Sitting down to urinate can be healthier for men, especially as they age

In Germany, they call them “sitzpinklers” – a term designed to poke fun at their masculinity – but some doctors believe that men should not be quite so quick to deride the possible benefits of sitting down to pee.

Recent research from YouGov has illustrated that most males around the world overwhelmingly opt to stand whilst relieving themselves. Thirty-three per cent of British men are adamant that they would never consider sitting, with just 24 per cent saying that they often choose to do so. When questioned, men from nations like Mexico and Poland made it particularly clear that they would not be willing to sit.

According to Gerald Collins, a consultant urological surgeon at the Alexandra Hospital, which is part of Circle Health Group, male attitudes towards this have likely evolved as a matter of convenience and circumstance. “The bottom line is, if you're on a golf course, and you need to nip behind a tree, you can get away with doing that,” he says. “Whereas if you squat and drop your pants, it could be a much more awkward scenario.”

But in certain countries male willingness to contemplate sitting down has steadily become more, dare we say it, progressive. In 2020, a poll found that 70 per cent of Japanese men sit down to pee, up by an encouraging 19 per cent from 2015, when the same poll was taken. Ironically, despite the sitzpinkler slur, Germany actually topped the YouGov survey, followed by Australia and then Sweden. Forty per cent of German males say they sit down every time they go to the toilet, with only 10 per cent insisting that they would never succumb to sitzpinkling.

Hygiene concerns

A lot of the reasons for this trend are actually hygiene-related. Stern signs reminding men to sit down are commonplace in many German public lavatories, with standing to urinate viewed as antisocial behaviour. Rebellious German males may even find themselves being reprimanded by the disembodied voice of Angela Merkel, thanks to an innovation known as the WC-Geist, which sits underneath the toilet seat – and using the voice of a well-known public figure – orders the user to sit down when they attempt to lift it.

Perhaps our Teutonic friends are onto something. After all, when a couple of American engineering professors conducted an investigation into “splashback” – with the help of a urination simulator and high-speed cameras – they uncovered some frankly disturbing findings.

Collisions of urine droplets in the falling stream as well as the splash from striking the water in the toilet from a great height, could send your pee to all corners of your bathroom. Unless your toothbrush is at least three metres away from the toilet, it is likely to be in range. If there has recently been faeces in the toilet, this splashback could be sending pee droplets harbouring colonies of harmful E. coli bacteria across much of your bathroom.

Is sitting healthier for your bladder?

Dutch researchers at Leiden University Medical Centre have previously found that sitting down could be beneficial by making it easier for the bladder to empty faster and more completely.

This is because when you stand, the muscles in your pelvis and spine are activated, but they are completely relaxed when you sit, making urination far easier. “Sitting is probably the most efficient way of doing it,” says Collins.

According to Collins, sitting down to urinate can be more beneficial for men as they age, due to a condition known as benign prostatic hyperplasia (BPH) which affects the vast majority of men over time. The prevalence rises from 8 per cent of men in their 30s, to 80 per cent of men in their 80s.

It occurs when the prostate gland and surrounding tissue expands, obstructing the urethra - the tube which goes down from the bladder, through the prostate and into the penis – making urination more difficult. Men with BPH can develop bladder stones, urinary tract infections and even kidney infections if they do not empty their bladder fully.

“BPH occurs due to a change in the hormonal environment within the prostate, mainly from the early 40s onwards,” says Collins. “You get an increase in a certain breakdown product of testosterone which causes the prostate to increase its cell development and size. As a result of this, men start to find they can pee much better sitting down.”

However, urologists say that any men experiencing consistent problems in urinating should seek urgent medical attention. “I would encourage men who do have new or consistent problems urinating to seek medical support,” says Philip Charlesworth, consultant urologist at private healthcare provider GenesisCare. “I see this frequently in my role as a clinician and it could be a sign of an underlying cause as it’s a common symptom of prostate cancer.”