Effect of bidet toilet use on preterm birth and vaginal flora in pregnant women

Decontamination effect of neutral electrolysed water for spray nozzles of electric warm-water bidet toilet seats in the healthcare setting

Background

There has been an increasing demand for more sanitary bidet seats in many healthcare settings because of concerns regarding potential contamination of the spray nozzles of warm-water bidet toilet seats. This contamination is thought to possibly serve as a reservoir for horizontal transmission of drug-resistant bacteria.

Aim

This study was performed to determine the optimal Pseudomonas aeruginosa decontamination conditions and verify the effectiveness of these decontamination conditions.

Methods

An in vitro test of rinsing with neutral electrolysed water was performed using seven strains of P. aeruginosa. The decontamination effect of the neutral electrolysed water was verified by a field test involving an analysis of the number of bacteria isolated from samples collected from the spray nozzles and the sprayed water from 10 toilet seats at the internal medicine ward of Juntendo University Hospital.

Findings

The in vitro test results showed that the decontamination effect of neutral electrolysed water tended to be higher with higher free chlorine concentrations in the nozzle-cleaning water and shorter intervals of rinsing. The field test involving the hospital ward toilets showed that routine physical cleaning was satisfactorily effective.

Conclusion

The study results suggest that the risk of horizontal transmission of drug-resistant bacteria via the use of bidet toilet seats in hospitals can be reduced by general cleaning and appropriate control of the free chlorine concentration in the nozzle-cleaning water.

The Effect of Bidet Use on Severity of Constipation and Quality of Life Among Pregnant Women

Background

Constipation is a common problem in pregnancy. This study aims to elucidate the efficacy of using a bidet before defecation to reduce the severity of constipation and improve the quality of life in pregnancy.

Methods

The sample consisted of an experimental group (n = 30) and a control group (n = 30), a total of 60 pregnant women. Randomization was performed using the pitch-and-toss method from simple probability randomization methods. The research data were collected using the Personal Information Form, the Constipation Assessment Scale for Pregnancy, and the Constipation Quality of Life Scale.

Results

There was a statistically significant difference between the pregnant women's mean scores on the Constipation Assessment Scale for Pregnancy due to the intervention of bidet before defecation. Although the members of the intervention group had severe constipation at first, they reported only "some problems" on defecation after the intervention. In addition, statistically significant improvements were observed in the intervention group via all subscales of the Constipation Quality of Life Scale except the satisfaction subscale.

Conclusion

Providing pregnant women with training on constipation and information about how to control constipation using a bidet is very important in terms of reducing the severity of constipation, enabling them to feel better and continue their daily activities, and thus to improve their quality of life.

Prospective study of bidet toilet use: Association of abnormal vaginal colonization and preterm birth in high-risk pregnant women

AIM

This study aimed to evaluate the association of bidet toilet use with abnormal vaginal microbial colonization and preterm birth (PTB) in high-risk pregnancies.

METHODS

This is a prospective cohort study of 208 women, who were admitted to a high-risk pregnancy unit, due to preterm labor, preterm premature rupture of the membrane, or short cervical length, in two tertiary hospitals from April 2015 to July 2017. Responses to a questionnaire about using bidet toilet and vaginal culture were obtained upon admission. Maternal baseline characteristics, vaginal culture results, and pregnancy and neonatal outcomes were compared between bidet toilet users and nonusers.

RESULTS

Among the 204 subjects, 67 (32.8%) women were identified as bidet toilet users. Overall, bidet toilet use was associated with a higher rate of abnormal vaginal microbial colonization, compared to the nonusers (60.7% vs 44.2%, P = 0.036). Notably, Escherichia coli colonization rate was significantly higher in bidet toilet users than nonusers (13.1% vs 3.3%, P = 0.023). Bidet toilet users had a significantly higher rate of PTB before 37 weeks of gestation, compared to the nonusers (87.3% vs 73.0%, P = 0.040).

CONCLUSION

Our study suggests that chronic use of a bidet toilet is associated with a higher rate of abnormal vaginal colonization by Gram-negative bacteria and PTB in high-risk pregnancies.

Microorganism levels in spray from warm-water bidet toilet seats: factors affecting total viable and heterotrophic plate counts, and examination of the fluctuations and origins of Pseudomonas aeruginosa

The objectives of this study were to conduct an appropriate microbial evaluation of warm-water bidet toilet seats. Health-related advantages and disadvantages have been associated with using warm-water bidet toilet seats, which are classified according to the tank type, including tanks equipped with reservoir water heaters and on-demand tankless systems equipped with an instantaneous water heater. However, related bacterial research is sparse. Here, we performed a long-term survey of the behavior of microorganisms (i.e., the total viable count (TVC), heterotrophic plate counts (HPCs), and Pseudomonas aeruginosa count) in a university campus. We also examined the differences between the tank and on-demand types, and the origins of P. aeruginosa. A low TVC (≤1/mL) in the spray waters from both on-demand and tank-type warm-water bidet toilet seats showed low bacterial contamination, although there was an increase in HPC, i.e., growth of biofilms, inside in the warm-water bidet toilet seats. When P. aeruginosa was detected in spray water over an extended duration, the P. aeruginosa origin was considered as either from feces or tap water. Collectively our findings demonstrate that hygienic safety of warm-water bidet toilet seats is being maintained overall.

Relationship between bidet toilet use and haemorrhoids and urogenital infections: a 3-year follow-up web survey

Given the growing use of electric bidet toilets in Japan and other countries, we assessed the relationship between bidet toilet use and haemorrhoids or urogenital infections. Data were collected using a web-based longitudinal survey. In total, 10 305 subjects randomly selected from panels of a Japanese website research company for the baseline survey in 2013 were asked about their frequency of bidet toilet use and receipt of a doctor's diagnosis or subjective symptom of haemorrhoids and urogenital infections. One- and three-year follow-up surveys were performed in 2014 and 2016, respectively, and information on newly diagnosed/experienced outcomes occurring during the follow-up period were collected. Cumulative incidence of haemorrhoids and urogenital infections was not significantly increased by habitual use of a bidet toilet. In men, more habitual users reported subjective symptoms of irritated skin around the anus, which were newly experienced during follow-up than non-habitual users (adjusted risk ratio 1.36 (95% confidence interval 1.06-1.75)). Further studies are needed to confirm this relationship. Several of the outcomes were significantly more prevalent in habitual users, but these results were probably explained by reverse causation.

Bidet toilet seats with warm-water tanks: residual chlorine, microbial community, and structural analyses

Despite the reported health-related advantages of the use of warm water in bidets, there are health-related disadvantages associated with the use of these toilet seats, and the bacterial research is sparse. We conducted a survey on the hygienic conditions of 127 warm-water bidet toilet seats in restrooms on a university campus. The spray water from the toilet seats had less residual chlorine than their tap water sources. However, the total viable microbial count was below the water-quality standard for tap water. In addition, the heat of the toilet seats' warm-water tanks caused heterotrophic bacteria in the source tap water to proliferate inside the nozzle pipes and the warm-water tanks. Escherichia coli was detected on the spray nozzles of about 5% of the toilet seats, indicating that the self-cleaning mechanism of the spray nozzles was largely functioning properly. However, Pseudomonas aeruginosa was detected on about 2% of the toilet seats. P. aeruginosa was found to remain for long durations in biofilms that formed inside warm-water tanks. Infection-prevention measures aimed at P. aeruginosa should receive full consideration when managing warm-water bidet toilet seats in hospitals in order to prevent opportunistic infections in intensive care units, hematology wards, and other hospital locations.