Abrams P, Anderson KE, Birder L Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010; 29:(1)213-240

Ahuma-Smith C, Bavuno S Access to public toilets facilities amongst physically challenged people. International Journal of Engineering Research and Technology (Ahmedabad). 2020; 9:(7)1353-1357

Bartram J, Cairncross S Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med. 2010; 7:(11)

Buitrago-García T, Sawadogo NH, Souares A Female-friendly toilets in schools in Burkina Faso: A mixed-methods study using photo-elicitation. J Glob Health. 2022; 12

Camenga DR, Brady SS, Hardacker CT US adolescent and adult women's experiences accessing and using toilets in schools, workplaces, and public spaces: a multi-site focus group study to inform future research in bladder health. Int J Environ Res Public Health. 2019; 16:(18)3338-3354

Prevalence and impact of chronic debilitating disorders. Chapter 7. 2016. https// (accessed 3 June 2024)

Central Statistics Office. Census of population 2022 Profile 4 – Disability health and carers. 2023. https// (accessed 12 June 2024)

Cotropia CA Menstruation management in United States schools and implications for attendance, academic performance, and health. Women's Reproductive Health. 2019; 6:(4)289-305

Crankshaw TL, Strauss M, Gumede B Menstrual health management and schooling experience amongst female learners in Gauteng, South Africa: a mixed method study. Reprod Health. 2020; 17

Ensign J Reproductive health of homeless adolescent women in Seattle, Washington, USA. Women Health. 2000; 31:(2-3)133-151

Good continence care can empower patients. 2022. https// (accessed 3 June 2024)

Freeman MC, Garn JV, Sclar GD The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis. Int J Hyg Environ Health. 2017; 220:(6)928-949

Frye EA, Capone D, Evans DP Open defecation in the United States: perspectives from the streets. Environmental Justice. 2019; 12:(5)226-230

Gorina Y, Schappert S, Bercovitz A, Elgaddal N, Kramarow E Prevalence of incontinence among older Americans. Vital Health Stat. 2014; 3:(36)1-33

Greed C The role of the public toilet in civic life. In: Gershenson O, Penner B (eds). : Temple University Press; 2009

Greed C Creating a non-sexist restroom. In: Molotoch H, Noren L (eds). : New York University Press; 2010

Greed C Taking women's bodily functions into account in urban planning and policy: public toilets and menstruation. Town Planning Review. 2016; 87:(5)505-524

User and provider perspectives on public toilets provision. 2002. https// (accessed 3 June 2024)

Groce N, Bailey N, Lang R, Trani JF, Kett M Water and sanitation issues for persons with disabilities in low- and middle-income countries: a literature review and discussion of implications for global health and international development. J Water Health. 2011; 9:(4)617-627

Heath H The nurse's role in helping older people to use the toilet. Nurs Stand. 2009; 24:(2)43-47

Health Service Executive (Ireland). Guidelines for the assessment, promotion and management of continence in adults by registered nurses. 2019. https// (accessed 3 June 2024)

Human rights to water and sanitation in spheres of life beyond the household with an emphasis on public spaces. 2019. https// (accessed 3 June 2024)

Hennegan J, Shannon AK, Rubli J, Schwab KJ, Melendez-Torres GJ Women's and girls' experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Med. 2019; 16:(5)

Herman JL Gendered restrooms and minority stress: the public regulation of gender and its impact on transgender people lives. Journal of Public Management and Social Policy. 2013; 19:(1)65-80

James S, Coley J Separate but unequal: revisiting the discussion of trans-inclusive bathrooms. Sexuality, Gender & Policy. 2023; 6:(1)33-46

Johnston-Robledo I, Chrisler JC The menstrual mark: menstruation as social stigma. Sex Roles. 2013; 68:(1-2)9-18

Publicly accessible toilets: an inclusive design guide. 2011. https// (accessed 3 June 2024)

Kogan T Sex separation in public restrooms: Law, architecture, and gender. Michigan Journal of Gender and Law. 2007; 14:(1)

Logan K Toilet privacy in hospital. Nurs Times. 2012; 108:(5)12-13

Mamee W, Sahachaisaeree N Public toilet design criteria for users with walking disability in conjunction of universal design paradigm (WCPCG 2010). Procedia Social and Behavioural Sciences. 2010; 5:1246-1250

Mara D, Lane J, Scott B, Trouba D Sanitation and health. PLos Med. 2010; 7:(11)

McMahon SA, Winch PJ, Caruso BA, Obure AF, Ogutu EA, Ochari IA, Rheingans RD ‘The girl with her period is the one to hang her head’ Reflections on menstrual management among schoolgirls in rural Kenya. BMC Int Health Hum Rights. 2011; 11:(1)

Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI) (Commitee 1). 2013. https// (accessed 3 June 2024)

Mitteness LS, Barker JC Stigmatizing a “normal” condition: urinary incontinence in late life. Med Anthropol Q. 1995; 9:(2)188-210

Moreira FD, Rezende S, Passos F On-street toilets for sanitation access in urban public spaces: A systematic review. Utilities Policy. 2021; 70:(June)

Navarro J, Andrade FP, Paiva TS, Silva D, Gessinger CF, Bós AJG Perception of young and long-lived Gaucho elderly people regarding the public spaces in which they live. Cien Saude Colet. 2015; 20:461-470

NHS England. Excellence in continence care: Practical guidance for commissioners, and leaders in health and social care. 2018. https// (accessed 3 June 2024)

Norling M, Stenzelius K, Ekman N, Wennick A A High school students experiences in school toilets or restroom. J Sch Nurs. 2016; 32:(3)164-171

Norton C Nurses, bowel continence, stigma, and taboos. J Wound Ostomy Continence Nurs. 2004; 31:(2)85-94

Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J Management of fecal incontinence in adults. Neurourol Urodyn. 2010; 29:(1)199-206

Palmer MH, Wu JM, Marquez CS, Rupp B, Conover MM, Newman DK “A secret club”: focus groups about women's toileting behaviors. BMC Womens Health. 2019; 19:(1)

Penner B A world of unmentionable suffering: women's public conveniences in Victorian London. J Des Hist. 2001; 14:(1)35-51

Phillips-Howard PA, Nyothach E, ter Kuile FO Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural Western Kenya. BMJ Open. 2016; 6:(11)

Pierce H, Perry L, Chiarelli P, Gallagher R Delaying voiding, limiting fluids, urinary symptoms and work productivity: a survey of female nurses and midwives. J Adv Nurs. 2019; 75:(11)2579-2590

Porta CM, Gower AL, Mehus CJ, Yu X, Saewyc EM, Eisenberg ME “Kicked out”: LGBTQ youths' bathroom experiences and preferences. J Adolesc. 2017; 56:(1)107-112

Ramster G, Greed C, Bichard JA How inclusion can exclude: the case of public toilet provision for women. Built Environment. 2018; 44:(1)52-76

Rubinsky V, Gunning JN, Cooke-Jackson A “I Thought I Was Dying:” (Un) Supportive Communication Surrounding Early Menstruation Experiences. Health Commun. 2020; 35:(2)242-252

Sanses TV, Kudish B, Guralnik JM The relationship between urinary incontinence, mobility limitations, and disability in older women. Curr Geri Rep. 2017; 6:(2)74-80

Schmitt M, Clatworthy D, Ogello T, Sommer M Making the case for a female-friendly toilet. Water. 2018; 10:(9)

Schluter PJ, Ward C, Arnold EP, Scrase R, Jamieson HA Urinary incontinence, but not fecal incontinence, is a risk factor for admission to aged residential care of older persons in New Zealand. Neurourol Urodyn. 2017; 36:(6)1588-1595

Schmitt ML, Hagstrom C, Gruer C “Girls May Bleed Through Pads Because of Demerits”: Adolescent Girls' Experiences With Menstruation and School Bathrooms in the U.S.A. Journal of Adolescent Research. 2024; 39:(2)511-536

Sebert Kuhlmann A, Peters Bergquist E, Danjoint D, Wall LL Unmet menstrual hygiene needs among low-income women. Obstet Gynecol. 2019; 133:(2)238-244

Secor-Turner M, Huseth-Zosel A, Ostlund R Menstruation experiences of middle and high school students in the Midwest: a pilot study. Journal Sch Nurs. 2020; 38:(6)504-510

Sheer J A legal analysis: The transgender bathroom debate. Journal of Sociology and Social Welfare. 2020; 47:(10)53-72

Siu KWM, Wong MMY Promotion of a healthy public living environment: participatory design of public toilets with visually impaired persons. Public Health. 2013; 127:(7)629-636

Society for Women's Health Research. Survey of school nurses reveals lack of bathroom policies and bladder health education. 2018. https// (accessed 3 June 2024)

Sommer M, Sahin M Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls. Am J Public Health. 2013; 103:(9)1556-1559

Stanwell-Smith R Public toilets down the drain? Why privies are a public health concern. Public Health. 2010; 124:(11)613-616

Sumpter C, Torondel B A systematic review of the health and social effects of menstrual hygiene management. PLoS One. 2013; 8:(4)

Access to a toilet is a human right – closing public loos is one austerity cut too many. 2016. http// (accesssed 12 June 2024)

Tatlow-Golden M, O'Farrelly C, Booth A, Doyle O “Bursting” to go and other experiences. J Sch Nurs. 2017; 33:(3)214-222

Boston's school bathrooms are a big mess. 2019. https// (accessed 12 June 2024)

Xu D, Zhu S, Li H, Gao J, Mou H, Wang K Relationships among occupational stress, toileting behaviors, and overactive bladder in nurses: a multiple mediator model. J Adv Nurs. 2019; 75:1263-1271

Vernon S, Lundblad B, Hellstrom AL Children's experiences of school toilets present a risk to their physical and psychological health. Child Care Health Dev. 2003; 29:(1)47-53

Wagg A, Gibson W, Ostaszkiewicz J Urinary incontinence in frail elderly persons: Report from the 5th International Consultation on Incontinence. Neurourol Urodyn. 2015; 34:(5)398-406

Wall B, Kelly AM, White P, McCann M Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study. Br J Nurs. 2024; 33:(9)S16-S28

World Health Organization. WHO Water, Sanitation and Hygiene Strategy 2018–2025. 2019. https// (accessed 3 June 2024)

World Health Organization, World Bank. World Report on Disability. 2011. https// (accessed 3 June 2024)

Public toilets and their potential impact on an individual's health

20 June 2024
Volume 33 · Issue 12


In modern society, people engage in social interactions and activities outside their own home. When in public settings people may need to eliminate bodily waste, so public toilets are required. Accessibility, availability and adaptability are essential principles for safe, private, and purposeful visits to public toilets. A diverse range of individuals use public toilets: various age profiles, all gender groups, vulnerable individuals and people with additional needs. Public toilets essentially need to be a place of privacy, safety and cleanliness to facilitate elimination of urine, evacuation of faeces, management of menstruation, and changing/disposing of continence wear products in a secure environment.

A recent United Nations (UN) report highlighted concerns regarding sanitation in places outside a person's home, in locations such as schools, hospitals, clinics, prisons, workplaces and public spaces (Heller, 2019). Public toilets fulfil a crucial basic human need, serving distinctive and diverse groups of people including adults, children, teenagers, transgender individuals, persons with disability, individuals experiencing homelessness, people who menstruate and older persons (Stanwell-Smith, 2010).

The World Health Organization (WHO) strategy highlights that access to safe, clean toilets is crucial for promoting public health (WHO, 2019). However, users of public toilets may feel apprehensive when they identify the need to use these facilities, because of concerns about availability and accessibility, cleanliness and safety (Camenga et al, 2019; Moreira et al, 2021).

People with additional needs make up approximately 15% of the global population (WHO and World Bank, 2011), unfortunately they face physical and social obstacles in accessing sanitation facilities, potentially preventing them from attending school, engaging in employment and using public services and amenities (Groce et al, 2011). Toilets should be safe places to visit, with physical and social barriers removed that could prevent people from using them – the principles of privacy, safety and cleanliness are essential prerequisites (Greed, 2016; Jaglarz, 2019).

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