It’s not uncommon to hear from patients that in public restrooms, for hygiene reasons, they will squat or hover above the toilet during urination in order to avoid contact with the toilet seat. This may still be better than holding it in all day and becoming uncomfortable and then only urinating once at home.
Nevertheless, there are different postures that women adopt when urinating, whether sitting, hovering above the toilet (“semi-squatting”), or actually crouching/squatting on the toilet seat itself. In certain cultures in Asia, women are accustomed to squatting over a floor drain in public restrooms. In the West women will sit of course, but evidence shows that the best overall posture is sitting on the toilet edge, legs separated but supported, leaning forward a little, to help open and relax the pelvic floor.
If women hover above the toilet or do not relax completely to urinate, does this affect their ability to empty the bladder? Is it detrimental to not sit to urinate?
A group of 45 university students was asked to participate in a survey of how they posture themselves during urination, as well as measuring residual urine and urine flow rate. They were also asked why they do this. What was found?
When voiding in the semi-squatting posture (hovering), women had a longer delay time to initiate voiding than in either the sitting or crouching (squatting on the toilet seat) posture. This is likely explained due to better relaxation of the pelvic floor which occurs with sitting. Forward bending helps to relax the pelvic floor, especially with the legs supported, and thighs spread apart. It was found that sitting allowed a smoother void pattern than either semi-squatting or crouching, but residual urine volume and maximum flow rate were no different among the three postures in these young women.
In order to squat or hover over a toilet, women have to contract their gluteus maximus and adductor femoris muscles, which when the latter is contracted, has been associated with failure of the pelvic floor to relax, impeding urination.