TikTok is filled with questionable medical advice, but sometimes a viral post comes up from a reputable source that makes you wonder if you should rethink a habit or adjust your behavior. Case in point: Alicia Jeffrey-Thomas, DPT, a pelvic floor physical therapist in Boston, Massachusetts addressed the topic of  “hovering” in a public bathroom, i.e., squatting over the toilet instead of sitting down to pee.

According to Dr. Jeffery-Thomas, hovering over the toilet isn’t great for your pelvic floor muscles—the group of bowl-shaped muscles near the bottom of your pelvis that help you release urine and stool, support your posture, and assist with sexual function. Why? When your bladder contracts to empty urine, your pelvic floor muscles relax so urine can flow, Dr. Jeffrey-Thomas explained in her video. “If we’re hovering, our pelvic floor isn’t going to relax, because we want to be able to do squats and not leak urine,” she said.

In order to pee when you’re squatting “you’re having to push past and bypass that normal mechanism,” Dr. Jeffrey-Thomas explained in the TikTok. “If we’re constantly messing with that relationship between your pelvic floor and your bladder, that can lead to difficulties with controlling urinary urgency, as well as issues with stress incontinence,” she continued. Meaning, you may end up being more likely to pee yourself in the future if you keep on squatting.

Telling people to sit on public toilet seats inspired colorful comments, and there was definitely some division on whether or not it’s actually safe to do it. So we spoke with an infectious disease doctor, a urologist, and a pelvic floor physical therapist to get their take on Dr. Jeffery-Thomas’ advice.

Infectious disease doctor: There’s no reason not to sit on a public toilet

It’s no secret that germs lurk on public toilet seats, but there’s a difference between germs being there and you actually getting sick from them, says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “You can go out and swab the toilet seat and see that there are germs on it, but we can do that with almost any part of the environment, including your phone, which you put up to your face,” Dr. Schaffner says.

“If an uncovered public toilet seat were a real hazard, we would all know about it and there would be public health messaging about it all the time,” he says. Still not convinced? Schaffner raises another interesting point: “Doctor’s offices and ERs are not flooded with people who have sores on their fannies or have acquired serious infections on their genitalia from public toilet seats.”

Urologist: Sitting down to pee is your best bet

David Kaufman, MD, director of Central Park Urology, a division of Maiden Lane Medical, says that squatting to avoid sitting on germs is understandable. Still, he says, it could cause issues for your bladder down the road.

“The act of squatting strongly engages and tenses the muscles of the groin and pelvic floor, which can potentially cause long-standing spasticity,” Dr. Kaufman says. That, he says, can lead to issues like being unable to fully empty your bladder, which can raise your risk of developing a UTI, and needing to go to the bathroom more often.

“Incomplete emptying of the bladder, if long-standing, can potentially damage the bladder’s detrusor muscle, exacerbating the problem,” Dr. Kaufman says.

Pelvic floor physical therapist: Take a seat

Ashley Rawlin, DPT, a doctor of physical therapy who specializes in women’s health issues at Origin, agrees with Dr. Jeffrey-Thomas. “When you ‘hover squat’ to avoid putting your tush on a public toilet seat, your pelvic floor muscles…automatically tense up to help support and balance your body,” she says. But, she points out, that’s “counterproductive” because you’re trying to release urine and empty your bladder.

“Repeated hover squatting in the bathroom can also confuse your body, so that you may feel like you have to pee more often,” Rawlins says. However, she notes that this is different from a full-on, knees-wide, deep squat like you’d do if you were peeing in the woods. That position allows your pelvic floor muscles to relax, she says. “Because your muscles can relax, your body isn’t getting any mixed signals,” Rawlins says.

Sitting down to pee on a public toilet seat when you’re concerned about germs

While you could simply plop down and do your thing, experts acknowledge that there can be an ‘ick factor’ involved with putting your bare butt on a public toilet seat. That’s why Dr. Schaffner says you’re more than fine to line the seat with toilet paper or use a disposable toilet seat cover if there happens to be one in the stall. If you want to be extra cautious, Dr. Kaufman suggests carrying antibacterial wipes in your bag. “Wipe down the seat and plot right down,” he says. “Then, relax and let it loose.”

And, if you get stuck without enough TP for the seat or just don’t feel like sitting down at any given moment, Rawlins says you’ll be OK. “Just don’t make it a habit,” she says. “It’s hovering repeatedly that leads to problems.”

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