For women with arthritis of the knees, going to the bathroom can be an excruciating exercise, but a new study suggests that relief may come from a simple piece of waterproof paper.
Researchers in China found that most women with knee arthritis can urinate while standing with the aid of the paper rolled into a funnel, and without experiencing any differences in flow, compared to the sitting position.
"We think that the homemade device should be helpful considering the high percentage of overweight and knee osteoarthritis among elderly women in the United States," said Dr. Eric Chieh-Lung Chou, the study's lead author and a urologist at China Medical University in Taiwan.
The discomfort of bathroom breaks for women with bad knees often is compounded by a fact of sanitation in Asia and other parts of the world: sitting toilets are uncommon, replaced instead by pits or other receptacles that require users to squat or crouch above them.
"Of course, there seems to be few squat toilets in the United States. But even if a sitting toilet is accessible, a woman may still be forced to urinate while squatting or crouching if the toilet seat is unsanitary," Chou told Reuters Health.
Difficulties using public restrooms may cause women to try to hold it in until they get home, which, the authors note, can lead to urinary tract infections and chronic bladder problems.
Arthritis of the knees is among the five leading causes of disability in the United States, affecting some 16 percent of adults over the age of 45, according to the Centers for Disease Control and Prevention. The condition is more common in women than men, and is linked to being overweight and obesity.
For their study, Chou and his colleagues assessed the feasibility of upright urination in 21 women age 65 and older with knee arthritis. The women reported being unable to crouch or squat comfortably.
The women were given sheets of waterproof paper with instructions for making a few easy folds at one end, then rolling the ends around each other to create a cone.
Seventeen of the women, or 81 percent, said they had no trouble urinating while standing, and the position did not appear to affect urine flow, according to the researchers. But four women (19 percent) reported difficulty — wet clothing and "errant" urine — while using the device.
That, Chou said, reflects their initial unfamiliarity with the stand-void technique. "They suggested some useful solutions — for example, wider separation of the thighs and closer placement of the paper device to the perineum — and these problems were gone subsequently. Practice makes perfect."
Although the Chinese researchers offer tips for how to make the cones, at least one company sells a ready-to-use version. Called the P-Mate (www.pmateusa.com), the device was developed in The Netherlands about a decade ago, said Karen Diamond, who distributes the product in North America.
The disposable cones, which sell for $1 each, can be folded and carried in a pocket, Diamond said. "For any medical condition that prevents a woman from getting up and down, a woman is going to want a P-Mate," Diamond said. Travelers to countries with few seated toilets also buy them, she said.
Chou said physicians who treat knee osteoarthritis should take the time to counsel women about their urination habits.
"We suggest that clinicians, especially urologists, orthopedic surgeons, and physiatrists, should first ask patients whether they have problems trying to void in public restrooms. If so, and the problems are related to painful knees preventing them from crouching and squatting, clinicians could suggest the patients try to make the device at home."
"Of course, the first few stand-void attempts should better be tried at home," he said. Practicing in the shower can help reduce the chances of getting clothes wet, he added.
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