is it good for a man to pee sitting down

Is it Normal for Men to Pee Sitting Down?

An innocent question from one guy's wife led to thousands of men explaining themselves.

An innocent question posed on Reddit garnered more than 5,000 replies yesterday, and also poked holes in the popular myth that all guys pee standing up.

“If his piss forks, which some men do, then he probably does it to avoid a mess,” one commenter suggested, with others bringing up the point that urine can often fork after sex, due to dried semen in the urethra.

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The truth is, there are a number of reasons why men might opt to sit down—and research suggests that more guys do it than might be expected.

Data—admittedly, data from 2007 , but hey, this isn't studied too often—shows that 42 percent of married men sit down to urinate, presumably due to spousal pressure. “Show me an Aimer who says he never misses the toilet and I’ll show you a liar,” says Chris, who runs a blog with his wife Kim .

“Not only that, but even perfectly aimed streams are messy. They create a fine mist of piss that missed. Though it can be invisible to the naked eye, the nose can’t miss the smell. And it accumulates, creating sticky floors and yellow porcelain. Nobody wants to deal with this, and we shouldn’t have to.”

Those stats will almost certainly have risen in the intervening decade, thanks to the proliferation of smartphones and social media. Who among us hasn’t indulged in a scroll through Instagram while in the bathroom?

More importantly, there could even be health benefits: A 2014 study by Leiden University Medical Centre in the Netherlands found that sitting down helps men with prostate problems such as lower urinary tract disease to urinate with greater force, as the sitting position encourages a “more favorable urodynamic profile.”

Of course, we also have to remember that for many older men, men with disabilities, and trans men, standing up to pee simply isn’t a given. In other words, there’s not just one way to have a number one.

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To Pee Standing Or Sitting Down: Which Is Healthier For Men?

“Real men pee standing up,” is something most men have grown up hearing. While the statement itself reeks of gender stereotyping and baseless machismo, the real question is whether it is healthier for men to pee standing or sitting. If you thought that there was some cool, evolutionary perspective behind why most men pee standing up, well, you’re wrong. Historically speaking, there’s no real reason why men began to pee standing up while women squatted. It’s probably just because it was quicker and easier. Or probably just because they could!

Today, there are enough people vouching for both sides of the argument. So, let’s delve right in and find out why sitting down is a healthier and a more hygienic position for men to pee in.

It Prevents The Spread Of Infectious Diseases

If the nasty splatter that you leave behind doesn’t convince you to change your position, think of all the infections you’re spreading! Although urine is sterile when it enters your body, it’s not so sterile when it accumulates on the toilet seat. Pee droplets can spread germs that cause the common cold, flu, rubella, and meningococcal disease, among others. 1 If you’re sick, you might spread your infection to the person who uses the restroom after you. And if you’re using a public stall, you might be at the receiving end of these infections.

It Might Be Healthier For Your Bladder

If you’re affected by lower urinary tract symptoms (or LUTS), you might want to sit down for this. The signs of LUTS include an urgent and frequent feeling of needing to pee, weak or poorly directed stream of urine, and retention of urine in the bladder even after urinating. 2 Studies suggest that sitting down to pee may improve prostate health. It relaxes the bladder, empties your bladder of urine, improves urine flow, and reduces LUTS. 3 4

For healthy men, however, the position does not matter.

It May Improve Your Sex Life

Some experts claim that by improving your prostate health, sitting down to pee also enhances your performance in bed. While this hypothesis hasn’t been clinically proven, it does have some merit. Both prostate problems and LUTS are linked with sexual dysfunction in men 5 6 and since peeing sitting down can deal with these to some extent, it spells good news for men’s sex life too.

On a lighter note, it can enhance sex life in other ways – a clean toilet seat is an aphrodisiac to women, haven’t you heard?

It’s More Comfortable

[pullquote]If you’re thinking “who pees sitting down,” or “why should I?”

• Most Asian men prefer to pee sitting down.
• One-third of the male population frequently sits down to pee.
• One hundred percent of all women hate seeing pee puddles that you leave on their toilet seat.[/pullquote]

Sitting down to pee can be more comfortable, especially when you also have to take a dump. We all know how the john awakens the reader in you who suddenly wants to know how to use the shampoo bottle. So, sit down, begin reading the label behind that bottle, and finish the performance at your own pace. While you’re at it, you could also take your phone in and finish typing out that important work email. And who doesn’t want to kill two birds with the same stone?

It Reduces The Janitor’s Work

Unless you’re highly skilled in the art of aiming, it’s definitely more hygienic to sit down and pee. Even on your best days, can you really assert without doubt that you’re piddling right into the bowl? Most men seem to agree upon the fact that there’s no way a man can piss directly into the bowl every single time. And if you’re not wiping the toilet seat clean post the deed, it’s better to just sit down.

So, unless it’s a urinal that we’re talking about, sitting down to pee is probably better for you (and us). Nobody wants to be greeted with pee as soon as they enter the restroom. If you feel that you “just can’t do it sitting”, we understand but only as long as you use toilet paper, and while you are at it, put down the toilet seat!

Your Doubts Answered

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Should Men Pee Sitting Down?

The best method of taking a leak is a subject of debate among people with penises., nur ibrahim, published sep 26, 2022.

Sitting, standing, squatting, there are many ways to urinate, especially if you have a penis. But what is the best way? It really depends on your preference – and aim . But sitting down to pee has also been found to have medical benefits for certain people according to a 2014 study . 

A non-medical reason to sit down while peeing mainly has to do with hygiene – there is less chance of splashing urine all over the toilet seat or on the ground. There is also less likelihood of splash-back: when splatter bounces out of the bowl, onto the floor, pants, seat, etc. 

Even if you still want to pee standing up, scientists at Brigham Young University's Splash Lab suggested the optimal position for taking a leak, whether at a urinal or toilet seat. For a toilet, they suggested not aiming for the water, and also argued, "Better yet, take a seat." For a urinal, they concluded, "Closer is cleaner," and going at it from an angle, pointing down and to the side rather than aiming straight. You can see the diagram of their findings here . 

The 2014 study by researchers in the Department of Urology, Leiden University Medical Center, titled "Urinating Standing versus Sitting: Position Is of Influence in Men with Prostate Enlargement," found that sitting was medically beneficial to patients with Lower Urinary Tract Symptoms (LUTS) or different urinary problems in men that include intermittent urine streams, the sudden urge to pee, straining to pee, and more. 

The study concluded :

In this report we've looked at the influences of changing urination posture on the maximum urine flow, the time spent voiding and the amount of urine that is left in the bladder. We conclude that the sitting posture is the best position for men with urination problems, e.g. due to an enlarged prostate to urinate in, whereas no difference was found in healthy men. This is clinically important, because residual urine may result in complications such as cystitis and bladder stones. 

They also pointed out that their study, "does not translate into a medically preferable position for healthy males to urinate in."

"Men may start peeing sitting if their prostates are large and they need to help relax the pelvic muscles in an effort to help push the urine out," Jamin Brahmbhatt, a urologist and professor at the University of Central Florida College of Medicine, told Fatherly .

Standing to pee isn't always an option for people with disabilities, older men, and trans people. Ultimately, there isn't just one medically preferable way to do it, but there certainly is a way to make it less messy. 

de Jong, Ype et al. "Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis." PloS one vol. 9,7 e101320. 22 Jul. 2014, doi:10.1371/journal.pone.0101320. Accessed 26 Sept. 2022.

"5 Reasons Why Guys Should Pee Sitting Down." Thrillist, https://www.thrillist.com/news/nation/health-benefits-of-peeing-sitting-down-for-men. Accessed 26 Sept. 2022.

Dutton, Judy. "Scientific Tips for Peeing Like a Proper Gentleman." Wired. www.wired.com, https://www.wired.com/2014/06/urinal-dynamics/. Accessed 26 Sept. 2022.

"Is It Normal for Guys to Pee Sitting Down?" Men's Health, 13 Feb. 2019, https://www.menshealth.com/health/a26322744/is-it-normal-for-men-to-pee-sitting-down/. Accessed 26 Sept. 2022.

"Lower Urinary Tract Symptoms (LUTS)." University of Miami Health System. https://umiamihealth.org/en/treatments-and-services/urology/lower-urinary-tract-symptoms-(luts)-. Accessed 26 Sept. 2022.

"Men Need to Stop Standing Up When They Pee." Fatherly, https://www.fatherly.com/health/why-you-should-sit-down-to-pee. Accessed 26 Sept. 2022.

By Nur Ibrahim

Nur Nasreen Ibrahim is a reporter with experience working in television, international news coverage, fact checking, and creative writing.

Article Tags

It’s Healthier For Some Men To Sit Down When They Pee, Urologists Say

Posted: March 23, 2023 | Last updated: September 23, 2023

Men might want to consider sitting down when they pee — not because it’s one of the few moments of the day they can rest, but because it might be better for them. For older men with prostate problems, in particular, sitting down to pee could help them empty their bladders more effectively and reduce the risks of cysts and other health complications.

“Men may start peeing sitting if their prostates are large and they need to help relax the pelvic muscles in an effort to help push the urine out,” says Jamin Brahmbhatt, M.D. , a urologist and professor at the University of Central Florida College of Medicine.

Scientists aren’t exactly sure what causes an enlarged prostate gland, or benign prostate hypertrophy. But the likelihood of having one increases with age. Hormones have something to do with it, as men who had their testicles removed at a young age due to cancer do not have these problems, research shows. And when men with enlarged prostates have their testicles removed, their prostates tend to shrink.

Fortunately, an enlarged prostate is thought to be a natural part of aging and not necessarily a precursor to prostate cancer . Unfortunately, however, all that pressure from the prostate can increase the risk of bladder cysts, infections, and discomfort or difficulty while urinating. But when men with enlarged prostates pee sitting down, studies suggest they’re able to empty their bladders more quickly and effectively, which can reduce some of these problems.

Still, once your prostate is so troublesome that you’re sitting down just to pee effectively, you’re probably overdue for an appointment with your urologist. “It should be a reason to talk to your doctor or urologist about medical or surgical options,” Brahmbhatt says. This is especially the case if you’re under the age of 50. Young men shouldn’t be experiencing age-related prostate enlargement or trouble peeing. If you’re noticing changes in stream, or blood in your urine, seek immediate medical attention.

For younger, healthy men, sitting to pee probably won’t provide any benefit to their prostates one way or another. But it still might be a more hygienic option. Physicists have found that peeing standing up significantly increases the velocity of the stream and potential for backsplash, amounting to less hygienic, more bacteria-filled bathrooms. So if men aren’t going to pee sitting down for their prostates, they can do it for their partners. It will be good practice for their 50th birthdays.

“There are men that have bad aim and can soak the toilet with splatters of urine,” Brahmbhatt says. “Sitting and urinating on the toilet does increase your odds of making sure the urine is actually going down the drain.”

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Does it matter if you sit or stand to pee? And what about peeing in the shower?

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Do you sit or stand? That is the question about 7,000 men around the world have been asked about how they pee.

We’ll get to their answers soon. But the media interest that followed prompted one urologist to recommend some men sit to urinate, especially as they age.

What is the best way to urinate? Does that apply to women? We research the bladder and lower urinary tract . Here’s what the evidence says.

Read more: Health Check: what can your doctor tell from your urine?

Do most men stand to pee?

The survey found men in different countries differ in how they pee.

In Germany, 40% of men report sitting while they pee every time, as do 25% of Australians. In the United States, it’s just 10%.

Some people even view standing to pee as “superior” and sitting inferior. In German, the word Sitzpinkler means someone who sits to pee; it can also be used as an insult.

But habits may be changing. In Australia, for instance, the survey found younger men are more likely to sit down than older men. Some 36% of younger men sit down most or every time, while only 20% of men aged 55 and older report doing so.

So should men stand or sit?

When it doesn’t matter

In general, the literature suggests it doesn’t matter if a healthy man stands or sits when he pees.

Regardless of the position, there seems to be no difference in the time taken to pee, the flow rate, and how completely the bladder is emptied.

So long as there are no urinary concerns, men are free to choose their preferred position. If you chose to stand, just be sure to aim well.

Read more: Is urine sterile? Do urine 'therapies' work? Experts debunk common pee myths

When it can

Recommendations for sitting or standing become less clear for men with lower urinary tract symptoms . These include issues such as having poor stream (for example, a dribble rather than a steady flow of urine), straining while urinating or feeling the bladder has not completely emptied after finishing.

For some of these men sitting is preferred to help increase the flow and empty the bladder. Others find the same relief comes from standing.

For men with benign prostatic hyperplasia , otherwise known as an enlarged prostate, there is evidence standing may help fully empty the bladder. But this advice may not work for all. That’s because how much the prostate has become enlarged, and the impact this has on urinary flow, can be different between people.

As standing or sitting can matter, for some men, it’s worth having a chat with your doctor about what’s best for you.

Read more: Do men really take longer to poo?

How about women?

The structure of the female pelvic area is quite different to males, as it accommodates the vagina, uterus and reproductive structures. And the female anatomy is just not designed to pee standing up. So, making a habit of, say, peeing in the shower, is not advised.

Females do not have a prostate, which helps supports the male bladder while standing. This lack of support can place extra strain on the bladder region when not sitting down, making it harder for the bladder to fully empty.

The structure of the pelvic floor muscles are also different in females. For females, it is particularly important to allow these muscles to fully relax to allow the urine to flow freely.

If the bladder doesn’t empty fully , it can lead to increased infections, bladder stones, and even impact kidney health in the long term.

Even with one leg up, the pelvic floor does not rest properly, so the bladder may not be able to fully empty. As such, sitting down is usually the best position to let these muscles relax.

Standing and “hovering” over the loo may keep these muscles slightly constricted, making it hard to fully empty the bladder. A contracted pelvic floor can also cause the urine to spray more than usual, which is why you might often find drops of urine on a toilet seat after someone before you has tried to hover over it.

How about peeing in the shower?

Peeing in the shower not only makes it harder for your muscles to relax, it can be unhygienic. It might also cause an association between water and urination, leading to issues where hearing water might make you need to rush to the bathroom.

So, for both males and females, peeing in the shower is a clear no-no.

If you or someone you know has bladder or bowel issues, the Continence Foundation of Australia has online resources and a helpline (1800 33 00 66).

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Urologist Explains Why You Should Teach Your Boys to Pee Sitting Down

June 29, 2022

Peeing standing up is the go-to for most men, but one expert has warned it might be better for you to take a seat .

If you usually urinate in a vertical position, you’ll know it has its benefits. This includes not having to sit on a questionable public toilet seat and generally being able to pee wherever. Doctors in the Netherlands however found that sitting down could be beneficial, especially for men who suffer with prostate issues. This is because it allows them to pee with greater force than they would be able to if they were stood up. If you stand up, they said, your muscles are stimulated in your pelvis and spine.

Writing in the 2014 study, the experts said people have been sitting and squatting to urinate for many years. Doctors added that when people sit, pelvic and hip muscles are relaxed, making urination easier. Associate Clinical Professor at the UCLA Department of Urology. Dr Jesse N. Mills said that sitting down is also a better option for men who might struggle to stand up for long periods of time.

“A lot of guys sit to pee if they can’t fully evacuate their bladder.

“When you sit down, you can use your abdominal muscles more, and you get your last few squirts out and feel like you’ve emptied better,” he told Thrillist.

However Dr Mills added the research doesn’t mean everyone now needs to take a seat when it’s time to pee. He explained that as long as you feel your bladder has emptied, then you are fine to urinate in either position. If you’re struggling to get that empty feeling then you should seek medical attention. You may not realise that your bladder is failing to empty properly every time you use the toilet.

Prof Stergios Stelios Doumouchtsis, a consultant obstetrician and gynaecologist previously said this could be down to an underlying cause.

“If the bladder is not emptying properly, it may cause stasis of urine [also known as urinary retention] and result in infections or bladder stones.

“Because infections can result in sepsis, or kidney infections, if you have symptoms of incomplete bladder emptying, it needs to be checked by a specialist.” Symptoms include a slow stream of urine, straining to urinate, intermittent stream, double or multiple voids in a sequence and taking a while for urination to start. 

The NHS says people who are unable to do this can end up with bladder stones. The experts explained that urine is produced by your kidneys and made up of water mixed with waste products that the kidneys remove from your blood.

“One of the waste products is urea, which is made up of nitrogen and carbon.

“If any urine remains in your bladder, the chemicals in urea will stick together and form crystals.

“Over time, the crystals will harden and form bladder stones,” guidance states.

There are some conditions that mean you might not be able to fully empty your bladder, such as damaged nerves and prostate enlargement. If the bladder isn’t emptied, urine can build up and lead to pressure in the kidneys. In turn this can cause the kidneys to fail which can be dangerous and result in lasting damage.

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Should Men Sit Down to Pee?

By meghan holohan | oct 15, 2013.

When Viggo Hansen, a county counselor from the Left Party in Sormland, Sweden, tried passing a law that required that men sit down to pee when using the public bathrooms, his motion caused a flood of reactions. Hansen argued when men sit down to pee it is better for public health because it reduces the splatter around the toilets and stops the spread of disease. Hansen is one of many—including the head of the environmental protection agency in Taiwan, Stephen Shen, who also tried mandating such an order—that believe errant urine is bad for public health. They argue that droplets of urine spread disease. But just how scientifically sound are these arguments? Is it actually better for men to sit down and pee?

“Urine is actually sterile,” says Benjamin Davies, an associate professor of urology at the University of Pittsburgh. “There is no bacteria in it. You can drink urine.” (Though he's not advocating that anyone does take a swig of urine.)

So puddles of urine might smell bad and look gross, but they won’t cause disease. But Hansen has another argument: Hansen claims that men who pee while sitting will fully empty their bladders, which is better for their prostates—and means they'll experience a longer, healthier sex life.

But again, Hansen's claims are totally off the mark. "This is total bullsh**," Davies says. "There is no relationship between voiding and sex life. I haven’t the slightest idea why it would improve your prostate. If you are a normal male your prostate muscles relax while you urinate.”

Bottom line: Completely healthy men experience no benefit by sitting to urinate instead of standing. Some conditions might mean it is easier for a man to fully empty his bladder if he sits down, but for the vast majority there is no difference between sitting and standing. However, some cultures prefer to sit rather than stand—almost half of all Japanese men sit to urinate.

Davies believes that sitting is a cultural or psychological preference, not a health issue. “If you are tired," he says, "go ahead and sit.”

🚽 Men: Sit down to pee, it’s better for the prostate (2023)

As most guys know and do, we stand to pee …And of course, women sit and squat to pee. However, did you know that sitting to pee can actually be good for your health?

Yup, sitting to pee is good for your prostate and it’s also less messy.

This is especially important if you’re over the age of 45 or 50 and are starting to have some prostate growth…

Of course, if you’re going to a public bathroom… It’s just best to stand and pee.

However, when you’re at home or in a private bathroom, you may consider taking a little break and sitting when you pee.

In fact, a global study showed that 40% of German men always sit to pee and 22% do so “ most ” of the time.

About 25% of Sweden and Australian men also always sit to pee.

In a 2020 study, almost 70% of Japanese men said they sit to pee.

Why It’s Better To Sit Down To Pee

Anyway, there are clinical benefits to sitting when peeing and it’s more specifically having to do with prostate and bladder health .

When you sit down to pee, you’re able to empty your bladder faster and more effectively . You’ll actually use your abdominal muscles more to get those last few squirts out and you’ll feel like you’ve emptied the bladder better.

On the other hand, when you stand to pee, you activate muscles in your pelvis and spine to help you stand… so things are a little more tense around your bladder area and it’s not as easy as sitting.

However, when you sit, everything is completely relaxed , and thus, urinating is easier and faster .

Lastly, when you sit, the aim is better and you’re not going to get pee all over the place. Something your girlfriend or wife would definitely be appreciative of.

This is especially true in the middle of the night when you’re sleeping and have to get up to pee and you don’t want to turn on the lights.

This is the time I always sit to pee. It’s just easier, faster and cleaner .

And if you’re concerned about prostate health, I have lots of great resources and videos for you. Take a look and implement some today.

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Peeing standing up is the go-to for most men, but one expert has warned it might be better for you to take a seat.

If you usually urinate in a vertical position, you’ll know it has its benefits.

This includes not having to sit on a questionable public toilet seat and generally being able to pee wherever.

Doctors in the  Netherlands  however found that sitting down could be beneficial, especially for men who suffer with  prostate issues .

This is because it allows them to pee with greater force than they would be able to if they were stood up.

If you stand up, they said, your muscles are stimulated in your pelvis and spine.

Writing in the 2014 study, the experts said people have been sitting and squatting to urinate for many years.

Doctors added that when people sit, pelvic and hip muscles are relaxed, making urination easier.

Associate Clinical Professor at the UCLA Department of Urology. Dr Jesse N. Mills said that sitting down is also a better option for men who might struggle to stand up for long periods of time.

“A lot of guys sit to pee if they can’t fully evacuate their bladder.

“When you sit down, you can use your abdominal muscles more, and you get your last few squirts out and feel like you’ve emptied better,” he told  Thrillist .

However Dr Mills added the research doesn’t mean everyone now needs to take a seat when it’s time to pee.

He explained that as long as you feel your bladder has emptied, then you are fine to urinate in either position.

If you’re struggling to get that empty feeling then you should seek medical attention.

You may not realise that your bladder is  failing to empty  properly every time you use the toilet.

Prof Stergios Stelios Doumouchtsis , a consultant obstetrician and gynaecologist previously said this could be down to an underlying cause.

“If the bladder is not emptying properly, it may cause stasis of urine [also known as urinary retention] and result in infections or bladder stones.

“Because infections can result in sepsis, or kidney infections, if you have symptoms of incomplete bladder emptying, it needs to be checked by a specialist.”

Symptoms include a slow stream of urine, straining to urinate, intermittent stream, double or multiple voids in a sequence and taking a while for urination to start. 

The  NHS  says people who are unable to do this can end up with bladder stones.

The experts explained that urine is produced by your kidneys and made up of water mixed with waste products that the kidneys remove from your blood.

“One of the waste products is urea, which is made up of nitrogen and carbon.

“If any urine remains in your bladder, the chemicals in urea will stick together and form crystals.

“Over time, the crystals will harden and form bladder stones,”  guidance states .

There are some conditions that mean you might not be able to fully empty your bladder, such as damaged nerves and prostate enlargement.

If the bladder isn’t emptied, urine can build up and lead to pressure in the kidneys.

In turn this can cause the kidneys to fail which can be dangerous and result in lasting damage.

This story originally appeared on The Sun and was reproduced here with permission.

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Home » Health News » Men should pee sitting down to avoid prostate-linked health issues, doctor says

Men should pee sitting down to avoid prostate-linked health issues, doctor says

Many men would agree that being able to pee standing up is one of the many perks of being a man. It’s quick, easy, and offers the ability of being able to pee almost anywhere.

When out and about, men don’t necessarily need to find a secluded bush and get someone to stand watch, all they need is a decent tree or wall and just pee away.

But that luxury may come with some risks, and many urologists will argue that it's high time men learned to pee sitting down or suffer the long term health consequences.

READ MORE: Changing your pooping posture could help bowel health – and give you an hour back per week

No, that isn’t referring to the harm a man might face from his angry wife having a go at him for peeing on the toilet seat, although that might explain why 42 percent of married men are already peeing while sitting down, according to a 2007 study.

Rather, sitting down to pee is recommended for men, especially those with prostate problems, as it allows them to pee with greater force, a 2014 study by Leiden University Medical Centre in the Netherlands found.

Standing up to pee, on the other hand, stimulates muscles in the lower abdomen, pelvis and spine that make urination more difficult, the study noted.

Speaking to the Thrillist , Dr Jesse N. Mills, an Associate Clinical Professor at the UCLA Department of Urology, says: “Sitting down is a better option for men with prostate conditions or men who just can’t stand up for a long time.

“A lot of guys sit to pee if they can’t fully evacuate their bladder. When you sit down, you can use your abdominal muscles more, and you get your last few squirts out and feel like you’ve emptied better.”

Further studies have found that peeing sitting down also helps men who have larger prostates lower the risk of other complications associated with it, such as bladder stones and cysts.

However, sitting down to pee isn’t necessarily an absolute must for all men at all times, Dr Mills explains.

He says: “As long as a guy feels like he’s emptying his bladder standing or sitting, he’s in good shape.

“If not, then he should see a urologist to make sure there's not a blockage that makes him need to sit down and generate that abdominal contraction to empty.”

Nonetheless, if only to avoid the wrath of a furious wife, it might be better to always pee sitting down when at home at the very least.

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The splashback scandal: should all men sit down to urinate?

The Germans call them Sitzpinklers , and more and more men are now taking the weight off their feet in the bathroom. It could be good for their health – and help protect the family toothbrushes

I n German, there’s a word for one. Of course there is. In German, there’s a word for everything. But this is an especially excellent word: Sitz pinkler . You can probably guess what it means even if you don’t speak German: a Sitz pinkler is a man who sits to pee.

We have German friends: Flora, Till, their two boys. Flora confirms that the males in the house are encouraged to sit at home, as is common throughout the country. Some German bathrooms have amusing signs reminding men to sit. There’s even a device called a WC-Geist – toilet ghost – that lives under the seat and, when the seat is lifted, orders you to sit down. You can get a WC-Geist with the voice of Angela Merkel. Germany is a brilliant country.

Wait, though. Because, Flora says, Sitzpinkler is used in a negative way to imply unmasculine behaviour. Something like “wuss” in English. In 2015, a court in Düsseldorf ruled in favour of a man’s right to urinate while standing when his landlord sought financial compensation for urine damage to the marble bathroom floor. Stand up for your rights, literally. Not all German men are happy to sit.

Not all British ones, either. There is no reliable data (come on, YouGov, get on it). A straw poll of my male friends, mostly in their 50s, reveals the majority – about 70% – to be standers. Their reasons: they’ve always stood; men stand, women sit; why would they; no, of course they don’t pee on the floor (we’ll come back to that – in short, they’re lying).

I may need to change my friends. My editor Chris is half my age; this article stems from a conversation he had with his friends in the pub. Then he asked Twitter and got about 400 responses, with just over half saying they are sitters. Chris has better followers than I have friends, though he is a stander. I may need to change my editor.

There is a poll from 2020 showing that 70% of men in Japan sit. Five years previously the figure was 51%. It seems the world – Japan at least – is changing. To clarify, we are talking about inside the home. Out and about, where there are urinals and queues, it’s a whole different world and a whole different article. I should probably also say that though I’ve been talking about men, it applies to anyone with a penis.

T ime to get personal: I am, I confess, a Sitz pinkler . No, not confess, I am proud to sitzpinkle . It wasn’t a sudden epiphany – a urethra moment, if you like – but things change as you age. Maybe your aim isn’t what it once was, flow rates decrease, bladders take longer to empty, you need more time, sitting is more comfortable and you can check Twitter while you’re at it (remember what happened once when you did that standing).

For some men it can also be healthier . In 2014, researchers from the department of urology at Leiden University Medical Center investigated how body position during urination affects “voiding time”, maximum flow rate and “post-void residual volume”. They concluded that sitting has a “more favourable urodynamic profile”, allowing the bladder to empty faster and more completely. For men with lower urinary tract symptoms (Luts), for example, caused by an enlarged prostate – “the sitting voiding position is preferable to the standing”.

We don’t have Luts, say my unreconstructed friends, our prostates are perfect. I think mine is OK, too. (Are we sure, though? We should get them checked.) There are other reasons to sit. Going back to that poor Düsseldorf landlord … Actually, no need, it’s hard to feel sorry for a Düsseldorf landlord with a marble floor and I can just look at my own bathroom floor. I have two sons who have been reluctant to adopt the Sitzpinkler approach. And the floor – not marble, admittedly, but fake wood laminate – is often disgusting. Awash. They piss all over it.

Boys will be boys; we’re grown men, say my friends. We may be getting on a bit but our aim is still true – we’re Robin Hood, snipers of the bathroom, the Jackal … Well, first of all, I don’t believe you. And second of all, even if you hit the bullseye every time, that’s not good enough. Once again we turn to science, this time to an American professor of mechanical engineering, Tadd Truscott. A while back, using a urination simulator and high-speed cameras, he and a colleague did an investigation into “splashback” caused by urination, which he presented at the 66th annual meeting of the American Physical Society’s Division of Fluid Dynamics in 2013.

Truscott now lives in Saudi Arabia and works at the King Abdullah University of Science and Technology, but I catch up with him by phone in a Japanese ski resort where – he admits – he has been investigating the fluid dynamics of a few sakes after a tough day on the slopes. Still, he manages to explain what happens when urine leaves the penile urethra. “A stream comes out but after between 3 and 6 inches it starts to break up into droplets, and that’s where most of the problem comes from. The droplets start to impinge on each other, then you get what we call satellite droplets and they splash off at very large angles and this is what causes it to splash on to your toothbrush …”

Yep, he said toothbrush, and maybe not just your toothbrush. It will depend on how big your bathroom is. “If your toothbrush is 3 or 4 metres away you’re probably fine; if it’s just 1 or 2 metres, that’s not good.”

That’s just from the falling stream. There’s also splashback from the wee hitting the surface of the water. “Water tends to have a large splash when droplets hit it from that height. That means a lot of splash can come out of the toilet. I was actually telling a friend tonight that when you pee into a toilet like that, you tend to pee on your toothbrush.”

Interesting topic for apres-ski chitchat. But this splash is ickier still, and possibly dangerous. “Pee in general is very sterile. It’s not really a big deal if it lands on your toothbrush and you brush your teeth then. But droplets are quite capable of harbouring bacteria, and in the toilet this is a problem if you’ve just used the restroom for something else. There can be faeces in there – urea is a wonderful harbinger of E coli growth – so later in the day it might not be safe to use your toothbrush.”

Stop saying toothbrush! Anyway, surely that’s enough to convert any remaining sceptics. For any splashback deniers or cavemen, I’ve got great role models too. Larry David, for starters. “It’s more comfortable when you get up in the middle of the night; you don’t have to turn the light on and wake up, and you get to read,” he says, in episode four of season four of Curb Your Enthusiasm . Lionel Messi, probably the greatest footballer of all time, admitted to sitting to pee on a Uruguayan TV show called Por La Camiseta (For the T-shirt). Messi by name, not so in the bathroom. Still not macho enough for you? Well, guess who he was talking to, also a confirmed Sitz pinkler (there is no Spanish word, we’ll have to stick to German). Only Luis Suárez – not only a brilliant football player but also a cannibal .

Speaking of cannibals and cavemen, I’m wondering what our ancestors and nearest relatives did and do. Ben Garrod , a professor of evolutionary biology at the University of East Anglia and a primate expert, tells me: “Gorillas and chimps just pee where they are. They might be walking through the forest and have a bit of a pee, they might be sitting in a tree eating figs and they’ll just pee beneath them and woe betide anyone beneath – I’ve been on the receiving end of that. We’re the only primate that is bipedal so we’re in a bit of a brave new world when it comes to peeing.”

Great apes don’t seem to mark territory. We are not olfactory-based like dogs or cats, which scent-mark. “That’s a sort of urban myth, that men pee standing up so they can pee higher and it’s all a bit of an evolutionary pissing contest,” says Garrod. “Sounds nice, sounds plausible, but there’s no evidence for it whatsoever.”

It’s thought that one of the reasons for humans becoming upright was to see further across the savannah. I wonder if standing to pee could be useful in spotting predators, and if squatting might make us more vulnerable. “I guess if I stand up while I pee I’ve got more of a chance of spotting a sabre-toothed cat running towards me, or someone from a different community who might wish me harm,” Garrod concedes. Again, sounds nice but no evidence. “It might be a nice addendum to my evolutionary journey but it hasn’t driven my evolution as a species.” From an evolutionary point of view, then, it doesn’t really matter how we pee. Garrod has worked with many tribes and communities around the world. “And most of us … I don’t usually make a conscious effort to watch other people pee, but working in forests with other blokes you often see people having a quick wee … usually it’s standing up. As far as I know there aren’t any massive cultural differences.”

He’s talking about in the forest, away from rules and etiquette and porcelain, that’s the baseline. Of course I stand up in the forest, too. And if there’s a cliff, I’ll piss over that, while pummelling my chest. What does Prof Garrod do at home in Norwich, though? “I am a stander,” he says, almost apologetically. “Though I am also a runner. Occasionally, with very tired legs, I will indulge in a sit …” Too bad. I was going to ask him to be my friend, to replace some of the recently dumped.

Back to Tadd Truscott (no toothbrush talk, promise) – surely he sits? “I do, unless it’s a particularly gross bathroom, then I’m not going to sit on the toilet.” He has two boys and two girls: “The whole house sits down to pee.” He even has advice on how men should do it. “You can sort of aim for the side. If you don’t hear much it’s probably a stream, if it’s a little noisier it’s probably droplets and that’s when things get worse. But remember, by sitting you’re protecting the whole space with your bottom.”

Happy days, though doesn’t that mean droplets on your bum? “It’s good to bathe every day,” he adds, helpfully. Thanks, Tadd, we can be friends.

He is also currently skiing in Japan, remember. “They have these wonderful toilets with all the sprays and things for your rear end. I think men probably sit here because it’s comfortable. Right now it’s cold, you come in and the seat’s heated! OK! I’m going to sit down.”

Sounds lovely, and I’m thinking it may be the way to solve my own bathroom horror show: carrot, not stick. A lovely heated seat on a cold day – that’s got to be a better way than being shouted at by the ghost of Angela Merkel.

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Urinating Standing versus Sitting: Position Is of Influence in Men with Prostate Enlargement. A Systematic Review and Meta-Analysis

Ype de jong.

1 Department of Urology, Leiden University Medical Center (LUMC), Leiden, the Netherlands

Johannes Henricus Francisca Maria Pinckaers

Robin marco ten brinck, augustinus aizo beent lycklama à nijeholt, olaf matthijs dekkers.

2 Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands

Analyzed the data: OD JHFMP. Wrote the paper: YDJ JHFMP RTB OD AABLAN.

Associated Data

It is suggested that the body posture during urination can influence urodynamic parameters in patients with Lower Urinary Tract Symptoms (LUTS) to an extent approaching pharmacological interventions. In this article, the influence of body position during micturition on maximum urinary flow rate (Qmax), voiding time (TQ) and post-void residual volume (PVR) in healthy males and patients with LUTS is analyzed by means of a systematic review and meta-analysis.

Evidence Acquisition

A systematic search was conducted in 14 medical databases. Studies comparing urodynamic parameters in standing versus sitting position were eligible for inclusion. Studies were stratified according to health status of included male participants: healthy individuals and patients with LUTS. Standardized mean differences for Qmax, TQ and PVR were pooled in a random effects model.

Eleven articles were included. In men with LUTS, a significantly lower PVR (−24.96 ml; 95%CI −48.70 to −1.23) was shown in sitting position compared to standing. In accordance, Qmax was increased (1.23 ml/s; 95%CI −1.02 to 3.48), and TQ was decreased (−0.62 s; 95%CI −1.66 to 0.42) in sitting position, although these differences did not reach statistical significance. In healthy men, Qmax (0.18 ml/s; 95% CI −1.67 to 2.02), TQ (0.49 s; 95%CI −3.30 to 4.27) and PVR (0.43 ml; 95%CI −0.79 to 1,65) were similar in sitting and standing position.

For healthy men, no difference is found in any of the urodynamic parameters. In patients with LUTS, the sitting position is linked with an improved urodynamic profile.

Introduction

Ever since men had the choice to urinate either standing or sitting, the optimal voiding position has been a topic of discussion. The introduction of the modern flush toilet during the 19th century [1] may have intensified this discussion. Geographically, voiding positions differ. In most Western countries the standing position is common, while in Eastern and Asian countries the sitting and crouching positions are more common [2] – [8] . The first medical description of the influence of voiding position on bladder health dates from 1883, when the English medical officer Raglan W. Barnes [9] stated his concerns about the high prevalence of bladder stones in the Indian population, which he linked to their voiding position. However, Barnes is likely to be biased as he perceived himself morally superior to the native population, which can be concluded from his last statement: “as the march of civilisation proceeds in India, he [the native] may become morally and physically more upright.”

Barnes' hypothesis that the voiding position could influence urodynamic parameters to such an extent that changes therein can lead to urological diseases is intriguing and may be relevant for the most prevalent group of urologic diseases: Lower Urinary Tract Symptoms (LUTS). Benign Prostate Hyperplasia (BPH), a nonmalignant enlargement of the prostate with an age-related prevalence of up to 90%, most commonly causes LUTS in males [10] . The urodynamic profile of LUTS is characterized by a decreased maximum urinary flow rate (Qmax, ml/s), an increased voiding time (TQ, s) and post-void residual volume (PVR, ml), which may result in complaints and complications like cystitis or bladder stones. Standard clinical management of LUTS therefore aims to decrease PVR and TQ while increasing Qmax [5] , [8] , [11] – [15] , which can be reached pharmacologically with use of alpha-blockers and 5α-reductase inhibitors. This form of treatment however only shows modest alleviation of the symptoms [16] . An alternative treatment is surgery, for example in the form of transurethral resection of the prostate (TURP) [13] , [17] .

Since Barnes propagated his hypothesis, only a handful of studies have investigated the effects of voiding posture on urodynamic parameters by comparing the standing versus the sitting position. One author [18] suggested that changing one's voiding position may yield in an effect that can approach the effects of standard pharmaceutical management. However, due to the heterogeneity of results in these studies, no conclusion can be drawn without performing a meta-analysis. In this article, we summarize the evidence of an easy lifestyle change in addition to the standard therapy: changing ones voiding position in order to achieve a beneficial urodynamic profile. This meta-analysis aims to analyze the influence of body position on urodynamic parameters in both healthy males and male patients with LUTS.

We have conducted this review in accordance with the PRISMA guidelines [19] ; this checklist is provided in Table S1 . No protocol was defined beforehand.

Data sources and search strategy

To identify eligible studies, we applied a systematic literature search to 14 electronic databases: PubMed, Embase (OVID-version), PubMed Central, Web of Science, the Cochrane Library, CINAHL, PsycINFO, Academic Search Premier, ScienceDirect, SpringerLink, Wiley Online Library, Lippincott-Williams&Wilkins ( divO@slanruoJ Full Text), Highwire, and Google Scholar. A non-systematic, manual search was conducted in the WHO International Clinical Trials Registry Platform. The searches were performed on April 25th, 2013.

Search queries were created in cooperation with a medical librarian. We combined synonyms for “position”, “standing”, and “sitting” with synonyms for “urinating”, “urodynamics”, and “urination disorders”. The search was restricted to human studies and male subjects. No restrictions were set to language or publication year. Complete search queries for each database are shown in Appendix S2. Non-English articles were translated if necessary. Only studies published as full-text articles were considered for meta-analysis. In order to obtain more information or full-text articles, affiliated authors were contacted via email or telephone.

Study selection

Search results from different databases were combined and duplicates were removed using EndNote for Windows (version X6, Thomson Reuters, 2012) and Reference Manager (version 12, Thomson Reuters 2008). We considered studies to be eligible for inclusion if they compared standing voiding position with the sitting in males and measured at least one of the three outcome measures of interest: Qmax, TQ, and PVR. Studies in healthy men as well as in men with clinical LUTS were considered for inclusion. Studies with conditions other than LUTS or with participants under the age of 18 were not eligible. Likewise, articles with no analyzable data or unavailability of the full text were not included.

Three reviewers (DJ, P, and TB) independently reviewed all citations and selected eligible studies. In three meetings, consensus was sequentially reached based on title, abstract, and full-text. In case of disagreement, an expert in the field of urology was consulted (LaN). A snowball search of the reference lists of included articles was performed independently; eligibility was assessed using the same method.

Data extraction and risk of bias assessment

A data extraction form was designed which was adapted after piloting. Data were extracted independently; inconsistencies in the data were discussed and resolved. We extracted data on: study design, year of publication, sample size, patient characteristics (age and morbidity), studied urodynamic parameters (Qmax, TQ, and PVR), and urination positions. Relevant missing information was requested from the study authors.

We assessed the studies on their risk of bias concerning variables known to be of influence in urodynamic research. Studies were considered to harbor a high risk of bias in the case of (1) inadequate exposure determination, (2) inadequate assessment of outcomes and (3) inadequate standardization of voiding conditions. For adequate exposure determination, studies should have assessed the severity of LUTS by a standardized questionnaire (International Prostate Symptom Score, IPSS [20] ). As all included studies used a one-group (cross-over) study design, differences in baseline characteristics were not an issue. For adequate outcome assessment, total bladder capacity should have been measured and the technique used for the assessment of urodynamic parameters should have been described. To ensure a valid comparison between standing and voiding position, voiding conditions should have been standardized and the following variables should have been taken into account: the influences of (1) the setting for the measurements (in a private, non-observed clinical setting, in an observed clinical setting or at home [21] ), (2) the circadian rhythm [22] , (3) the time since last ejaculation [23] and (4) defecation [5] , [18] , (5) changes in intra-abdominal pressure [24] , [25] , and (6) the accustomed voiding position [6] , [8] , [11] , [14] , [18] , [26] – [28] on urodynamics.

Statistical analysis

The primary outcomes of our study were pooled mean differences of Qmax, TQ, and PVR. As all studies reported these outcomes on the same scale, no standardization was necessary. We aimed to extract mean differences and accompanying standard errors based on paired t-tests. If these data were not provided, we extracted the mean and standard error for sitting and standing position separately. Subsequently, we calculated a mean difference with a combined standard error according to the Cochrane Handbook for Systematic Reviews of Interventions using a correlation coefficient of 0.5 [29] , accounting for the fact that data were paired. Four articles [3] , [7] , [30] , [31] were assumed to report standard errors instead of standard deviations and data were subsequently converted accordingly by multiplying the value with the square root of number of participants. One study [32] reported interquartile ranges which were converted to standard deviations by multiplying the value by 0.68, hereby assuming normal distribution.

Study results were stratified by the included population (healthy participants and participants with LUTS). Mean differences were pooled in a random effects model. I 2 statistics were calculated as a measure of between-study heterogeneity. Analysis of the data was performed with STATA (version 12.0, STATA Corp).

Overall, 2352 publications were retrieved through our search strategies. A flowchart of the study selection is presented in figure 1 . After removal of duplicates, 1962 publications were independently assessed for eligibility. A total of 69 abstracts were identified, 27 relevant publications were assessed in full-text for eligibility. Eleven studies [3] , [7] , [8] , [14] , [18] , [26] , [28] , [30] – [33] fulfilled the inclusion criteria and were included in the meta-analysis ( table 1 ). A snowball search of the references in these 11 articles did not yield additional articles. One author [18] sent his database for further analysis.

Study characteristics

Included studies were published between 1999 and 2012. All studies used a cross-over design. A total of 800 participants were included, with the number of participants in individual studies ranging from 20 to 200. In five studies [3] , [7] , [26] , [31] , [33] only healthy men were included, in four studies [8] , [14] , [18] , [28] only patients with LUTS, and in two studies [30] , [32] both groups were studied. For studies with healthy participants all seven [3] , [7] , [26] , [30] – [33] investigated Qmax, four measured TQ [3] , [7] , [26] , [31] , and four studies [3] , [26] , [30] , [31] measured PVR. For studies with LUTS patients, all six [8] , [14] , [18] , [28] , [30] , [32] investigated Qmax, four studies [14] , [18] , [28] , [32] measured TQ, and five studies [8] , [14] , [28] , [30] , [32] measured PVR. The study characteristics are shown in table 1 .

Risk of bias assessment

Risk of bias assessment is presented in table 2 . Of the six LUTS studies, two [14] , [30] defined the severity of LUTS by means of the IPSS and clinical examination, two [8] , [28] by clinical examination only, one [18] by IPSS only, whereas one study [32] did not describe the severity at all. With regard to standardization of measurements, seven studies [3] , [7] , [14] , [28] , [30] , [31] , [33] , used a private, non-observed clinical setting, one [18] instructed to measure at home, and three studies [8] , [26] , [32] did not describe the setting in which measurements took place. The following factors of influence were accounted for: circadian rhythm in three studies [3] , [14] , [26] , time since last ejaculation in none and time since last defecation in one [18] of the studies, intra-abdominal pressure in six studies [3] , [8] , [28] , [30] , [31] , [33] , and the accustomed position in two studies [18] , [26] . With regard to outcome assessment, of eight [3] , [8] , [14] , [26] , [28] , [30] – [32] studies which measured PVR only two [8] , [28] measured total bladder capacity. All studies defined their methods for the other urodynamic measurements.

Meta-analysis of urodynamic parameters in healthy individuals

In healthy participants, no clear differences were found in any of the measured parameters for sitting versus standing position. Pooled mean differences from a random effects model were 0.18 ml/s (95% CI −1.67 to 2.02) for maximum urinary flow rate (Qmax), 0.49 s (95% CI −3.30 to 4.27) for voiding time (TQ) and 0.43 ml (95% CI −0.79 to 1.65) for post-void residual volume (PVR). Accompanying I 2 statistics were 82% (p<0.001), 87% (p<0.001) and 31% (p = 0.229) respectively. These results are graphically depicted in figures 2 – 4 .

Meta-analysis of urodynamic parameters in patients with LUTS

For patients with LUTS, post-void residual volume (PVR) was found to be significantly decreased in the sitting position: −24.96 ml (95% CI −48.70 to −1.23) for PVR. In accordance Qmax was increased (1.23 ml/s; 95% CI −1.02 to 3.48), and TQ was reduced (−0.62 s; 95% CI −1.66 to 0.42) in sitting position, although these differences did not reach statistical significance. Accompanying I 2 statistics were 90% (p<0.001), 98% (p<0.001), and 0% (p = 0.557) respectively. These results are graphically depicted in figures 2 – 4 .

This study aims to determine the influence of body position during voiding on urodynamic parameters for both healthy males and men with LUTS by summarizing the scientific evidence for either the sitting or standing position. We found that in patients with LUTS the sitting position is associated with a trend towards a more favorable urodynamic profile: Qmax is increased, PVR is lowered and time spent urinating is shorter than in the standing position. In healthy males however, the results of our meta-analysis show no posture-related differences in any of the measured urodynamic parameters. We therefore conclude that for healthy men the debate on the standing versus sitting voiding posture cannot be settled by urodynamic arguments alone.

To our knowledge, this is the first systematic review and meta-analysis to assess urodynamics and posture-related changes. Three articles [3] , [26] , [34] provided a summarization in the form of a literature review, however a meta-analysis is of greater value in evidence-based clinical decision making. Apart from demonstrating a trend towards an improved urodynamic profile in LUTS patients, we unfortunately proved the accompanying heterogeneity as well. Consequently, some care should be taken in the interpretation of the results. Statistical analysis in order to identify the exact cause of the heterogeneity remains difficult in such a small number of studies. An arbitrary minimum number of ten studies is needed to perform funnel plot analysis and Egger tests to objectify publication bias. A lower number of studies results in diminished power and subsequently is prone to misinterpretation [35] , [36] . It is not possible to pool our data in such a way that this requirement is met. For this reason, no additional tests to objectify bias of published studies were performed.

A possible explanation for heterogeneity in the data is the lack of standardization in the measurements of urodynamics. Influences of ejaculation [23] , defecation [5] , [18] , intra-abdominal pressure [24] , [25] and the setting in which measurements take place [21] affect urodynamics. Apart from the lack of standardization in measurements, the demography of the investigated population should be adequately described; for example, severity of LUTS was not properly objectified in all studies, allowing the possibility of inappropriate comparison. Another possible influencing factor is the accustomed voiding position or location: it is suggested that the mere change to a new position or urinating in a clinical research setting reflects negatively on urodynamic parameters, although no calculable data to perform a meta-analysis on this subject was presented [6] , [8] , [11] , [14] , [18] , [26] – [28] . As seen in the risk of bias assessment, many studies did not take these influences into account. Methodological bias seems of lesser importance in this study. LUTS progresses relatively slowly, long-term follow-up is not required and a carry-over effect of the intervention (changing one's position) seems not likely. Therefore, the use of a cross-over design is an adequate study design, not prone to result in methodological bias [29] , [37] .

Several explanations for the described trend towards a better urodynamic profile in the sitting position are found in the included literature. The typical patients with LUTS/BPH are elderly males who are more prone to fall. It is suggested that the fear of falling while standing can result in involuntary contractions of the pelvic muscles to stabilize one's position [38] . Contraction of the pelvic muscles is related to a disturbed urinary flow [8] ; relaxation of these muscles is better achieved by urinating in a sitting position and by supporting the feet in a comfortable position [39] – [41] . Also, muscle tension in the medial and anterior compartments of the hip is decreased in the sitting position [7] . These muscles, if actively contracted, increase the contractility of the pelvic floor muscles. Furthermore, contraction of the pelvic floor musculature inhibits the activity of the detrusor urinae muscle [42] . Contraction of the detrusor is needed for urination, consequently increased activity of the pelvic floor musculature negatively influences urodynamics [5] , [8] , [25] , [28] .

Besides muscle contraction, urination in the sitting position is also associated with defecation. During sitting and especially during defecation, the intra-abdominal pressure rises, influencing urodynamics [5] , [28] . Furthermore, innervation of the anal sphincter and the pelvic floor musculature both arise from the sacral plexus (S2–4). It is suggested that the contraction of the anal sphincter is associated with an increased activity of the pelvic floor muscles due to this common innervation [5] , [7] . The desire not to lose defecation or flatus in standing position, especially in public conveniences, can thus lead to increased activity of the pelvic floor musculature and consequently impaired micturition.

The urodynamic profile of LUTS patients is one of decreased Qmax and increased TQ and PVR, a pattern that is known to increase the risk of certain urological complications, e.g. cystitis and bladder stones. We found a decrease in PVR and TQ, while Qmax was increased in the sitting position. Extrapolating this trend, the alleviation of this impaired urodynamic profile in this group may possibly reduce complaints as well as the incidence of cystitis and bladder stones [5] , [8] , [11] – [14] . The increase in maximum urinary flow rate (Qmax) of 1.23 ml/s may seem low. However, compared to existing medical treatments of LUTS, the increase is relevant despite not reaching statistical significance. A meta-analysis of the efficacy of four alpha-1 blockers (Alfuzosin, Tamsulosin, Terazosin, and Doxazosin) found an increase in Qmax by 1.32 ml/sec (95% CI: 1.07 to 1.57) [16] . We did not find meta-analyses on the influence of these pharmaceutics on TQ or PVR. It is intriguing that the effect of changing to a sitting voiding posture – a simple intervention without any serious side effects – approaches the effect of conventional pharmacological treatment of LUTS. However, it should not be regarded as the sole therapy instead of pharmacological treatment, perhaps both interventions combined could have a synergistic effect on urodynamics in the management of LUTS.

In patients with LUTS, an improved urodynamic profile approaching the effect of alpha-blockers is found in the sitting position. Incorporating the positive effect of this voiding position in the management of LUTS could have a synergistic effect on improvement of urodynamics in this group of patients. As no effect of changing voiding position in healthy males was found, our study does not translate into a medically preferable position for healthy males to urinate in.

Patient summary

In this report we've looked at the influences of changing urination posture on the maximum urine flow, the time spent voiding and the amount of urine that is left in the bladder. We conclude that the sitting posture is the best position for men with urination problems, e.g. due to an enlarged prostate to urinate in, whereas no difference was found in healthy men. This is clinically important, because residual urine may result in complications such as cystitis and bladder stones.

Take home messages

• Comparing the standing with the sitting position, for patients with Lower Urinary Tract Symptoms (LUTS) the sitting voiding position is preferable to the standing. However, there is medically no superior posture for healthy men to urinate in.
• The positive influence of urinating in the sitting position approaches the effects of standard pharmacological therapy in LUTS patients.

Supporting Information

PRISMA checklist.

Appendix S1

Search strategies.

Acknowledgments

We wish to thank the medical librarian Jan Schoones (Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands) for his efforts with developing the search queries and his involvement in the progress of this study.

Funding Statement

Expenses for the retrieval of included articles were being paid for by the department of Urology of the Leiden University Medical Center (LUMC). No other forms of funding or financial compensation was provided to the authors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Guys Who Sit Down to Pee: Why?

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Men, You Should Be Sitting Down To Pee For Your Health

Lifestyle Editor

Men, grab a seat, take a load off. No – we’re not talking about having a rest on the sofa, we’re talking about sitting down the next time you head to the loo for a wee.

Let us explain. YouGov conducted a 13-country study on men’s peeing preferences internationally and it turns out just 24% of British men regularly partake in a sit down wee.

‘So what?’, you might ask. Well, it turns out there’s actually a whole host of health benefits you could be missing out on if you choose to stand when you urinate.

According to the data gathered by YouGov, British men are among the least likely to sit for a wee internationally, with 33% saying they ‘never’ do so.

Dr Jesse N. Mills, Associate Clinical Professor at the UCLA Department of Urology previously told Thrillist that sitting down to pee could help men empty their bladders.

“Sitting down is a better option for men with prostate conditions or men who just can’t stand up for a long time,” he explained.

“A lot of guys sit to pee if they can’t fully evacuate their bladder. When you sit down, you can use your abdominal muscles more, and you get your last few squirts out and feel like you’ve emptied better.”

Scientific research backs up Mills too. In 2014, researchers from the department of urology at Leiden University Medical Center discovered that sitting down to pee allowed men to empty their bladders faster and more effectively.

Another pro of a sit down pee is that you don’t have to worry about getting urine on the floor.

Mills said: “When you’re sitting you’ve got better aim. If you’re sitting in the right place, then chances are you will get it in the right place.”

So grab a seat the next time nature calls – your bladder and housemates will probably thank you for it.

Before You Go

Dayna McAlpine

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Should a man sit down to pee?

We all men stand up and pee, standing up to pee is often associated with men. Its fun to standing up to pee. Have you ever considered sitting down for pee? There are several health benefits of peeing sitting down for men. So today i am going to share the complete details on why all men should pee sitting down.

The research is done in 2007 mentioned that 42 per cent of a married man sat down to pee. In 2021, i can guarantee that these numbers are increased. Most men love to aim while they pee, other than aiming i don’t see any special benefit of standing up to pee. When you are drunk, you have to force yourself to aim your pee. To avoid the mess on the toilet seat, you have to ensure that your pee falls on the toilet commode and not on the floor. Here is the list of the 5 Most common urination mistakes that people do.

Michael S. Bardwell is a healthcare professional with a passion for advancing patient care and improving healthcare systems. With expertise in patient-centered care and a track record of implementing innovative solutions, he is a respected voice in the medical community. As a regular contributor to TAFMED.org, Bardwell shares his insights on healthcare topics and is committed to making a positive impact. When he’s not working, he enjoys spending time with family and giving back to the community through philanthropy.

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