Evaluation of the Relationship Between Urinary Tract Infections and Toilet Habits and Post-Toilet Cleaning Behaviors in Women: A Questionnaire-Based Study

Evaluation of the Relationship Between Urinary Tract Infections and Toilet Habits and Post-Toilet Cleaning Behaviors in Women: A Questionnaire-Based Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the Relationship Between Urinary Tract Infections and Toilet Habits and Post-Toilet Cleaning Behaviors in Women: A Questionnaire-Based Study Bulut Dural, İbrahim Topcu, Ömer Faruk Yıldırım, Resul Çiçek, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7762222/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objectives: To evaluate the relationship between urinary tract infections (UTIs) and toilet habits as well as post-toilet cleaning behaviors among women. Methods: This cross-sectional questionnaire-based study included 202 women, equally divided into infected and healthy groups. Data on demographic characteristics, toilet habits, and post-toilet hygiene behaviors were collected. Statistical analysis included descriptive statistics, chi-square tests, principal component analysis, and logistic regression. Results: Vaginal discharge (OR=0.20, p<0.001), vaginal douching (OR=0.317, p=0.009), and certain toilet habits (OR=2.858, p=0.033) were significantly associated with UTI presence. Factor analysis identified two protective behavioral constructs: “cleaning habits” (OR=0.580, p<0.001) and “application technique” (OR=0.654, p=0.006). Conclusions: Toilet and hygiene habits significantly influence UTI risk in women. Education on correct cleaning direction and consistent hygiene practices may help reduce UTI incidence. Urinary Tract Infections Hygiene Toileting Behavior Women Logistic Regression Factor Analysis Brief Summary This study examined urinary tract infections in women, showing associations with toilet habits and hygiene behaviors, highlighting protective factors and preventive education importance Introduction UTIs represent the most frequent bacterial infections in women, and nearly one in two women are estimated to experience at least one episode during their lifetime. (1). Risk factors for UTIs include congenital abnormalities of the urinary tract, a history of diabetes mellitus (particularly those requiring insulin therapy), prior catheterization, urinary stones, spinal cord injuries, neurological disorders, pelvic organ prolapse, and pelvic floor trauma (2). The most frequently isolated pathogen in women with UTIs is Escherichia coli, which highlights the potential importance of anal and perineal hygiene practices after toileting in UTI prevention (3,4). While E. coli commonly colonizes the intestinal tract, it may reach the urinary system through perineal contamination or fecal-to-urethral transfer. A study by Magruder et al. demonstrated a positive correlation between the abundance of E. coli in the gut and the frequency of recurrent UTIs (5). Due to anatomical factors—specifically the short female urethra and the close proximity of the anus and vagina—women are more prone to UTIs, as these features facilitate the migration of enteric bacteria to the urinary tract (6). Statistical Analysis The data obtained in this study were analyzed using the Statistical Package for the Social Sciences (SPSS), version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as mean ± standard deviation (SD) for continuous variables, and as frequency and percentage (%) for categorical variables. The assumption of normality for the age variable between groups was evaluated using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Since the data were not normally distributed, the Mann-Whitney U test was used for comparison. For categorical variables, Pearson’s chi-square test and, where appropriate, Fisher’s exact test were employed. To identify the underlying structure of five categorical variables related to hygiene behaviors (toilet type, cleaning frequency, habitual behavior, and direction), Principal Component Analysis (PCA) was performed. The number of factors was determined using the criterion of eigenvalue > 1, and Varimax rotation was applied to improve interpretability. The suitability of the data for factor analysis was assessed using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett’s test of sphericity. The resulting factor scores were added to the dataset for use in multivariate models. To assess the relationship between independent variables and the likelihood of being in the infected group, univariate and subsequently multivariate logistic regression analyses were performed. In the first model, the original independent variables (vaginal discharge, vaginal douching, toilet habits) were included. In the second model, factor scores derived from the principal component analysis were incorporated into the model. The validity of the logistic regression models was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Model explanatory power was assessed using the Nagelkerke R² coefficient, and predictive accuracy was reported using classification tables. A p-value of < 0.05 was considered statistically significant for all analyses. Materials and Methods Data analysis was conducted using IBM SPSS Statistics version 25. Descriptive statistics summarized continuous variables as mean ± SD, and categorical data as frequencies and percentages. The assumption of normality for the age variable between groups was evaluated using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Since the data were not normally distributed, the Mann-Whitney U test was used for comparison. For categorical variables, Pearson’s chi-square test and, where appropriate, Fisher’s exact test were employed. To identify the underlying structure of five categorical variables related to hygiene behaviors (toilet type, cleaning frequency, habitual behavior, and direction), Principal Component Analysis (PCA) was performed. The number of factors was determined using the criterion of eigenvalue > 1, and Varimax rotation was applied to improve interpretability. The suitability of the data for factor analysis was assessed using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett’s test of sphericity. The resulting factor scores were added to the dataset for use in multivariate models. To assess the relationship between independent variables and the likelihood of being in the infected group, univariate and subsequently multivariate logistic regression analyses were performed. In the first model, the original independent variables (vaginal discharge, vaginal douching, toilet habits) were included. In the second model, factor scores derived from the principal component analysis were incorporated into the model. The validity of the logistic regression models was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Model explanatory power was assessed using the Nagelkerke R² coefficient, and predictive accuracy was reported using classification tables. A p-value of < 0.05 was considered statistically significant for all analyses. Results A total of 202 women were included in the study. Of these, 50% (n = 101) were classified into the “infected” group and 50% (n = 101) into the “healthy” group. There was no statistically significant difference between the groups in terms of mean age or comorbid conditions (healthy: 36.4 ± 11.8 years; infected: 36.9 ± 13.5 years). Similarly, no significant differences were found in the presence of chronic disease (p = 0.316), asthma (p = 0.312), hypertension (p = 0.234), diabetes mellitus (p = 1.000), educational level (p = 0.665), or marital status (p = 0.447) (Table 1). When the distribution of categorical variables was examined, statistically significant differences were observed between the groups in the presence of vaginal discharge (p < 0.001), vaginal douching (p < 0.001), toilet type preferences (s1–s3; each p < 0.001), cleaning frequency (s4; p < 0.001), and cleaning direction (s5; p = 0.012). In the multivariate model, original variables including vaginal discharge, vaginal douching, toilet type, and cleaning frequency were included. Vaginal discharge (OR = 0.20; p < 0.001), vaginal douching (OR = 0.317; p = 0.009), and toilet habit (s3) (OR = 2.858; p = 0.033) were found to be significantly associated with the presence of infection. To identify the common structures underlying hygiene behaviors, a factor analysis was conducted on the five questionnaire items that showed statistical significance. The first factor was primarily loaded by s1, s2, and s4 and represented “toilet and cleaning habits,” while the second factor was loaded by s3 and s5 and represented “cleaning orientation and technique.” The factor scores derived from this analysis were added to the dataset for further modeling. The first factor—“cleaning habits”—was found to significantly reduce the risk of infection (B = − 0.545; OR = 0.580; p < 0.001). Similarly, the second factor—“application technique”—also demonstrated a protective effect (B = − 0.425; OR = 0.654; p = 0.006) (Table 2). Discussion Urinary tract infections (UTIs) are among the most common infections encountered in clinical practice worldwide [ 7 ] and represent a frequent health problem, particularly among women throughout their lives. According to Foxman et al epidemiological data suggest that more than half of all women will develop a UTI at least once during their lives. Because the female urethra is short and positioned near the anus and vagina, bacteria from the intestinal flora can more easily reach the urinary tract, contributing to higher infection rates in women [ 6 , 8 ]. The vagina is an important anatomical region in the pathogenesis of UTIs in women, serving as a potential reservoir for pathogenic bacteria and as an area where interventions could either reduce or increase UTI risk. Alterations in the vaginal microbiome, especially reduction of Lactobacillus species, can predispose women to UTIs by diminishing the protective barrier against uropathogens. Due to their bactericidal activity, vaginal Lactobacillus species are thought to be protective against Escherichia coli, the most common cause of UTIs [ 8 – 12 ]. Therefore, interventions that disturb the flora of this region may increase UTI risk. For example, in women with bacterial vaginosis—who consequently have low levels of vaginal lactobacilli—or in those who perform vaginal douching, the vaginal flora is weakened. This allows pathogenic bacteria to colonize more easily, indirectly increasing UTI risk [ 13 ]. In our study, both vaginal discharge (OR = 0.20; p < 0.001) and vaginal douching (OR = 0.317; p = 0.009) were significantly associated with infection status, supporting findings from previous literature. In addition, studies have shown that toilet type preference (Western-style vs. squat) may also be associated with UTI risk. In our study, a statistically significant difference in toilet type preference was observed between the infected and healthy groups (p < 0.001). In a Turkey-based study by Dağcıoğlu et al., no significant relationship was found between UTI history and the type of toilet used at home or the frequency of Western toilet use; however, they did report associations with cleaning direction, use of public toilets (e.g., urinals), and use of toilet paper [ 14 ]. Wiping habits and direction are also thought to have a long-term impact on UTI occurrence. In a study conducted in Japan, Tetsuya Akaishi found that women who wiped from back to front after defecation—particularly in younger age groups—may be at increased risk of UTIs, and suggested switching to a front-to-back wiping direction as a preventive measure [ 15 ]. Furthermore, some studies have suggested that toileting posture may be related to UTI risk. In particular, the practice of urinating without fully sitting on the toilet seat (“hovering”) has been shown to result in incomplete bladder emptying, which adversely affects bladder health [ 16 ]. Moore et al. reported a 149% increase in post-void residual urine volume among women who did not sit comfortably during urination compared to those who did [ 17 ]. A representative study by Parasuraman et al. in Malaysia assessed the correlation between defecation posture and UTI risk, finding that most participants avoided Western toilets in public settings, preferring squat toilets, and that 10.7% reported a history of UTI [18]. Over time, hovering may affect pelvic floor function and bladder emptying, thereby increasing the risk of UTIs and lower urinary tract symptoms (LUTS). Consistent with these findings, our study also demonstrated that the behavioral factors representing toilet and hygiene habits were significantly weaker in the infected group, and that these habits had a protective effect against both UTIs and LUTS. This finding supports the notion that hygiene and toileting behaviors play an important role in reducing infection risk. In conclusion, this study was conducted to evaluate the relationship between urinary tract infection (UTI) occurrence and toilet habits as well as post-toilet hygiene behaviors among women, yielding several noteworthy findings. The data demonstrated that genital hygiene-related behaviors—particularly the presence of vaginal discharge and the practice of vaginal douching—were significant determinants of UTI risk. Additionally, daily habits such as toilet type preference, cleaning frequency, and cleaning direction were also found to have a statistically significant impact on infection risk. Results from factor analysis revealed that behavioral constructs representing toilet and cleaning practices may have a protective role against UTIs. Specifically, consistent and appropriately directed cleaning habits, along with healthy toilet preferences, emerged as important protective factors not only against UTIs but also against lower urinary tract symptoms (LUTS). These findings suggest that toilet habits and personal hygiene practices may have a more substantial influence on women’s health than previously recognized. Raising public awareness, promoting proper hygiene behaviors, and implementing educational interventions—particularly from an early age—may contribute meaningfully to the prevention of UTIs. Furthermore, the results of this study provide a foundation for future large-scale, prospective research that may further elucidate the link between toileting behavior and infection risk. Abbreviations UTI: Urinary Tract Infection LUTS: Lower Urinary Tract Symptoms PCA: Principal Component Analysis SPSS: Statistical Package for the Social Sciences OR: Odds Ratio CI: Confidence Interval Declarations Ethics Approval and Consent to Participate The study was approved by the institutional ethics committee, and written informed consent was obtained from all participants. Consent for Publication Not applicable. Availability of Data and Materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ Contributions All authors contributed to writing and approving the final manuscript. Questionnaire Availability The questionnaire used in this research was specifically developed for this study and has not been published elsewhere. An English version of the questionnaire has been uploaded as a supplementary file. Acknowledgments The authors thank all participants for their contributions to this study. Ethics Approval and Consent to Participate This study was approved by the Inonu University Health Sciences Non-Interventional Clinical Research Ethics Committee (Approval No: 2025/8051). Written informed consent was obtained from all participants prior to inclusion in the study. All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Consent for Publication ]Not applicable. Availability of Data and Materials The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ Contributions ÖFY and BD conceived and designed the study. İT and RÇ performed data collection and analysis. BD and AB drafted the manuscript. All authors read and approved the final manuscript. Acknowledgements The authors express their gratitude to all participants who took part in this research and to the staff of Inonu University Faculty of Medicine for their valuable assistance. References Nicolle LE. Epidemiology of urinary tract infections. Infect Med. 2001;18:153–162. Salvatore S, Cattoni E, Siesto G, Serati M, Sorice P, Torella M. Urinary tract infections in women. Eur J Obstet Gynecol Reprod Biol. 2011;156(2):131–136. Lee DS, Lee SJ, Choe HS. Community-acquired urinary tract infection caused by Escherichia coli in the era of antibiotic resistance. Biomed Res Int. 2018;2018:7656752. doi:10.1155/2018/7656752 Mao BH, Chang YF, Scaria J, Chang CC, Chou LW, Tien N, et al. Identification of Escherichia coli genes associated with urinary tract infections. J Clin Microbiol. 2012;50(2):449–456. doi:10.1128/JCM.00640-11 Magruder M, Sholi AN, Gong C, Zhang L, Edusei E, Huang J, et al. Gut uropathogen abundance is a risk factor for development of bacteriuria and urinary tract infection. Nat Commun. 2019;10:5521. doi:10.1038/s41467-019-13467-w Hatamleh R, Shaban IA, Homer CSE. Evaluating Jordanian women's experiences of maternity care services. Health Care Women Int. 2013;34(6):499–512. 7.Öztürk R, Murt A. Epidemiology of urological infections: a global burden. World J Urol. 2020;38:2669–79 Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014;28(1):1-13. doi:10.1016/j.idc.2013.09.003. 9.Echols RM, Tosiello RL, Haverstock DC, Tice AD. Demographic, clinical, and treatment parameters i nfluencing the outcome of acute cystitis. Clin. Infect. Dis. 1999;29(1):113–119. Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2007. Vital Health Stat. 13. 2011;169:1–38. Gupta K, Stapleton AE, Hooton TM, Roberts PL, Fennell CL, Stamm WE. Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infections. J. Infect. Dis. 1998;178(2):446–450. doi: 10.1086/515635. Stapleton AE, Au-Yeung M, Hooton TM, et al. Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clin. Infect. Dis. 2011;52(10):1212–1217. doi: 10.1093/cid/cir183. 13.Hillebrand L, Harmanli OH, Whiteman V, Khandelwal M. Bakteriyel vajinozisli gebe kadınlarda idrar yolu enfeksiyonları. Am. J. Obstet. Gynecol. 2002;186(5):916–917. doi: 10.1067/mob.2002.123987. 14. B. F. Dağcıoğlu Et Al. , "Is there an association between urinary tract infection and toilet type?," Turkish Journal of Family Medicine and Primary Care , vol.15, no.2, pp.335-340, 2021 Akaishi T. Post-Toilet Wiping Style Is Associated With the Risk of Urinary Tract Infection in Women. Cureus. 2024 Apr 12;16(4):e58107. doi: 10.7759/cureus.58107. PMID: 38738052; PMCID: PMC11088791. Wang K, Palmer MH. Development and validation of an instrument to assess women's toileting behavior related to urinary elimination: preliminary results. Nurs Res. 2011;60(3):158-164. 16. Moore KH, Richmond DH, Sutherst JR, Imrie AH, Hutton JL. Crouching over the toilet seat: prevalence among British gynaecological outpatients and its effect upon micturition. Br J Obstet Gynaecol. 1991;98:569–72. Parasuraman, Subramani; Wen, Lim Ee; Sam, Aaseer Thamby1; Christapher, Parayil Varghese; Kumar, Krishnamoorthy Venkates2. Analysis of correlation between defecation posture and risk of urinary tract infections among adolescent populations. Environmental Disease 1(2):p 77-82, Apr–Jun 2016. | DOI: 10.4103/2468-5690.185305 Tables Table 1. Distribution of demographic and clinical characteristics of participants according to infection status Variable Healthy (n=101) Infected (n=101) p-value Age (mean ± SD) 36.4 ± 11.8 36.9 ± 13.5 0.918 Educational level - Primary school 20 (19.8%) 24 (23.8%) — - High school 32 (31.7%) 34 (33.7%) — - University 49 (48.5%) 43 (42.6%) — Marital status 0.447 - Single 64 (63.4%) 58 (57.4%) - Married 37 (36.6%) 42 (41.6%) Chronic disease (present) 12 (11.9%) 17 (16.8%) 0.316 Hypertension (HT) 4 (4.0%) 8 (7.9%) 0.234 Diabetes mellitus (DM) 6 (5.9%) 6 (5.9%) 1.000 Asthma 1 (1.0%) 3 (3.0%) 0.312 Rheumatologic disease 3 (3.0%) 3 (3.0%) 1.000 Coronary artery disease (CAD) 1 (1.0%) 5 (5.0%) 0.097 Table 2. Logistic regression analysis of factors associated with infection status Variable OR 95% CI p-value Analysis Type Vaginal discharge (present) 0.20 0.10 – 0.42 <0.001 Univariate Vaginal douching (present) 0.32 0.13 – 0.78 0.009 Univariate Toilet type (s1, Western-style) 1.10 0.36 – 3.38 0.862 Univariate Toilet preference (s2, Western-style) 1.38 0.33 – 5.76 0.657 Univariate Toilet habit (s3, Western-style) 2.86 1.09 – 7.49 0.033 Univariate Cleaning frequency (s4, frequent) 2.13 0.67 – 6.76 0.201 Univariate Cleaning direction (s5, other) 0.46 0.20 – 1.07 0.078 Univariate Age 1.00 0.97 – 1.04 0.737 Univariate Factor 1: Cleaning habits 0.58 0.44 – 0.77 <0.001 Multivariate Factor 2: Application technique 0.65 0.48 – 0.89 0.006 Multivariate Notlar / Notes: OR: Odds Ratio CI: Confidence Interval “Western-style” = “Alafranga”; “Other” = different cleaning directions (e.g., not front-to-back) “Factor 1” represents toilet type, cleaning frequency, and related preferences. “Factor 2” represents cleaning direction and technique Additional Declarations No competing interests reported. Supplementary Files QuestionnaireEnglish.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers invited by journal 04 Dec, 2025 Editor assigned by journal 01 Dec, 2025 Editor invited by journal 15 Oct, 2025 Submission checks completed at journal 15 Oct, 2025 First submitted to journal 15 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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their lifetime. (1). Risk factors for UTIs include congenital abnormalities of the urinary tract, a history of diabetes mellitus (particularly those requiring insulin therapy), prior catheterization, urinary stones, spinal cord injuries, neurological disorders, pelvic organ prolapse, and pelvic floor trauma (2). The most frequently isolated pathogen in women with UTIs is Escherichia coli, which highlights the potential importance of anal and perineal hygiene practices after toileting in UTI prevention (3,4). While \u003cem\u003eE. coli\u003c/em\u003e commonly colonizes the intestinal tract, it may reach the urinary system through perineal contamination or fecal-to-urethral transfer. A study by Magruder et al. demonstrated a positive correlation between the abundance of E. coli in the gut and the frequency of recurrent UTIs (5). Due to anatomical factors\u0026mdash;specifically the short female urethra and the close proximity of the anus and vagina\u0026mdash;women are more prone to UTIs, as these features facilitate the migration of enteric bacteria to the urinary tract (6).\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThe data obtained in this study were analyzed using the Statistical Package for the Social Sciences (SPSS), version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for continuous variables, and as frequency and percentage (%) for categorical variables.\u003c/p\u003e\u003cp\u003eThe assumption of normality for the age variable between groups was evaluated using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Since the data were not normally distributed, the Mann-Whitney U test was used for comparison. For categorical variables, Pearson\u0026rsquo;s chi-square test and, where appropriate, Fisher\u0026rsquo;s exact test were employed.\u003c/p\u003e\u003cp\u003eTo identify the underlying structure of five categorical variables related to hygiene behaviors (toilet type, cleaning frequency, habitual behavior, and direction), Principal Component Analysis (PCA) was performed. The number of factors was determined using the criterion of eigenvalue\u0026thinsp;\u0026gt;\u0026thinsp;1, and Varimax rotation was applied to improve interpretability. The suitability of the data for factor analysis was assessed using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett\u0026rsquo;s test of sphericity. The resulting factor scores were added to the dataset for use in multivariate models.\u003c/p\u003e\u003cp\u003eTo assess the relationship between independent variables and the likelihood of being in the infected group, univariate and subsequently multivariate logistic regression analyses were performed. In the first model, the original independent variables (vaginal discharge, vaginal douching, toilet habits) were included. In the second model, factor scores derived from the principal component analysis were incorporated into the model. The validity of the logistic regression models was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Model explanatory power was assessed using the Nagelkerke R\u0026sup2; coefficient, and predictive accuracy was reported using classification tables. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant for all analyses.\u003c/p\u003e\u003c/div\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eData analysis was conducted using IBM SPSS Statistics version 25. Descriptive statistics summarized continuous variables as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, and categorical data as frequencies and percentages.\u003c/p\u003e\u003cp\u003eThe assumption of normality for the age variable between groups was evaluated using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Since the data were not normally distributed, the Mann-Whitney U test was used for comparison. For categorical variables, Pearson\u0026rsquo;s chi-square test and, where appropriate, Fisher\u0026rsquo;s exact test were employed.\u003c/p\u003e\u003cp\u003eTo identify the underlying structure of five categorical variables related to hygiene behaviors (toilet type, cleaning frequency, habitual behavior, and direction), Principal Component Analysis (PCA) was performed. The number of factors was determined using the criterion of eigenvalue\u0026thinsp;\u0026gt;\u0026thinsp;1, and Varimax rotation was applied to improve interpretability. The suitability of the data for factor analysis was assessed using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett\u0026rsquo;s test of sphericity. The resulting factor scores were added to the dataset for use in multivariate models.\u003c/p\u003e\u003cp\u003eTo assess the relationship between independent variables and the likelihood of being in the infected group, univariate and subsequently multivariate logistic regression analyses were performed. In the first model, the original independent variables (vaginal discharge, vaginal douching, toilet habits) were included. In the second model, factor scores derived from the principal component analysis were incorporated into the model. The validity of the logistic regression models was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Model explanatory power was assessed using the Nagelkerke R\u0026sup2; coefficient, and predictive accuracy was reported using classification tables. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant for all analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 202 women were included in the study. Of these, 50% (n\u0026thinsp;=\u0026thinsp;101) were classified into the \u0026ldquo;infected\u0026rdquo; group and 50% (n\u0026thinsp;=\u0026thinsp;101) into the \u0026ldquo;healthy\u0026rdquo; group. There was no statistically significant difference between the groups in terms of mean age or comorbid conditions (healthy: 36.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8 years; infected: 36.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5 years). Similarly, no significant differences were found in the presence of chronic disease (p\u0026thinsp;=\u0026thinsp;0.316), asthma (p\u0026thinsp;=\u0026thinsp;0.312), hypertension (p\u0026thinsp;=\u0026thinsp;0.234), diabetes mellitus (p\u0026thinsp;=\u0026thinsp;1.000), educational level (p\u0026thinsp;=\u0026thinsp;0.665), or marital status (p\u0026thinsp;=\u0026thinsp;0.447) (Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eWhen the distribution of categorical variables was examined, statistically significant differences were observed between the groups in the presence of vaginal discharge (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), vaginal douching (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), toilet type preferences (s1\u0026ndash;s3; each p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), cleaning frequency (s4; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and cleaning direction (s5; p\u0026thinsp;=\u0026thinsp;0.012). In the multivariate model, original variables including vaginal discharge, vaginal douching, toilet type, and cleaning frequency were included. Vaginal discharge (OR\u0026thinsp;=\u0026thinsp;0.20; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), vaginal douching (OR\u0026thinsp;=\u0026thinsp;0.317; p\u0026thinsp;=\u0026thinsp;0.009), and toilet habit (s3) (OR\u0026thinsp;=\u0026thinsp;2.858; p\u0026thinsp;=\u0026thinsp;0.033) were found to be significantly associated with the presence of infection.\u003c/p\u003e\u003cp\u003eTo identify the common structures underlying hygiene behaviors, a factor analysis was conducted on the five questionnaire items that showed statistical significance. The first factor was primarily loaded by s1, s2, and s4 and represented \u0026ldquo;toilet and cleaning habits,\u0026rdquo; while the second factor was loaded by s3 and s5 and represented \u0026ldquo;cleaning orientation and technique.\u0026rdquo; The factor scores derived from this analysis were added to the dataset for further modeling. The first factor\u0026mdash;\u0026ldquo;cleaning habits\u0026rdquo;\u0026mdash;was found to significantly reduce the risk of infection (B = \u0026minus;\u0026thinsp;0.545; OR\u0026thinsp;=\u0026thinsp;0.580; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, the second factor\u0026mdash;\u0026ldquo;application technique\u0026rdquo;\u0026mdash;also demonstrated a protective effect (B = \u0026minus;\u0026thinsp;0.425; OR\u0026thinsp;=\u0026thinsp;0.654; p\u0026thinsp;=\u0026thinsp;0.006) (Table\u0026nbsp;2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUrinary tract infections (UTIs) are among the most common infections encountered in clinical practice worldwide [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and represent a frequent health problem, particularly among women throughout their lives. According to Foxman et al epidemiological data suggest that more than half of all women will develop a UTI at least once during their lives. Because the female urethra is short and positioned near the anus and vagina, bacteria from the intestinal flora can more easily reach the urinary tract, contributing to higher infection rates in women [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe vagina is an important anatomical region in the pathogenesis of UTIs in women, serving as a potential reservoir for pathogenic bacteria and as an area where interventions could either reduce or increase UTI risk. Alterations in the vaginal microbiome, especially reduction of Lactobacillus species, can predispose women to UTIs by diminishing the protective barrier against uropathogens. Due to their bactericidal activity, vaginal Lactobacillus species are thought to be protective against Escherichia coli, the most common cause of UTIs [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, interventions that disturb the flora of this region may increase UTI risk. For example, in women with bacterial vaginosis\u0026mdash;who consequently have low levels of vaginal lactobacilli\u0026mdash;or in those who perform vaginal douching, the vaginal flora is weakened. This allows pathogenic bacteria to colonize more easily, indirectly increasing UTI risk [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In our study, both vaginal discharge (OR\u0026thinsp;=\u0026thinsp;0.20; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and vaginal douching (OR\u0026thinsp;=\u0026thinsp;0.317; p\u0026thinsp;=\u0026thinsp;0.009) were significantly associated with infection status, supporting findings from previous literature.\u003c/p\u003e\u003cp\u003eIn addition, studies have shown that toilet type preference (Western-style vs. squat) may also be associated with UTI risk. In our study, a statistically significant difference in toilet type preference was observed between the infected and healthy groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In a Turkey-based study by Dağcıoğlu et al., no significant relationship was found between UTI history and the type of toilet used at home or the frequency of Western toilet use; however, they did report associations with cleaning direction, use of public toilets (e.g., urinals), and use of toilet paper [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWiping habits and direction are also thought to have a long-term impact on UTI occurrence. In a study conducted in Japan, Tetsuya Akaishi found that women who wiped from back to front after defecation\u0026mdash;particularly in younger age groups\u0026mdash;may be at increased risk of UTIs, and suggested switching to a front-to-back wiping direction as a preventive measure [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, some studies have suggested that toileting posture may be related to UTI risk. In particular, the practice of urinating without fully sitting on the toilet seat (\u0026ldquo;hovering\u0026rdquo;) has been shown to result in incomplete bladder emptying, which adversely affects bladder health [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Moore et al. reported a 149% increase in post-void residual urine volume among women who did not sit comfortably during urination compared to those who did [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A representative study by Parasuraman et al. in Malaysia assessed the correlation between defecation posture and UTI risk, finding that most participants avoided Western toilets in public settings, preferring squat toilets, and that 10.7% reported a history of UTI [18]. Over time, hovering may affect pelvic floor function and bladder emptying, thereby increasing the risk of UTIs and lower urinary tract symptoms (LUTS). Consistent with these findings, our study also demonstrated that the behavioral factors representing toilet and hygiene habits were significantly weaker in the infected group, and that these habits had a protective effect against both UTIs and LUTS. This finding supports the notion that hygiene and toileting behaviors play an important role in reducing infection risk.\u003c/p\u003e\u003cp\u003eIn conclusion, this study was conducted to evaluate the relationship between urinary tract infection (UTI) occurrence and toilet habits as well as post-toilet hygiene behaviors among women, yielding several noteworthy findings. The data demonstrated that genital hygiene-related behaviors\u0026mdash;particularly the presence of vaginal discharge and the practice of vaginal douching\u0026mdash;were significant determinants of UTI risk. Additionally, daily habits such as toilet type preference, cleaning frequency, and cleaning direction were also found to have a statistically significant impact on infection risk.\u003c/p\u003e\u003cp\u003eResults from factor analysis revealed that behavioral constructs representing toilet and cleaning practices may have a protective role against UTIs. Specifically, consistent and appropriately directed cleaning habits, along with healthy toilet preferences, emerged as important protective factors not only against UTIs but also against lower urinary tract symptoms (LUTS).\u003c/p\u003e\u003cp\u003eThese findings suggest that toilet habits and personal hygiene practices may have a more substantial influence on women\u0026rsquo;s health than previously recognized. Raising public awareness, promoting proper hygiene behaviors, and implementing educational interventions\u0026mdash;particularly from an early age\u0026mdash;may contribute meaningfully to the prevention of UTIs. Furthermore, the results of this study provide a foundation for future large-scale, prospective research that may further elucidate the link between toileting behavior and infection risk.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUTI: Urinary Tract Infection\u003cbr\u003e\u0026nbsp;LUTS: Lower Urinary Tract Symptoms\u003cbr\u003e\u0026nbsp;PCA: Principal Component Analysis\u003cbr\u003e\u0026nbsp;SPSS: Statistical Package for the Social Sciences\u003cbr\u003e\u0026nbsp;OR: Odds Ratio\u003cbr\u003e\u0026nbsp;CI: Confidence Interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional ethics committee, and written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to writing and approving the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire used in this research was specifically developed for this study and has not been published elsewhere. An English version of the questionnaire has been uploaded as a supplementary file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all participants for their contributions to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the \u003cstrong\u003eInonu University Health Sciences Non-Interventional Clinical Research Ethics Committee\u003c/strong\u003e (Approval No: 2025/8051). Written informed consent was obtained from all participants prior to inclusion in the study. All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e]Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026Ouml;FY and BD conceived and designed the study. İT and R\u0026Ccedil; performed data collection and analysis. BD and AB drafted the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their gratitude to all participants who took part in this research and to the staff of Inonu University Faculty of Medicine for their valuable assistance.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNicolle LE. Epidemiology of urinary tract infections. Infect Med. 2001;18:153\u0026ndash;162.\u003c/li\u003e\n\u003cli\u003eSalvatore S, Cattoni E, Siesto G, Serati M, Sorice P, Torella M. Urinary tract infections in women. Eur J Obstet Gynecol Reprod Biol. 2011;156(2):131\u0026ndash;136.\u003c/li\u003e\n\u003cli\u003eLee DS, Lee SJ, Choe HS. Community-acquired urinary tract infection caused by Escherichia coli in the era of antibiotic resistance. Biomed Res Int. 2018;2018:7656752. doi:10.1155/2018/7656752\u003c/li\u003e\n\u003cli\u003eMao BH, Chang YF, Scaria J, Chang CC, Chou LW, Tien N, et al. Identification of Escherichia coli genes associated with urinary tract infections. J Clin Microbiol. 2012;50(2):449\u0026ndash;456. doi:10.1128/JCM.00640-11\u003c/li\u003e\n\u003cli\u003eMagruder M, Sholi AN, Gong C, Zhang L, Edusei E, Huang J, et al. Gut uropathogen abundance is a risk factor for development of bacteriuria and urinary tract infection. Nat Commun. 2019;10:5521. doi:10.1038/s41467-019-13467-w\u003c/li\u003e\n\u003cli\u003eHatamleh R, Shaban IA, Homer CSE. Evaluating Jordanian women\u0026apos;s experiences of maternity care services. Health Care Women Int. 2013;34(6):499\u0026ndash;512.\u003c/li\u003e\n\u003cli\u003e7.\u0026Ouml;zt\u0026uuml;rk R, Murt A. Epidemiology of urological infections: a global burden. World J Urol. 2020;38:2669\u0026ndash;79 \u003c/li\u003e\n\u003cli\u003eFoxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014;28(1):1-13. doi:10.1016/j.idc.2013.09.003.\u003c/li\u003e\n\u003cli\u003e9.Echols RM, Tosiello RL, Haverstock DC, Tice AD. Demographic, clinical, and treatment parameters i nfluencing the outcome of acute cystitis. Clin. Infect. Dis. 1999;29(1):113\u0026ndash;119.\u003c/li\u003e\n\u003cli\u003eSchappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2007. Vital Health Stat. 13. 2011;169:1\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eGupta K, Stapleton AE, Hooton TM, Roberts PL, Fennell CL, Stamm WE. Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infections. J. Infect. Dis. 1998;178(2):446\u0026ndash;450. doi: 10.1086/515635. \u003c/li\u003e\n\u003cli\u003eStapleton AE, Au-Yeung M, Hooton TM, et al. Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clin. Infect. Dis. 2011;52(10):1212\u0026ndash;1217. doi: 10.1093/cid/cir183. \u003c/li\u003e\n\u003cli\u003e13.Hillebrand L, Harmanli OH, Whiteman V, Khandelwal M. Bakteriyel vajinozisli gebe kadınlarda idrar yolu enfeksiyonları. Am. J. Obstet. Gynecol. 2002;186(5):916\u0026ndash;917. doi: 10.1067/mob.2002.123987.\u003c/li\u003e\n\u003cli\u003e14. B. F. Dağcıoğlu Et Al. , \u0026quot;Is there an association between urinary tract infection and toilet type?,\u0026quot; Turkish Journal of Family Medicine and Primary Care , vol.15, no.2, pp.335-340, 2021 Akaishi T. Post-Toilet Wiping Style Is Associated With the Risk of Urinary Tract Infection in Women. Cureus. 2024 Apr 12;16(4):e58107. doi: 10.7759/cureus.58107. PMID: 38738052; PMCID: PMC11088791.\u003c/li\u003e\n\u003cli\u003eWang K, Palmer MH. Development and validation of an instrument to assess women\u0026apos;s toileting behavior related to urinary elimination: preliminary results. Nurs Res. 2011;60(3):158-164.\u003c/li\u003e\n\u003cli\u003e16. Moore KH, Richmond DH, Sutherst JR, Imrie AH, Hutton JL. Crouching over the toilet seat: prevalence among British gynaecological outpatients and its effect upon micturition. Br J Obstet Gynaecol. 1991;98:569\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eParasuraman, Subramani; Wen, Lim Ee; Sam, Aaseer Thamby1; Christapher, Parayil Varghese; Kumar, Krishnamoorthy Venkates2. Analysis of correlation between defecation posture and risk of urinary tract infections among adolescent populations. Environmental Disease 1(2):p 77-82, Apr\u0026ndash;Jun 2016. | DOI: 10.4103/2468-5690.185305\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Distribution of demographic and clinical characteristics of participants according to infection status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthy (n=101)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfected (n=101)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.4 \u0026plusmn; 11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.9 \u0026plusmn; 13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.918\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e- Primary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (19.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e- High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34 (33.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e- University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43 (42.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e- Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64 (63.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (57.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e- Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37 (36.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42 (41.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChronic disease (present)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHypertension (HT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus (DM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.312\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRheumatologic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCoronary artery disease (CAD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Logistic regression analysis of factors associated with infection status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnalysis Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVaginal discharge (present)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.10 \u0026ndash; 0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVaginal douching (present)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.13 \u0026ndash; 0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eToilet type (s1, Western-style)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.36 \u0026ndash; 3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eToilet preference (s2, Western-style)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.33 \u0026ndash; 5.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eToilet habit (s3, Western-style)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.09 \u0026ndash; 7.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCleaning frequency (s4, frequent)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.67 \u0026ndash; 6.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCleaning direction (s5, other)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.20 \u0026ndash; 1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.97 \u0026ndash; 1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor 1: Cleaning habits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.44 \u0026ndash; 0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor 2: Application technique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.48 \u0026ndash; 0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotlar / Notes:\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u003c/p\u003e\n\u003cp\u003eCI: Confidence Interval\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Western-style\u0026rdquo; = \u0026ldquo;Alafranga\u0026rdquo;; \u0026ldquo;Other\u0026rdquo; = different cleaning directions (e.g., not front-to-back)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Factor 1\u0026rdquo; represents toilet type, cleaning frequency, and related preferences.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Factor 2\u0026rdquo; represents cleaning direction and technique\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Urinary Tract Infections, Hygiene, Toileting Behavior, Women, Logistic Regression, Factor Analysis","lastPublishedDoi":"10.21203/rs.3.rs-7762222/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7762222/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eTo evaluate the relationship between urinary tract infections (UTIs) and toilet habits as well as post-toilet cleaning behaviors among women.\u003cbr\u003e\n\u003cstrong\u003eMethods:\u003c/strong\u003e This cross-sectional questionnaire-based study included 202 women, equally divided into infected and healthy groups. Data on demographic characteristics, toilet habits, and post-toilet hygiene behaviors were collected. Statistical analysis included descriptive statistics, chi-square tests, principal component analysis, and logistic regression.\u003cbr\u003e\n\u003cstrong\u003eResults: \u003c/strong\u003eVaginal discharge (OR=0.20, p\u0026lt;0.001), vaginal douching (OR=0.317, p=0.009), and certain toilet habits (OR=2.858, p=0.033) were significantly associated with UTI presence. Factor analysis identified two protective behavioral constructs: “cleaning habits” (OR=0.580, p\u0026lt;0.001) and “application technique” (OR=0.654, p=0.006).\u003cbr\u003e\n\u003cstrong\u003eConclusions: \u003c/strong\u003eToilet and hygiene habits significantly influence UTI risk in women. Education on correct cleaning direction and consistent hygiene practices may help reduce UTI incidence.\u003c/p\u003e","manuscriptTitle":"Evaluation of the Relationship Between Urinary Tract Infections and Toilet Habits and Post-Toilet Cleaning Behaviors in Women: A Questionnaire-Based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-05 17:11:15","doi":"10.21203/rs.3.rs-7762222/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-11T17:05:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"99053333984559575742294757650507672690","date":"2025-12-11T15:50:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-04T14:00:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-01T21:50:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-15T08:41:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-15T07:54:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-10-15T07:52:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d4f856c-0c8a-472e-90d6-a42878db8203","owner":[],"postedDate":"December 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-05T17:11:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-05 17:11:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7762222","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7762222","identity":"rs-7762222","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}