Toilet Seats Are a Touchy Topic-Do You Have TP (Toilet Phobia)?

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, too. But there is the opposite perspective. We frequently get spanked (metaphorically speaking) for writing about germs in bathrooms. This is a highly emotional no-win subject.

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.

Fast forward 20 years to a US study (International Journal of Nursing Studies Advances, Nov. 10, 2021). These investigators studied something called LUTS (lower urinary tract symptoms).

Here are some of the findings:

“Women who reported delayed voiding often/always had 2.8 times higher odds to report bothersome emptying symptoms relative to women who reported delaying voiding rarely/never.

“Women who endorsed a preference for crouching, squatting, or standing, when away from home, had 2.5 times higher odds of reporting bothersome emptying symptoms and 1.8 times higher odds of reporting any bothersome LUTS relative to women who endorsed a preference for sitting when away from home.”

The take home messages from this study:

• Delaying a trip to the bathroom when nature calls, is not good for LUTS (lower urinary tract symptoms). Some of these women are suffering from TP (toilet phobia).
• Crouching or squatting over a toilet to avoid touching the toilet seat is also unhealthy.

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.

The Squatty Potty once sponsored our nationally syndicated radio show a long time ago. To learn more about this device, here is a link.

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

Bacteria in the Bathroom!

A reader recently took us to task for our statement that:

“people don’t catch horrible diseases from sitting on the toilet”

Here is her legitimate complaint:

Q. You have written that people can’t catch anything from a toilet seat. I beg to disagree!

Diarrhea viruses can linger around toilets. I have been reading about norovirus and the amount of virus that can be spread during an attack. When I see how dirty many public restrooms are these days, I wonder why columnists such as yourselves don’t advocate for more sanitary conditions.

A. It’s not just the toilet seat that can be easily contaminated with viruses when someone has diarrhea. We are in the middle of a nasty norovirus outbreak across the country. When someone experiences this intestinal apocalypse, they may shed billions of viral particles in a bathroom.

Norovirus can spread to every available surface, including faucets and door handles. As few as 18 of these invisible specks could transmit the disease to the next person who enters a contaminated public restroom. Norovirus can linger on surfaces for up to two weeks.

The CDC emphasizes that careful handwashing is essential to prevent the spread of this gastrointestinal virus. Handwashing alone may not be sufficient, but soap and water are more effective than hand sanitizer.

The British National Health Service warns about “close contact with someone with norovirus who may breathe out small particles of the virus that you then inhale.” We agree that improved sanitary conditions in public restrooms, including better ventilation, would be highly desirable.

You will read more about norovirus momentarily.

Other “Bugs” 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.”

There’s only one problem with this research. Most public restrooms have “lidless conventional toilets.” Scroll to the top of this article and look at the photo to see what we are talking about. We are told this is a problem. We are told that lidless conventional toilets should be discouraged. And yet virtually all public restrooms are lidless. Talk about a double bind!

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.

This problem is more relevant for men than women. A man who wishes to pee in a stall rather than at a urinal will almost always have to lift the lid if he wants to avoid spraying droplets on the toilet seat. But, lifting the lid with your fingers means scrub a dub dub when you wash your contaminated fingers.

Nasty Norovirus!

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.”

We just happen to be in the middle of a major norovirus attack across the United States at this very moment. We aren’t getting up-to-the-minute details from the CDC because of government restrictions, but last month there were widespread reports of outbreaks.

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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