Does it matter whether men pee sitting or standing? A randomized test has an answer: ScienceAlert

It’s a question many men may have asked themselves: should they pee sitting or standing?

The best option may not be the same for everyone.

Previous research suggests that men with enlarged prostates or other urinary problems may be better off sitting down.

Compared to standing, sitting may relax the pelvic floor and empty the bladder more completely.

But some studies suggest otherwise.

When men aged 50 or younger urinate while sitting, evidence suggests there may be a higher risk of post-void “dribbling.”

Now a randomized crossover trial has put the dilemma to the test.

The research was led by scientists from the Colombian Urology Research Group and the results are published in Neurourology and urodynamics.

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The crossover study included 52 healthy male volunteers aged 18 to 39 whose urination was monitored while sitting and standing.

About half the group was randomized to sit first, then stand, while the other half tried to stand, then sit.

Between each posture, participants took a break of at least 24 hours, as a “washout period.”

During a single pee, the researchers measured peak urine flow – or the speed at which urine comes out at its peak – as well as the total amount of urine expelled.

Sitting or standing does not seem to change the results.

“In healthy men, voiding posture did not significantly change peak urine flow or voided volume,” the team concluded.

The only difference was that it took healthy men a little longer to reach their fastest urine output while standing.

The difference was statistically significant, but it was based in part on a single outlier, and the researchers say it is unlikely to be clinically significant.

Ultimately, the trial results suggest that for healthy men, it doesn’t really matter how they go to the bathroom.

For some, this may be a relief.

In 2023, a global survey of more than 7,000 men found that in the United States, about 10% of men sit while peeing, although the rate is much higher in other countries.

In Germany, for example, 40 percent of men report sitting to urinate, yet the German word for this phenomenon is still sometimes used as an insult.

The decision to sit or stand to urinate can be heavily stigmatized in some cultures, and yet, based on the available literature, it doesn’t really seem to matter much in the end, beyond matters of hygiene.

“Regardless of position, there appears to be no difference in the time it takes to pee, the flow rate, and the degree to which the bladder is completely emptied,” bladder physiology researchers Christian Moro and Charlotte Phelps wrote for The Conversation in 2023.

“As long as there are no urinary concerns, men are free to choose their preferred position. If you choose to stand, just be sure to aim carefully.”

However, if urinary problems exist, the healthiest position may differ.

A 2020 survey, for example, found that among nearly 200 men, those who preferred to sit while peeing were more likely to report urinary tract symptoms.

This is not to say that sitting is causing the problems. Respondents might choose to sit because they are already experiencing urinary difficulty.

But is this decision useful?

After the age of 50, many men develop an enlarged prostate which can restrict their urethra and make it more difficult to urinate.

Urologist Rena Malik explained on YouTube that this can cause some people to have tightness when urinating or a weaker stream.

This can make it difficult to stand and aim.

“So it may be more convenient to sit for hygiene reasons,” Malik explained.

“But those are just theories,” she admitted.

For now, the results are uncertain.

In 2014, a meta-analysis of 11 studies found that sitting while urinating was associated with greater bladder emptying, but only in men with lower urinary tract symptoms.

Among healthy men, there were no differences related to posture.

The studies included in this review, however, tend to have small sample sizes and lack randomization of the standing/sitting sequence.

“And, importantly,” add the authors of the most recent study, “those who claim ‘no difference’ rarely perform formal equivalence analyses, leading to claims that go beyond what the data can support.”

This new research addresses some of these limitations.

“From a clinical point of view,” the authors conclude, micturition posture “appears to have little practical influence on flowmetry in healthy men.”

Healthy men, the team adds, can therefore “empty in their preferred position”.

Empty.

The research was published in Neurourology and urodynamics.