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A urologist went viral for saying you don't need to wipe front to back. Is it true?

A urologist is going viral for tweeting that it doesn't matter if you wipe front to back or back to front. But is the direction as important as we thought?
/ Source: TODAY

Wiping front to back is a bathroom habit ingrained into many people's minds from early childhood. The premise is simple: Don’t bring anything from the back up to the front, where it can enter another orifice and cause problems.

Recently, urologist Dr. Ashley Winter flipped that piece of common knowledge on its head when she tweeted that "it doesn't matter if you wipe front to back or back to front." The Twitter thread quickly gained traction and now has over one million views.

Many of the responses were mixed and confused. "Wait, have we been lied to all our lives?" one user replied.

Winter was quick to point out in the thread that this does not apply to babies, children or people with incontinence issues, but rather toilet-trained adults, particularly women and those assigned female at birth who are wiping after urinating.

The tweet sparked some debate about the significance of wiping direction and the health risks. So does it actually matter which direction you wipe and why?

Does it matter which direction you wipe?

The theory behind wiping front to back, especially for women and people with vulvas, is that doing the opposite may result in urinary tract infections because of the bacteria from the anus.

But the direction you wipe "does not matter for the average adult," Winter, a board-certified urologist and chief medical officer of Odela Health, tells Of course, there are exceptions that depend on factors like a person's anatomy, mobility and continence.

And Winter cautions that if you're wiping back to front, it does matter where you start to wipe. “Certainly ... don’t wipe all the way from your anus forward to your urethra, but again, the average adult is not doing that," says Winter, adding that most people know not to wipe feces onto themselves.

“I’m referring to wiping back to front, (starting) from somewhere slightly behind (the) urethra, over the vaginal area, and forward," says Winter.

In people assigned female at birth, the urethra (the tube that lets urine exit the body) is located at the top of the vulva (the outer part of the vagina), below the clitoris and above the vaginal opening, per the Cleveland Clinic. The area between the bottom of the vulva and the anus is called the perineum.

"There’s no magic line where there's zero dangerous bacteria on the skin in front of your urethra and then suddenly there's dangerous bacteria on the skin behind your urethra," explains Winter. “Our skin is not sterile. ... There is bacteria, including some gastrointestinal bacteria, living around the entire pelvic and perennial area."

Asked which direction he recommends patients wipe, board-certified urologist Dr. Evan Goldfischer, president of the national non-profit urology trade association LUGPA, says front to back. “If you wipe back to front, there’s a potential to introduce bacteria from the feces into the urinary tract and get an infection,” he says.

He adds that women have a shorter urethra than men, which is why they get more UTIs and it’s recommended for women to wipe from front to back. However, he notes that UTI-causing bacteria can come from a range of places and infect the urethra during sexual activity.

According to the Mayo Clinic, which also recommends wiping front to back to prevent UTIs, this bacteria can also come from other sources outside the body.

Does wiping from front to back lead to more UTIs?

The focus on wiping in the “wrong direction” can actually be stigmatizing, according to Winter, who says she posted the Twitter thread to dispel a common misconception about women with recurring UTIs: that the cause is poor hygiene or wiping habits.

"When the average adult (who does not have incontinence) comes to the doctor for recurrent UTIs, most of the time the first question is, 'Which way are you wiping?' or, 'Tell me about your hygiene,'" says Winter. Most of these patients are not wiping from their anus to their urethra and know not to do this, Winter emphasizes.

"It's not because of toilet habits. (It is) maybe one in 1,000 times," says Winter, adding in a tweet that this type of questioning needs to be dispelled because it's "stigmatizing and unhelpful."

“I wish most health care providers would stop asking that question to those patients because they come in the office feeling like they’ve done something wrong, and end up getting a lecture on hygiene instead of a discussion about how to prevent (UTIs),” says Winter.

This may also delay beneficial interventions for UTI prevention, according to Winter, who says she often sees this among post-menopausal women, who are at higher risk for developing UTIs.

Women who get recurrent UTIs can continue to get them "no matter what they do or how great their hygiene is," if there’s an underlying problem that hasn't been treated, says Winter.

The diagnostic criteria for recurrent UTIs in an adult female is three infections in a year, says Winter, which should prompt an evaluation by a urologist.

“They will screen for underlying health conditions that could predispose somebody to an infection, like kidney stones or a neurologic condition that prevents you from emptying your bladder,” says Winter.

There are various medications (such as the antiseptic drug methenamine), supplements and behaviors that can help prevent UTIs, says Winter. Topical estrogen cream, for example, is safe and effective for preventing UTIs in post-menopausal women.

It’s also important to note that toilet norms vary among different countries and cultures, and many people do not even wipe with toilet paper. (Winter is pro-bidet).

So while the advice to wipe front to back is not harmful, Winter notes, it may not be as strict of a rule as many people were perhaps taught.