Abstract
Although bidet toilets are widely used in Japan, the relationship between habitual bidet toilet use and the incidence of hemorrhoids or urogenital infections has not been prospectively studied.We performed a web survey and followed bidet toilets users and non-users to assess the incidence of hemorrhoids or urogenital infections from 2013 to 2014. Study subjects were randomly selected from a research company's (Macromill, Inc.) web panel. The baseline survey inquired about toilet use and confounding parameters, and the follow-up survey examined outcome parameters.A total of 7637 subjects were analyzed using single or multiple logistic regression models. The prevalence odds ratios (ORs) between bidet toilet users and non-users for hemorrhoids, urological infections, and vulval pruritus were significantly > 1.0 but their incidence ORs were not significant. The adjusted incidence OR for bacterial vaginitis symptoms was significant (2.662, 95% confidence interval [CI] [1.315–5.520]).These findings suggest that positive relations between habitual bidet toilet use and hemorrhoids and urogenital symptoms, except bacterial vaginitis, were due to reverse causation. The incidence of bacterial vaginitis might be caused by bidet toilet use, but the incidence rates were too small to make a definite conclusion, and further studies are needed.
Highlights
A bidet toilet is a sanitary toilet facility with a warm lavatory seat and a warm water shower to clean the anal or urogenital area after defecation, urination, or menstruation
The adjusted incidence odds ratio (OR) of other confounding parameters are shown in Supplemental Table 2a, b and c. In this prospective 1-year follow-up study of bidet toilet users, we found that hemorrhoids and urogenital infections, excluding bacterial vaginitis, were not causally related to habitual bidet toilet use
The incidence of bacterial vaginitis might have been caused by bidet toilet use, incidence rates were small and further studies are needed
Summary
A bidet toilet is a sanitary toilet facility with a warm lavatory seat and a warm water shower to clean the anal or urogenital area after defecation, urination, or menstruation. Some physicians have expressed concern that the habitual use of a bidet toilet causes hemorrhoids or urogenital infection (Ogino et al, 2010; Ogino, 2010; Kohdaira, 2009). These studies failed to exclude reverse causation, and the role of habitual bidet toilet use as a cause of hemorrhoids or urogenital infections remains controversial. To assess the relationship between habitual bidet toilet use and the incidence of hemorrhoids or urogenital infection, we conducted a web survey. A baseline survey was performed in February 2013, and a follow-up survey in February 2014
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