To Sit or to Stand – That is the Question

When I was four years old, I asked my Mom why my Dad’s vagina hung over the sink. From that day on, my dad became a sitter. There’s a part of me that likes to think that this is when my path to Urology really started…But I can’t be certain.

(For those of you who are concerned, don’t worry, at some point my parents did teach me the difference between vaginas and penises.)

So which is it, men? Should you sit or should you stand? 

Let’s talk about it.

Should men sit or stand when urinating?

The shortest answer is: it’s a matter of personal preference.

Some men find it easier to empty their bladders when they stand. I have found that many men, as they age, naturally start to sit down to empty their bladders. 

I have found that many men, as they age, naturally start to sit down to empty their bladders.

This is when I need to ask you about how you are emptying your bladder. 

Since the holidays are around the corner, let’s organize this into a naughty and nice bladder behavior list. 

The “Naughty” list (What not to do/things to watch out for): 

• If you’re pushing to empty your bladder
• You experience a spraying stream
• Your urine stream stops and starts
• It’s hard to keep urine from leaking on the way to the bathroom
• You’re constantly holding your urine for 4+ hours during the day
• If you’re waking up more than twice a night to pee
• And worst of all, CONSTIPATION! It shouldn’t be a struggle to pee

The “Nice” list (signs everything’s okay):

• It’s a relaxing feeling to empty your bladder
• You have a nice, straight stream
• Being able to write your name in the snow
• On average, you’re  emptying your bladder every 2-3 hours during the day
• You’re sleeping through the night, or waking up once
• One normal bowel movement, without straining, every day

Notice that sitting or standing didn’t make either list. 

That’s because it really doesn’t matter all that much. Often, my male patients are embarrassed to confess to me that they sit down. Notice I used the word ‘often’ because I promise you, I hear this a lot! 

It might be weird to you, but many men find that as they grow older, sitting to empty their bladder is the easier thing to do. Now if this is because you might be unsteady on your feet, then that’s OK. If you are sitting to pee because your bladder and/or prostate aren’t functioning well, then you need to come see me. 

If you are sitting to pee because your bladder and/or prostate aren’t functioning well, then you need to come see me.

And hear me out – SIZE DOESN’T MATTER. I’m talking about your prostate, boys. At least half of you reading this have a diagnosis in your medical record of ‘BPH.’ Scientifically, this is benign prostatic hypertrophy or hyperplasia. Simply, it means your prostate has some extra oomph to it. 

As you age, it is natural for your prostate to increase in size. The only reason to worry about this is if it is hindering your ability to empty your bladder. And THAT’S when size matters.. 

I know it seems contradictory, but I have seen prostates the size of oranges and those men have no issues peeing. Conversely, I have seen prostates the size of a lime making a man miserable from obstruction. It basically comes down to physics – big prostates and small prostates can cause obstruction. And if you are obstructed, then you’re in trouble. 

The first signs of prostatic obstruction include a weakening stream, pushing to empty, feeling that you can’t empty, and waking up more at night to pee. Further signs that occur later may be a split stream or a stream that starts and stops. If your bladder muscle over time is starting to grow tired of working against your prostate, you can then develop irritating symptoms like urgency, frequency, or leaking on the way to the bathroom. You want to get your prostate under control before the bladder starts talking back. 

The first signs of prostatic obstruction include a weakening stream, pushing to empty, feeling that you can’t empty, and waking up more at night to pee.

So now we circle back to the beginning. 

If you’re a sitter, that’s OK. If you’re a stander, that’s OK too. But if you are choosing to sit or stand because you are having trouble peeing, then you need to find a Urologist. 
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