Should men sit down while urinating? Here's why it might be better than standing

Males need to consider their age if deciding between taking the weight off their feet or standing up when they have the urge to pee

Pic: iStock

It's thought to be better for the bladder, and it’s certainly far more hygienic, but despite this, men who choose to sit down to urinate still endure scorn and ridicule in many parts of the globe.

While public urinals exist in Germany, standing to urinate is widely viewed as antisocial behaviour and many of these lavatories are adorned with stern notices reminding users to sit down.

But German men who comply can find themselves openly mocked by the moniker “sitzpinklers” — a term intended to poke fun at their perceived lack of masculinity.

“There’s a stigma around a man sitting down to pee — no two ways about it,” Bray-based GP Dr Emmett Byrne says.

“Certainly, if you tell a group of mates, you’ll get slagged about it. That’s the world we live in, and Irish people will probably be worse than most for it.”

Perhaps for this very reason, there are currently no statistics regarding how many Irish men secretly choose to sit. 

But earlier this year, British market research company YouGov conducted the first comprehensive international survey into male bathroom habits.

Speaking to more than 7,000 men across 13 different countries, researchers identified considerable variations between nations. 

Despite the sitzpinkler jibe, Germans still top the list (40%) of those most likely to sit, followed by Australians (25%) and Swedes (22%). 

Men from Mexico and Poland were emphatic, with most saying they wouldn’t contemplate the idea under any circumstances.

Byrne suspects that men who choose to sit often have to do so secretly, which taps into the general awkwardness of the male bathroom experience. 

Contrary to female public toilets, male lavatories are rarely sociable spaces, with some men experiencing a common condition known as paruresis or “stage fright’, where the bladder neck automatically tightens to the extent that they cannot urinate.

Despite varying opinions about how men should use the toilet, research increasingly shows that sitting down can lower the risk of urinary tract infections (UTIs) in men and mitigate bladder problems, which generally increase with age.

“If you’re a healthy young man, it doesn’t matter if you sit or stand up,” consultant urologist at the Beacon Hospital in Dublin, Dr Michel De Wildt says.

“As men get older, they’re sometimes better at emptying the bladder when they sit.”

Prostate changes

Studies by Dutch researchers at Leiden University Medical Centre show how the male prostate changes with age. 

Stromal cells within the prostate convert testosterone into dihydrotestosterone (DHT), which is beneficial for male development.

However, in adulthood, DHT can drive excessive cell growth within the prostate, causing it to expand in size.

This condition is known as benign prostatic hyperplasia (BPH), affecting most men at some point in their lives.

Some 80% of men over 80 will have symptoms of BPH.

Byrne explains that as the prostate expands it eventually starts to press on the urethra, the tube which goes into the penis, enabling men to urinate. 

“So you get problems with the ability to pass urine, a weaker stream, and you start feeling the need to pee more frequently,” he says.

Sitting down can help those with an enlarged prostate because it relaxes the muscles in the pelvis and spine, making urinating easier.

“They’re contracted when you stand to keep you supported,” Byrne adds.

“And this means your ability to increase downward abdominal pressure is limited.

“But when you sit down, those muscles switch off and you can expel urine at a higher pressure. The need for straining reduces.”

It’s crucial men fully empty their bladder for health reasons. The main one is reducing the risk of cystitis or bladder inflammation.

Lingering stagnant urine in the bladder can also lead to the formation of bladder stones, which develop when the minerals in concentrated urine crystallise into hard lumps.

Because bacteria are attracted to dormant pools of liquid, this can also increase men’s vulnerability when it comes to developing UTIs.

This risk grows by 5% every year after the age of 65. “For a long period of time, urine stays at 37C, which makes it a great place for bacteria to grow,” De Wildt says.

Avoid splashback

Sitting down or sitzpinkling is not just about health.

A decade ago, American researcher Tadd Truscott investigated the phenomenon of urination splashback using a urine simulator and high-speed cameras.

His shocking findings revealed that when men pee from a height, the collisions between urine droplets in mid-air and the resulting splash when they hit the toilet water surface, can send them flying off at considerable angles.

According to his calculations, if your bathroom sink lies within two metres of the toilet, you are effectively urinating on your toothbrush, a potential health risk if the toilet is still harbouring E coli bacteria from a recent poo, as urine is an excellent carrier vehicle for E.coli.

“Obviously sitting down reduces the risk of splashing and soiling around the toilet area,” De Wildt says.

So, will sitzpinkling take on? In certain parts of the world, particularly Asia, it is becoming an expected practice, mainly for hygiene reasons. A 2020 survey found that 70% of Japanese men now sit down to pee, compared to just 19% in 2015.

Also, a Taiwanese environmental minister in 2012 advised all men in government buildings to sit down while urinating.

De Wildt says he now recommends the practice to all his male patients over a certain age who are experiencing bladder issues. However, he stops short of calling for it to become a broader behavioural trend in Ireland.

“It’s culture,” he says. “It’s proven that it might be a little bit better, but I don’t think we should judge men who are not sitting down.”

However, Byrne believes urinating while sitting should be more openly discussed.

“There is a stigma around it, and you will find guys who point blank just won’t do it. But if championed by doctors, it could become more accepted.”

As for those men who fear being mocked by their friends over their masculinity, Byrne says there’s no need to declare it. 

“If it helps with your health, I would certainly recommend doing it in private, although whether I told my friends or not would be a different story. The acceptance of it shouldn’t be an issue.”