DEAR DOCTOR,

I worry about my child’s use of toilets at school. Can she easily get an infection from them and how do I control that?

SUSAN

DEAR SUSAN, 

How old is your child? Did she ever suffer from UTI (urinary tract infection), any time till now?

Public toilets, particularly if not cleaned frequently and have large number of users, do harbour germs like E.coli, streptococci, and et cetera, which cause UTIs. But it is not that every time one uses a public toilet, they are bound to get a UTI. It is only due to physical contact with the contaminated surface (toilet seat in this case), that one can be infected, as germs can potentially enter the bladder via urethra, from the infected surface. More frequent the contact, longer the duration of contact, greater is the risk. 

The risk is more in females as they are vulnerable to urinary tract infections due to multiple reasons. Short length of the urethra (tube connecting bladder to exterior) in women makes it easy for infecting germs to travel and enter the urinary system via bladder. The vulnerability is further increased during puberty, menopause, during menstrual periods and pregnancy. Furthermore, sexual activity, specially unprotected sex also increases the susceptibility to UTIs, as well as other sexually transmitted infections, uncontrolled diabetes, prolonged or frequent use of steroids and other conditions which lower immunity, also make one vulnerable to UTIs. 

Once the urinary bladder is infected, one develops frequency of urination, creating the need to go to the toilet more frequently, which further increases exposure to the infecting microbes. Other symptoms of UTI include urgent need to urinate, burning pain during urination, pain over lower abdomen and back, with or without fever.

Urinary tract infections are easily diagnosed by the typical clinical symptoms and signs. It can be confirmed by microscopic examination of first morning sample of urine and is curable by suitable antibiotics.

There is nothing to be worried about. Encourage your daughter to drink more water. This helps to cleanse the bladder as frequent urination helps to flush out the microbes present in the system. Teach her to keep good pelvic hygiene during menses. Pelvic parts should be kept clean and dry always. If she has to use the school toilet, it is a good idea to clean the toilet seat by tissue or toilet paper, before use. Washing vagina after urination   and then washing both hands with soap and water, are hygienic measures that help prevent UTI. 

It is also important to keep immune system strong by a diet rich in proteins and antioxidants.

Dr. Rachna Pande is a specialist in internal medicine.

rachna212002@yahoo.co.uk