Asking specialists (for women)
about the proper use of spray seat

Profile1990 Graduated Kitasato University
1998 Acquired Doctorate in Medicine
Worked at Kitasato University Hostpital and St. Luke's International Hospital until working at present position. Specializing in urinary disorders such as pelvic organ prolapse from pelvic floor disorders in women, overactive bladder, and surgical treatment of stress incontinence. Japanese Urological Association Specialist, Medical Advisor. Japanese Society for Dialysis Therapy Specialist.

Female urinary concerns and proper use of the spray seat(Dr. Asako Okawa of the Musashimurayama Hospital)

It’s possible that many people feel women are hesitant to visit urology clinics or doctors?
The truth is that they are not.
For women, cystitis *1 is a familiar ailment. Because this ailment is so familiar, they tend to think of it lightly and recurrence is common. It is because this ailment is so familiar, proper knowledge must be learned to take appropriate measures. This time we asked Dr. Asako Okawa, Chief of the Department of Urology of the Musashimurayama Hospital, about urology and particularly on what kind of ailment cystitis is as the main topic and preventative measures. *1 The cystitis here refers to the most common "acute cystitis". There are other types of cystitis such as "chronic cystitis" and "interstitial cystitis".

*The stated affiliation on this website is true at the time of publication.


Urology and Women

Q1.I'm afraid this question is rather basic but for urology, what ailment is the most common?

The most common is cancer of the kidney, bladder, and prostate.
Next would be prostatic hyperplasia, urinary disorders, and urinary tract stones. It is said that 1 in 6 men have had urinary track stones. For women, it is 1 in 15 so more than twice the number of men have this ailment than women.
When people think of urology, many associate it with sexually transmitted disease or STD, however only few people consult urologist for STD.

Q2.So it seems there are more men’s aliments. What about women’s ailments?

Overall, there are more male ailments however, there are ailments particular to women. Representative of this is pelvic organ prolapse. This is a disease where internal organs fall out through the vagina caused by weakened muscles. Acute cystitis is also also highly prevalent among women.

In the area called Urogynecology*2, (also known as Women's urology), we treat pelvic organ prolapse, urinary incontinence, frequent urination, and aliments covered by both urology and gynecology. For many women, giving birth to a child causes them to have urinary incontinence. But problems concerning the “bottom” are embarrassing and it is difficult to talk to people about and so many patients do not go to receive medical attention. However, urinary problems are a great concern that directly affects QOL (Quality of Life). In fact, there are people who give up ongoing out or traveling because of this. This area tries to improve this condition. This still a minor area but it is rapidly gaining a familiar presence.

*2:Urogynecology is a word coined for the combination of Urology and gynecology.


Women and cystitis

Q3.I'm afraid this question is rather basic but for urology, what ailment is the most common?

Cystitis a condition where the bladder gets infected with bacteria and becomes inflamed. When germs get into your throat, you get a cold, when germs enter the bladder, the result is cystitis. However, one germ will not immediately result in cystitis. As a guide, when there are 10 ,000/cc of bacteria, it is called cystitis. If the following symptoms are present, it is consider cystitis.

Could it be cystitis? "Cystitis checklist"

  • ・Pain felt at the end of urination
  • ・Cloudy urine (blood may also be present)
  • ・Cloudy urine (blood may also be present)
  • ・Lasting feeling for need to urinate (lingering urge even after urinating)

The urethra in women is shorter than in men (men have 14~18 cm as opposed to women who have on the average 3.5 cm) and the area where urine exits (the urethral opening) is closer to the anus and therefore it is thought that bacteria is more able to infect the bladder because of this. High fever does not usually accompany cystitis however, if the bacteria travels through the ureter and reaches the renal pelvis of the kidney, a high fever of 38℃ or higher can occur when inflamed. This ailment is called pyelonephritis and pain felt around the waist (because the kidney is located about the height of the waist) is another symptom. When this condition arises, you should immediately seek medical attention and visit a medial facility.

Q4.What should you do when you get cystitis?

First, you should drink lots of liquids and urinate frequently. If the symptoms continue for more than half a day, seek medical treatment. It may be difficult to visit a urologist from the start so in that case, visiting a physician or a gynecologist is alright. When visiting a urologist, only a normal urine test will be conducted so there is no need to be embarrassed. If there are no unusual circumstances, there will not be anything like a pelvic examination. The medical institution will prescribe an antibiotic to kill the bacteria and so it is important to completely drink it. Many patients will stop drinking the medication when they symptoms are alleviated. However, the bacteria may not have all been eliminated and doing so may cause a relapse so it is important to take the medication completely as prescribed. Also it is important to drink more liquids than you usually would and not wait for prolong periods when going to the toilet to urinate. I tell my patients to "flush out and clean out your bladder by urinating". The antibiotic will kill off the bacterial but curing the inflammation depends on your immune system so you must also take care of your physical condition. Also it is important to maintain cleanliness so sanitary napkins and sheets should not be used for extended periods and should be changed every 3 hours or so. Additionally, when using pads for urinary incontinence and such, always use those made specifically for that purpose. Some people will place tissue paper or toilet paper on sanitary napkins and only discard and replace the tissue paper or toilet paper when soiled, I do not recommend this. Urine pads are made similarly to paper diapers and it is made so that when moisture is absorbed, it will stay dry. However, paper will retain the moister and stay damp and cause skin rash in addition to creating an environment for bacteria to thrive. Therefore, if you have leakage of urine, use a urine pad with absorption that is just right and change them frequently.

Q5.Is it true that you will develop cystitis if you hold back on going to the toilet?

That is not true. The situation where cystitis may easily be contracted is if liquids are not taken and you only go to the toilet 2 to 3 times a day. The bladder can hold 350 to 450 cc of urine in an adult. Going to the toilet once every 4 to 5 hours is ideal. If you are able to maintain this routine, even if a small number of bacteria should enter your bladder, you will be able to wash them out before they multiply. Also I do not recommend extreme diets. When dieting, not only is the amount of food is reduced but also the amount of liquids consumed is also reduced in many cases and that also causes the amount of urine per day to be reduced. If it is “not possible to eat breakfast”, you should take 500cc of liquids in addition to what you would normally consume per meal.
However, it is not just a matter of urinating every 3 to 4 hours to be good. If you frequently go to the toilet even when no urine has accumulated in your bladder for an extended period, the capacity to hold urine of your bladder will slowly diminish and it will no longer be able to store an ample amount of urine. To achieve a satisfactory toilet lifestyle, it is important to routinely take ample liquids, store appropriate amount of urine in the bladder and use the toilet an appropriate number of times to prevent cystitis.


The proper way to clean your bottom and use a spray seat

Q6.Is there anything you should be careful of when using a spray seat when you have cystitis?

When you have contracted cystitis, your bladder is infected with bacteria. This may cause you to want to be more clean than usual and apply stronger water pressure or scrub harder but this should be avoided.

There is no special need to use a spray seat for the treatment of cystitis. If you really want to use one, avoid the area where urine exits (urethral opening) and after gently washing the surrounding with low pressure, dry the droplets gently. But instead of wiping when drying off the droplets, press gently to soak the moisture off. This method should also be used normally and not only for cystitis. pressure or scrub harder but this should be avoided.

Q7.What about use of a spray seat normally?

Basically, I think that people may use the spray seat often for bowel movement and during menstruation. I think that people using the spray seat for urination are in the minority. Speaking from the point of urologists, the bladder is inherently sterile and urine is clean. When only urinating, there is no need to be anxious. Of course, there is no problem using it when you feel concerned but when you do, use low water pressure to wash around the area and ensure to avoid aiming directly for where urine exits (urethral opening).

Q8.Thank you very much. Lastly, could you say a few word to women who are having concerns about their bottom?

It is difficult to talk about your bottom. What I recommend to women is to have a regular doctor, whether a gynecologist or physician. I think that if you have a regular physician, it would be a little easier to talk about your bottom and it is very effective for self -management. If it is a only a mild case of cystitis, even a physician can cure it and if necessary introduce you to a specialist so it will give you peace of mind if you have a doctor you can trust. However, if you are repeatedly having relapses of cystitis, you should see a urologist. Some people will choose a female doctor at a gynecology clinic but female doctors for urology are only about 3% and there around only about 300 female doctors nationwide and are few in numbers. It is important to appropriately visit a urologist instead of desperately searching for a female doctor.


10 Tactics for the prevention of "cystitis"

1.Consume appropriate amounts of liquids (1 to 2 L per day)2.Avoid extreme diets3.Avoid accumulation of stress and fatigue (prevent lowering physical strength and resistance)4.Avoid cooling lower body area5.Exercise lower pelvic muscles6.Keep vulva clean, wipe soil from front to back after defecation7.Replace sanitary napkins and menstruation sheets every 3 to 4 hours, keep them clean8.If there is urinal leakage, use a dedicated urinal pad.9.Urinate as soon as possible after sexual activity10.Moderation in irritants (spicy hot, alcohol, caffeine, etc.)