Debate rages on post-defaecation manners

THE debate on which method is the best to use in cleaning the anus after using the toilet is getting hotter. While some say that using water is the best, others argue that using paper is most hygienic and that using water encourages the spread of water borne diseases such as diarrhea and dysentery.

The Guardian investigation revealed that most Nigerians throw hygiene to the wind when it comes to post defecation manners. Indeed, when it comes to universal human activities, nothing is more overlooked than post-defecation clean up.

According to Wikipedia, anal cleansing is the hygienic practice of cleaning the anus after using the toilet, especially after defecation.

The anus and buttocks may be either washed with liquids or wiped with toilet paper or other solid materials. In Muslim and Indian cultures, water is usually used for anal cleansing using a jet, as with a bidet, or splashed and washed with the hand.

A common hand technique is fill one hand with hot soapy water and wash the anus thoroughly until a desired comfort is achieved. Some people follow this up with toilet paper afterwards for drying purposes.

In other cultures (such as most Western countries), wiping is done with toilet paper or similar paper products. In low-income settings of developing countries or during camping trips, materials such as vegetable material, mudballs, stones, sticks and leaves are also used.

Although wiping from front to back minimizes the risk of contaminating the urethra, the directionality of wiping varies based on sex, personal preference, and culture. Having a hygienic means for anal cleansing available at the toilet is important for overall public health.

The absence of anal cleansing material in households can in some circumstances be correlated to the number of diarrhea episodes per household.

The common questions in support of post defecation practices are: what happens to the faecal matter laden water left on top of the toilet seat after using water?

Do most of the toilets have soap and water for washing hands after touching faeces by washing with water? Does the individual have clean towel to clean the dripping water after washing his or her anus with ordinary water?

Should people stop shaking hands to avoid spread of diseases? According to a study published in Diarrhoeal Disease Research, “transmission due to contaminated hands is one of the important routes by which the pathogens of diarrheoa spread.

The hands commonly become contaminated while cleaning the anus after defaecation. The study… reports on the different methods of anal cleansing after defaecation in mothers with children aged under five and also the association of diarrhea and dysentery with the cleansing methods…. “The hands of mothers using water were more contaminated than those using paper.

However, thorough hand-washing with soap and water was found to be effective in decontaminating the hands. Furthermore, there was a relation between the incidence of diarrhea and dysentery and the method of cleansing.

The incidence was lowest in those children whose mothers used paper. “The risk to water users was 3.8 times that of paper users, but the relative risk was not statistically significant.

These findings indicate the importance of hand-washing after defaecation and before food handling or eating and the use of paper in cleaning the anus after defaecation because of the reduced faeces-finger contact.”

According to Wikipedia, waterborne diseases are caused by pathogenic microorganisms that most commonly are transmitted in contaminated fresh water.

Infection commonly results during bathing, washing, drinking, in the preparation of food, or the consumption of food thus infected.

Various forms of waterborne diarrheal disease probably are the most prominent examples, and affect mainly children in developing countries; according to the World Health Organization (WHO), such diseases account for an estimated 4.1 per cent of the total DALY global burden of disease, and cause about 1.8 million human deaths annually.

The WHO estimates that 88 per cent of that burden is attributable to unsafe water supply, sanitation and hygiene. Meanwhile, it has become a tradition in some parts of the country to use water to wash off the anus after using the toilet.

This is against the conventional or rather the Western ways of using tissue paper. The former is also supported by some religious organisations such as Islam.

However, the debate on which method is ideal to use in the toilet rages. Several researches have shown that water can only be effective when used with water to wash off not just the anus but the hands after using the toilet.

Also, the use of ordinary water to wash off after using the toilet has been associated with diarrhea, cholera, typhoid fever, food poisoning and other gastro-intestinal problems.

Water has been in existence since the creation of man, while toilet papers use dates back to the sixth century AD, in early medieval China where paper was invented in 105 CE, before the advent of modern day toilet tissues.

The argument is that users of both claim either way is the most ideal. Users of water claim that it is more hygienic, since it washes all the urine and faeces, and it leaves users underwear clean with no stenches. From the Islamic perspective, use of water is a ‘sunnah’ of the Holy prophet (S.A.W) that water is idle and the use of other materials are only accepted in the absence of it.

Seeking the health perspective, The Guardian spoke to a doctor from the University of Ilorin Teaching Hospital (UITH) in Kwara State. The doctor who pleaded anonymity, said, “water washes clean than anything else I know”, hence one can use water to clean up in the toilet.

He added that, not just any water, but clean water, as the user could be prone to infections when dirty water is used. According to him, using water can clean everything, but leaves users wet and most times uncomfortable with such situation.

Though water use reduces the inherent chances of infections that toilet tissues might expose the user to, toilet tissues are easier to carry than water.

And it will leave a cleaner toilet environment than were water is used. He further explained that, toilet tissues too cleans well, and that users’ hands do not come in contact with feces in most cases unlike water were the left hand that is used to clean comes in contact with the faeces. This he said leaves some parts of the genitals unclean and sometimes with tissue particles left there unknowingly.

He also added that, most people in this part of the world prefer to use water because it is affordable and accessible. When The Guardian probed about any health outcomes of the usage of both methods, the doctor told our correspondent that, both methods could expose users to infections depending on the circumstances.

He said, the water might be contaminated with unseen particles, while the toilet tissue too can be exposed to harmful substances like dust, which have micro organism, and when users uses them in these circumstance, they are prone to diverse rectal infections, which need medical attention.

In some cases too, users of toilet tissue fail to clean from front to back as advised, and this as well can expose them to genital infections as well, most especially in females.

The problem with most people is that, even after the use of either method, they do not wash their hands with soap and water, and this aids the carrying of germs even into foods, he emphasized. “In my own opinion, I think the combination of the two is ok, because if you use water and get wet, you can as well use toilet tissue to pat the wetness dry for comfort ability,” he said.

With regards to this, most people who build these days fashion in a bidet hand shower that can afford the use of water, as well as a tissue space for either use.

He then advised that people should endeavor to wash their hands with water and soap after leaving the toilet, irrespective of the method of clean up they use, for that is safer.

In developed nations like The United States of America, a fortune of over 10 billion dollars is spent on toilet paper. Environmentally, experts fears the challenges of ecological problem, as the global toilet paper production, consumes 27,000 trees daily and that leads to the harvest of millions of trees in north and south America.

Public health physician, Dr. Dumebi Owa, said the toilet-related unhygienic practices is the bane several deadly diseases in the public. Owa said micro-organisms causing diseases, like dysentery, cholera, typhoid among others were often toilet-related.

According to her, “There are so many side-effects of not washing hands after using a toilet. People can get dysentery, even Ebola Virus Disease (EVD) through such means because of the micro organisms involve.

There is also E-coli, helminth (eggs of worms). If the person passes stool and the hands are not properly washed, helminth sticks to the fingers and it is passed on to other persons — either by handshake or mere touching. If the receiving person puts the hand in the mouth, then he or she becomes infected.

If the person is a food seller then that is even worse,” she said. Owa, who is the former president of Medical Women Association of Nigeria (MWAN), added that there had been more incidences with typhoid diseases that health officials should begin to pay greater attention. “There have been incidences in the past of people getting salmonella (organism causing Typhoid) through food sellers.

The organism has to be passed on for one to have typhoid; it is like eating someone else’s faeces (faecal-oral). Faeces is the natural carrier of the salmonella typhus (typhoid fever).

The organisms live inside the carriers. So, if they go to toilet and fail to wash their hands, they can pass it on to other people. “That is why you’d notice that in a good organisation where there are caterers or they have a canteen, they will regularly do health checks on people working in the canteen, because they shed these organisms because it is regularly inhabiting in them.”

Owa added that the public must be aware that our warm climate helps the microorganisms to breed and multiply very quickly, coupled with the dirty environment around us. “For someone to get infected by microorganisms, it has to be in quantity and period of time.

Because the warm weather is good for them, they tend to multiply very fast, so the quantity of organism a carrier has and the period of time it takes to transmit are what is called the virulent of the organism. “A lot of this microorganisms tend to inhabit in dirty environment and nothing can be more dirty than faeces.

That is why here, I’m personally advocating awareness campaign on proper hygiene. “The olden days ways of checking the environment has to return. If you really look around, we as a people are very dirty.

We really have to enlighten our people. It is so sad that our enlightenment campaigns are never sustained. We have to get it down the grassroots and begin to catch them young. If we can really work on it, our disease burden will reduce because they are self afflicted. Since after the Ebola, people have stopped washing their hands.”

On some people that may have restricted the habit of handshake, she said if some people have stopped shaking hands for religious reasons, why not for health reasons. “There is only one life. We are just too careless in so many things. People still call malaria common, not knowing that that ‘common malaria’ kills many people on daily basis. You will see young promising boy or girl get killed by typhoid.

Typhoid can perforate the digestive system. If anyone decides not to shake hands for health reasons, then so be it. We live in a free and democratic world.” To Abosede Musa: “Water is more hygienic, since all the urine and poop gets washed off, leaving a clean bottom.

There is no poop-y smell left in the underwear. No matter how much you scrub with a toilet paper, a residual smell is always left behind. “With water, there is less friction against the skin.

No matter how soft the toilet paper is, you still have to scrub it against your skin. Water is a boon for people who are sensitive to toilet paper. If clean water is used, it reduces the inherent chances of infection that toilet paper causes when one forgets to wipe from front to back. “You don’t need to spend a fortune on buying toilet paper every month.

Too much toilet paper in the bowl can clog it, but water will not. Toilets that use water often have wet floors. And so, they also have a drain on the floor, so that the entire toilet and floor can be washed clean regularly. “The hems of pants and skirts are liable to get wet in a wet bathroom, and it takes a lot of careful planning and contortions to ensure that the clothes stay dry.

After a hard day of dusty labour, one would not feel really clean by just wiping down with a dry paper towel. A shower would do the job.

Just like that, wiping poop with a dry toilet paper is not going to actually clean the area well. Washing with water would. “When a woman has given birth to a baby, especially by vaginal delivery, the doctors insist that she wash her private parts with warm water to help heal better and prevent infection.

If water can keep a woman safe during the most vulnerable period of her life, then why can’t it be used at all times in daily life? “When women have their monthly cycle, washing with water is recommended as most hygienic and best-practice by doctors. “People use wet wipes to clean babies’ bottoms and private areas.

Wet, not dry. Best practices for newborn baby care recommends washing the private areas with water, since their skin might be too sensitive for even wet-wipes.

The water actually cleans the messiest of messes. If that is the case, then why do people stop using water when they become older, and use dry toilet paper instead? “Doctors recommend washing the genital area with water under the following circumstances, for hygiene and also to reduce the chances of infection.”