CHENNAI: Vijaya Sridhar* just recovered from a painful Urinary Tract Infection (UTI). “The bathroom is filthy,” said Vijaya, a class 9 student who studies at a private school in the city. “I used to restrict my water intake to ensure I never went to the restroom in school. The days that I could not hold it in any longer, I used the bathroom but otherwise from 8.30 am to 4:30 pm when I got back home, I would not use the bathroom.”
When she visited the doctor, Vijaya was asked to increase her water intake and be more forgiving to her bladder on days when she drank a lot of water.
While it is commonly known that one is susceptible to pick up a UTI from using an unhygienic restroom, what is less known is that not using a restroom at all and keeping one’s bladder full for prolonged periods too can cause UTIs.
UTI is a common bacterial infection known to affect the different parts of the urinary tract and the occurrence is found in both males and females. Despite the fact that both the genders are susceptible to the infection, women are most vulnerable due to their anatomy and reproductive physiology. The infection is usually caused as a consequence of the bacterial invasion of the urinary tract including the lower and the upper urinary tract.
“It used to get so hot that on some days I would drink a lot of water but when I saw that it was almost time to go home, I used to just wait for the bell to ring so that I could rush back home,” she said.
While the absence of a restroom in schools forces a number of girls to drop out, even in schools and colleges that provide restrooms, the toilets are often in an abysmal condition leading to many girls and women refraining from using.
Doctors warn that this leads to a number of other health issues among young girls and women. “UTIs are very common among young school-going girls,” said Dr Sai Meenakshi, a gynaecologist in the city. “It is something that needs to change because once the bladder is full, one must use the restroom and relieve oneself. In not doing so, these children are putting a lot of burden on the bladder that can lead to it stretching which is extremely harmful. There is no point in cleaning the tables and chairs in classrooms if the restrooms are dirty. It is essential for homemakers too to learn the importance of a dry bathroom.” Doctors did concede that there were young boys too who fell prey to UTIs mainly due to lack of clean public restrooms.
In the case of girls, not being able to use a restroom gets more complex during their period. Doctors advise that girls should change their pads every three or four hours, however, many school and college girls said they waited to get home before changing their pads because they felt the bathrooms were dirty.
“Even on heavy flow days, I don't change my pad till I get home,” said Rajeshwari V, who is studying in a well-known college in the city. “The college restrooms are so smelly that I don't even feel like entering them. I would rather wear the same pad through the day than go into that bathroom and change it.”
This is extremely harmful, doctors said, as it can lead to a number of other issues like fungal infections. According to a study published in 2015 in the Annals of Medical and Health Sciences Research journal, the negative perceptions of public and staff toilets is well-spread among students, and girls are fearful of “catching germs from the toilet seat.”
“Public toilets which are available are usually, unhygienic hence in response to the lack of hygienic toilet provision, girls are likely to ‘hold on’ resulting in urine (and pathogen) retention, leading in Urinary Tract Infection (UTI),” the study said.
Various other studies suggest that there is a strong association between UTI and improper perineal washing technique, use of unsanitary pads, malnutrition, vaginal discharge and pinworm infestation.
“While I do see the number of complaints from older women for UTIs because of not using the bathroom being less, the number of children who come in with these complaints is still very high. The school management should ensure that they have clean bathrooms because this is particularly essential for schoolgirls who have reached puberty,” said Dr A Shaji Bharath.
However, this is not a phenomenon that is restricted only to school- and college-going children. Even for people in taxing professions like law and order, for instance, access to clean restrooms is limited.
“Many a time, we have to stand stationed in one place for hours together,” said Rekha M, a police constable. “There are no restrooms around and so we don't drink too much water either. It gets very hard. Even the makeshift restrooms that are sometimes constructed for political rallies and so on are so terrible that we'd rather not use them.”
Doctors warned that in very serious cases, it can even lead to kidney failure. “Reverse flow of urine can also damage the kidney over a period of time. Girls can carry a bottle of Savlon, add some water to it and wash the toilet seat if required. It is also important to drink water in sips rather than gulping it down. That will help to remain hydrated and reduce the need to frequent the restroom too. Children can also look at drinking water with lime, peppermint, tulsi or even ginger because they are natural anti-bacterial agents and help the body remain alkaline rather than acidic,” said general physician, Dr Sunita Maithreya.
While UTIs are far more common among women than men, there is one segment of the male population that is prone to picking up UTIs — elderly men.
“After the age of 50, this is a very common issue in men. Further, those who do not empty their bladders often are prone to catching infection too. In addition to these causes, diabetics, those with cancer, poor personal hygiene and those on steroids can easily pick up UTIs because their immune system is weak. Even structure urethra and renal stones can make elderly men more prone to picking up a UTI,” said Dr VS Natarajan, founder of the Dr VS Natarajan Geriatric Foundation.
He said that the best way for elderly men to keep UTIs at bay was to empty the bladder every two hours. Further, he stressed the importance of good personal hygiene and also keeping sugar levels well within check. If men notice any symptoms of prostate enlargement, he said medical and surgical treatment should be sought.
*Name changed