I have to tell you about the toilet bowl. Yes yes, the wc, the toilet. It turns out that, from my point of view, a very important cause of urinary tract infections is the use of sitting toilets (i.e. "normal" toilets). This is again related to pelvic floor statics, muscle relaxation and urethral alignment. It is important to know that our natural way of urinating, at least in the case of women, is squatting. This position favours relaxation of the pelvic floor and alignment of the bladder neck with the urethra. However, if we sit at 90° and, above all, if our knees are below our hips (which is the most common position when we sit on the toilet), this relaxation and alignment will not occur, and urination is likely to be dysfunctional. This is why Turkish toilets (the ones that are just a sort of hole in the floor), although they look disgusting, allow for a much more physiological way of urinating. As I know that most people don't have this type of toilet at home or at work, and there's no plan to call the plumber to install it, in future articles I'll give you a few useful tips on how to adopt the correct position.
Bibliography:
Rocca Rossetti S. Functional anatomy of pelvic floor. Arch Ital Urol Androl. 2016 Mar 31;88(1):28-37.
Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007 Apr;1101:266-96.
Easley DC, Abramowitch SD, Moalli PA. Female pelvic floor biomechanics: bridging the gap. Curr Opin Urol. 2017 May;27(3):262-267.
Rocca Rossetti S. Functional anatomy of pelvic floor. Arch Ital Urol Androl. 2016 Mar 31;88(1):28-37.
Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007 Apr;1101:266-96.
Easley DC, Abramowitch SD, Moalli PA. Female pelvic floor biomechanics: bridging the gap. Curr Opin Urol. 2017 May;27(3):262-267.
Sinha S. Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian J Urol. 2011 Oct;27(4):437-47.
Haifler M, Stav K. Dysfunctional voiding in adults. Isr Med Assoc J. 2013 May;15(5):247-51.
Minardi D, d’Anzeo G, Parri G, Polito M Jr, Piergallina M, et al. The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study. Urology. 2010 Jun;75(6):1299-304.
van Geen FJ, van de Wetering EHM, Nieuwhof-Leppink AJ, Klijn AJ, de Kort LMO. Dysfunctional voiding: exploring disease transition from childhood to adulthood. Urology. 2023 Apr 5:S0090-4295(23)00266-2.
Sinha S. Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian J Urol. 2011 Oct;27(4):437-47.
Haifler M, Stav K. Dysfunctional voiding in adults. Isr Med Assoc J. 2013 May;15(5):247-51.
Minardi D, d’Anzeo G, Parri G, Polito M Jr, Piergallina M, et al. The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study. Urology. 2010 Jun;75(6):1299-304.
Lee PJ, Kuo HC. High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections. Low Urin Tract Symptoms. 2020 Jan;12(1):33-40.
Haylen BT, Lee J, Husselbee S, Law M, Zhou J. Recurrent urinary tract infections in women with symptoms of pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Jul;20(7):837-42.
Lazaros T, Ioannis T, Vasileios S, Christina P, Michael S. The effect of pelvic floor muscle training in women with functional bladder outlet obstruction. Arch Gynecol Obstet. 2023 May;307(5):1489-1494.
Kao YL, Ou YC, Tsai KJ, Kuo HC. Predictive Factors for a Successful Treatment Outcome in Patients with Different Voiding Dysfunction Subtypes Who Received Urethral Sphincter Botulinum Injection. Toxins (Basel). 2022 Dec 15;14(12):877.
Jhang JF, Kuo HC. Recent advances in recurrent urinary tract infection from pathogenesis and biomarkers to prevention. Ci Ji Yi Xue Za Zhi. 2017 Jul-Sep;29(3):131-137.
van Geen FJ, van de Wetering EHM, Nieuwhof-Leppink AJ, Klijn AJ, de Kort LMO. Dysfunctional voiding: exploring disease transition from childhood to adulthood. Urology. 2023 Apr 5:S0090-4295(23)00266-2.
Sinha S. Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian J Urol. 2011 Oct;27(4):437-47.
Haifler M, Stav K. Dysfunctional voiding in adults. Isr Med Assoc J. 2013 May;15(5):247-51.
Minardi D, d’Anzeo G, Parri G, Polito M Jr, Piergallina M, et al. The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study. Urology. 2010 Jun;75(6):1299-304.
Lee PJ, Kuo HC. High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections. Low Urin Tract Symptoms. 2020 Jan;12(1):33-40.
Haylen BT, Lee J, Husselbee S, Law M, Zhou J. Recurrent urinary tract infections in women with symptoms of pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Jul;20(7):837-42.
Lazaros T, Ioannis T, Vasileios S, Christina P, Michael S. The effect of pelvic floor muscle training in women with functional bladder outlet obstruction. Arch Gynecol Obstet. 2023 May;307(5):1489-1494.
Kao YL, Ou YC, Tsai KJ, Kuo HC. Predictive Factors for a Successful Treatment Outcome in Patients with Different Voiding Dysfunction Subtypes Who Received Urethral Sphincter Botulinum Injection. Toxins (Basel). 2022 Dec 15;14(12):877.
Jhang JF, Kuo HC. Recent advances in recurrent urinary tract infection from pathogenesis and biomarkers to prevention. Ci Ji Yi Xue Za Zhi. 2017 Jul-Sep;29(3):131-137.
van Geen FJ, van de Wetering EHM, Nieuwhof-Leppink AJ, Klijn AJ, de Kort LMO. Dysfunctional voiding: exploring disease transition from childhood to adulthood. Urology. 2023 Apr 5:S0090-4295(23)00266-2.
Sinha S. Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian J Urol. 2011 Oct;27(4):437-47.
Haifler M, Stav K. Dysfunctional voiding in adults. Isr Med Assoc J. 2013 May;15(5):247-51.
Minardi D, d’Anzeo G, Parri G, Polito M Jr, Piergallina M, et al. The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study. Urology. 2010 Jun;75(6):1299-304.
Lee PJ, Kuo HC. High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections. Low Urin Tract Symptoms. 2020 Jan;12(1):33-40.
Haylen BT, Lee J, Husselbee S, Law M, Zhou J. Recurrent urinary tract infections in women with symptoms of pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Jul;20(7):837-42.
Lazaros T, Ioannis T, Vasileios S, Christina P, Michael S. The effect of pelvic floor muscle training in women with functional bladder outlet obstruction. Arch Gynecol Obstet. 2023 May;307(5):1489-1494.
Kao YL, Ou YC, Tsai KJ, Kuo HC. Predictive Factors for a Successful Treatment Outcome in Patients with Different Voiding Dysfunction Subtypes Who Received Urethral Sphincter Botulinum Injection. Toxins (Basel). 2022 Dec 15;14(12):877. Jhang JF, Kuo HC. Recent advances in recurrent urinary tract infection from pathogenesis and biomarkers to prevention. Ci Ji Yi Xue Za Zhi. 2017 Jul-Sep;29(3):131-137.