time in many years. It has now cleared up but I have no doubt it was from a public toilet seat, as I am a fastidious bather.

    Re: STDs —I worked at an inpatient addiction unit. One patient had HIV and developed a severe Herpetic outbreak on his buttocks. When I insisted he use the Clinic bathroom while he had active lesions he filed a complaint saying there was no evidence of spreading HIV by toilet seat transmission. It was considered a civil liberty issue and he was allowed to use the communal toilets
    Having seen his bottom as a Physician I personally would be loathe to put my tush on an uncovered toilet seat but I did and it only resulted in acne this time . Let the others poo-poo those who are careful. Better safe than sorry

  2. Nan
    VA
    Reply

    I find it interesting that the emphasis is on washing hands AFTER using a toilet. Unless one carries an infection, urine is sterile when it leaves the body and I don’t usually pee on my hands. Washing the hands before going makes more sense to me to remove whatever I have picked up along the way prior to wiping myself. Using a bit of tp to raise the seat, I squat over the bowl and wipe up any splashes on the porcelain that rarely occur.

    Just another way of seeing things and BTW at 83 I can still squat just fine, thank you.

  3. Judith Coffin
    Florida
    Reply

    My career included travel all over South Fl for years, including into many private homes in various states of cleanliness. Thus, constant use of rest rooms public & private. My pet leave are those toilet seat phonics! They have no consideration for us who must follow them after they’ve “sprinkled all over the seat plus! I just avoid wet ones & wipe seat with toilet paper before I sit. In 30 years I have never “caught” anything. If everyone would just sit on the damn seat, no one would have to worry!!

  4. Kirk
    St. Paul
    Reply

    If it’s any consolation, urine from healthy people should be sterile. Of course, not everyone is healthy. My gripe is with places that exclusively use blow dryers for drying hands, but don’t install adequate numbers. They take much longer to dry hands, so often people skip washing their hands entirely, rather than wait for access to the dryer during times of heavy use. Not to mention water being blown all over.

  5. Emma
    USA
    Reply

    Born in WWII Britain, myself and siblings were taught never to sit on a public toilet seat. When we grew up figured out why…lice. Soldiers from WWI especially, came home with lice from the trenches. Sometimes what our parents were taught in their day is passed on to us in our day. We make of it what we can. Considering how many women I see not washing their hands after using restaurant public toilets, I use a paper towel to open a door. Ever notice how many restrooms open inward? McD’s is one…and they now have no paper towels. Trying to avoid peeing there. I’m sort of glad to learn why i have the bladder control of a leaky hose. But am not changing now. Too old.

  6. Lyn
    Puget Sound, WA
    Reply

    Yuk! Our local clinic is one of the worst places to poo & wee. There are spots of poo, dribbles and sometimes the seat is so wet, a thorough cleaning would be in order to use the facility. The clinic has old-fashioned handles to turn sink water on, and at times, soap dispensers sitting on countertops – then there’s the door handle. I use public bathrooms as little as possible, and feel that management should make certain that bathrooms are cleaned several times daily.

  7. Dj
    Ohio
    Reply

    I always close lid before flushing at home. I also cover my toothbrush and holder with a clean cloth.

  8. Wendy
    Central Florida
    Reply

    A few years back I read an article in one of the health magazines by a female gynecologist who admitted that she had no qualms about sitting directly onto a public toilet seat. You would think that she would have reservations about doing so, but she didn’t. I use those paper seat covers when available. If not, I cover the seat with toilet paper. You can’t be too careful.

  9. JP
    web
    Reply

    Why people store their toothbrushes on the bathroom counter has always been a mystery to me!!

  10. Carol
    Seattle, WA
    Reply

    I have to defend women’s bathrooms as the consensus is that they are dirtier than men’s bathrooms. I contend that it’s usually the women’s bathrooms where small children go and they have a tendency not to flush, have accidents on the floor or toilet seat and other gross issues.

  11. roumiana
    Los Angeles area, CA
    Reply

    I travelled recently to the UK, used public restrooms in malls, airports, supermarkets. Nowhere were toilet seat covers to be found. You have to fabricate them from TP. The good thing was that the flush button on the wall behind was often with a remote action. You just wave. I will know how it is in France, when I will travel there in spring 2019. It’s extremely difficult to find a public restroom there, even a paying one. I remember many years ago when I was living in France, “LA dame pipi” in the big department stores in Paris gave you 2 small squares of TP after you paid. You leave a tip when done. I hope it’s changed. There is an app about how to find public restrooms throughout France. The boxed paying restrooms in big cities are sanitized after each use. But I am scared of them.

    • Val
      USA
      Reply

      Do these children travel alone? As a parent, I take the responsibility of cleaning up after then.

  12. Annie
    Midwest
    Reply

    Personally I think that these discussions of toileting perils are often used as an opportunity for many people to display how widely-traveled and world-weary they are, and how sophisticated, compared to the rest of us rubes who really prefer not to sit in the waste products of other people. Public toilets are the best (i.e. worst) examples of human primitiveness, even in the most advanced societies, and are very depressing places to realize that this is the humanity that is probably caring for old people, children, serving at restaurants – and if you believe all the “sophisticates” above it all – doing your surgery, piloting your airplanes and running your bank. Give me a break.

    The one quality that has advanced civilization is the advancement of public health, and a key factor of that is sanitation and environmental health (and “environmental health” is not what it sounds like – it is about sanitation, hygiene, and – well – public health). To accept, and even promote the acceptance of, filth and the deposit of human waste for other humans to dip into is disgusting. One of the things that sets (or used to set) America apart from other places was PUBLIC HEALTH. Now in the name of something that is anti-progressive, we seem to be adopting a nonsensical attitude that it is somehow foolish and ignorant to respect and promote public health., and that includes the rather amazing advancement that was flush toilets, clean water, washing hands, and all that implies. The decline of social and public “good” and the ascendence of a laissez-faire, “don’t act superior with your flush toilets and toilet paper” ideas seems to go along with all the dog worship, dog feces, hordes of dogs and their waste everywhere in the country. Motels, restaurants, and all public places now allowing dogs inside; homeless people defecating on public streets and in all public places of cities and towns; occupying public park;,drugged out people dropping on sidewalks – “modern” America looks a lot like some contemporary version of ancient stupidity.

  13. Jill
    NJ
    Reply

    A fellow I work with got crabs from a public toilet seat. Gross. Some toilet seats have pee and poop smeared on them. What’s with that??? Call me crazy, but here’s my take: I don’t sit. I hover, but will wipe if I sprinkle. Then I got an FUD (feminine urination device. I LOVE IT!!!!. When I flush I actually pull my shirt up over my nose and hustle out. I have a paper towel ready to open the doors and get out. I will wash my hands or use antibacterial gel once out of the bathroom. Personally, I dont care if I have MY pee on MY hands, but I don’t wan’t to share your pee. Phobic? Yeah, probably. That’s why I would rather pee in the woods and get a tick on my bum.

    • Laurie
      Waseca MN
      Reply

      Tell me more about your FUD!! Where can I get one and how do they operate?

  14. Ann
    Cambridge ma
    Reply

    Loved it! I’ve always maintained that sitting was just fine. Glad to LEARN about the dangers of flushing with the seat up and squatting .

  15. Susan
    TX
    Reply

    What I think is disgusting is when the person before me covered the toilet seat with toilet paper, but didn’t dispose of it when she was done! It’s hanging on the seat, partly on the floor and partly IN the toilet, wicking toilet water up to seat. Thanks so much for worrying about germs only to leave a far worse mess behind for the next person!!!

  16. Marilynn
    NE Illinois
    Reply

    Like one of the responders above, I caught the ‘little bugs’ that could NOT have come from another human with sex. I did not have sex with anyone or even come close. VERY embarrassing!

    I have seen the video of a toilet flushing with the lid up, under a black light. And the stuff spreads 6-8 feet. My toothbrush is only 2 feet away. I don’t care to brush teeth with a contaminated brush.

  17. Rich
    Pittsburgh
    Reply

    This issue was hammered into me growing up by a germaphobic mom. But now days there is much more information available. It occured to me that they make sanitizing wipes, Lysol or Clorox, that can be carried with you in a ziplock snack bag. These are NOT flushable but wastebaskets are usually close by. I believe they sell smaller purse/pocket size packs too. I used half the wipe, and it had plenty of wetness to easily wipe down the seat. Next time I will do handles first. They claim that kills 99% of germs. Ought to increase the safety odds!

  18. Dan
    Minnesota
    Reply

    One other thought about public rest rooms. They have floor drains which never have water in the trap. (Did you ever wonder where the sewer smell comes from in those places?) When a toilet is flushed, a rush of air can be flushed from inside the plumbing into the rest room. It’s scary to imagine what bacteria and viruses are mixed into the air. There’s a simple fix–just put a cup of water into the drain but nobody ever does that.

  19. Cathie
    Phnom Penh
    Reply

    First, let me say that public toilets in the US are generally dirtier and wetter than toilets anywhere else in the world. I hate going into a stall and finding that someone has peed all over the seat and left a stream of urine on the floor. My dream is this: People will be considerate and think of those who will be following them to use the toilet. Truthfully, I am quite content in other countries when I find a squat toilet. They are generally kept clean, and I know that I am not going to touch someone else’s urine. And if you are really fussy, travel to Japan. The toilets are amazing. They often self-clean and will provide you with a bidet or “full” spray while you remain sitting, and you never have to touch a handle to flush.

  20. Marilyn K.
    Houston
    Reply

    Re: Public bathroom habits – hilarious – what I needed after reading world news tonight. Though I admit I’m grossed out momentarily if my thighs come in contact with a wet toilet seat (always try to wipe before sitting down, time permitting!), I’ve traveled to several countries where sanitation was non-existent. On a Kenyan rural road, it was a bed sheet stretched between two poles for privacy in front of a Western toilet, but was attended to afterward by an unfortunate employee armed with only a pot to dispose of the contents – no running water was connected to the toilet. And on the “Lunatic Express” to Mombasa, there were only two “footholds” carved above a hole which exited beneath the speeding train. On the Amazon, there was a Western toilet seat (thank you), but one definitely felt the rush of water below. Yeah, a swipe of TP on the seat is all I need.

  21. Ariel
    U.S.
    Reply

    What about the germs that get on the inside of the toilet seat when it is close when Flushing?c

  22. Miranda Forbes
    UK
    Reply

    If I use public toilets I normally wipe the seat with a wet tissue or toilet paper. I find it hard to crouch over a toilet so I sit down most times I use the public toilets. This debate as to if you can pick up germs from toilets I am not to sure of myself. But I do know some public toilets aren’t very nice. But unfortunately I now have a bladder problem and I have to use a toilet most times I go out.

    One women’s toilet I went in was very unsavoury it didn’t look like it had been cleaned for ages and some dirty women who had used it had put soiled sanitary towels behind the pipes in one of the toilets. It makes me annoyed as there where plenty of waste bins around why people are so lazy I do not understand it makes me wonder what their homes are like.

    • Carole Heath
      Reply

      I quite agree Miranda some people are very uncaring about places which aren’t there’s like public toilets. Not being rude but I once went into a women’s public toilet where some person had actually messed in the corner of the toilet and rubbed the mess on the toilet door the mind boggles.

  23. Tony C.
    Reply

    Yeah its right toilet area is a touchy topic to discuss. If you have kids and elderly person than use handles for toilet seats this will help them to use toilet seat without any problem and also helps then how to use other toilet accessories carefully.

  24. a k
    Reply

    yukk!!!

  25. a k
    Reply

    you say that communicable diseases cannot be acquired through toilet seats? I disagree. Diarrhea viruses can fester around toilets. We know that the hepatitis virus can live outside the body for up to a week. I’ve been in some restrooms where there was blood on the seat. If someone had an issue from their reproductive organs such as blood or seminal fluid the virus could remain there and should male or female organs contact this area, well you take the chance doc. Furthermore little children should be attended in public restrooms. It’s terrible society has so little respect for cleanliness in public places. I grew up on a farm. While the stalls and manure were filled with animal waste and microbes, I felt much more safer around that then some public restrooms used by so called ‘educated, informed humans’. I do clean up after myself and take precautions.

  26. Cindy M. B.
    Reply

    The very thought of all those paper towels being used just to close doors or shut off water taps makes me ill. I have never done any of those things, ever! And I simply never get sick. If I use a paper towel at home, I rinse it out, hang it up to dry and re-use it until it’s tattered! Then I recycle it. OH, the poor poor trees, giving their lives so people could just turn off a tap with their remains and then toss it in the garbage.
    If I sit in someone’s pee, I just wipe off my thighs when I’m done, badda-boom; it’s all good. And I NEVER flush the toilet at home till it’s been used at least 4-5 times. If I’m out and about, I’ll avoid putting TP in the toilet so people hopefully won’t notice it’s not flushed (I have very light pee) and thus another gallon+ of water is saved for the planet. I am simply amazed that people are so psychotic about germs; I think they must have horrible immune systems.

    • Susan
      Texas
      Reply

      It’s marketing. There is money to be made off of paper goods and anti-bacterial products.

    • T Keeth
      VA
      Reply

      Funny, and I re-use paper towels that are not germy; however, I learned that paper towels can not be recycled bec the fibers are too short. Those who put non-recyclable items in the bins are a problem, albeit non maliciously. Caused recycling program to be less profitable.

  27. abigail
    Reply

    Reply to Gloria G -( comment #1) The Vermont Country Store carries many types of 100% cotton clothing. Their catalogue is a trip down memory lane. All cotton bras like the Maidenform ones in the 50’s, 100% cotton panties, p.j.s, socks. and many other items like chemises and petticoats. No doubt there is also an on-line shopping site.

  28. Kim
    Reply

    Sorry to hear you are having such problems, Gloria. I would recommend you purchase natural cotton fabric and have a bra sewn. Check out local seamstresses or with relatives that can sew if you are not able. Then you will have a comfortable custom bra.

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