Defecation (or Pooping) is the final step of digestion where we eliminate waste material via the anus. The frequency of pooping varies from few times daily to few times weekly. How we clean ourselves after a poop is however a topic that is rarely discussed. In most countries people use the toilet paper to clean themselves while lesser population prefers using water. While water is considered more hygienic, tissue paper is most widely used around the globe. However, toilet paper does have some drawbacks which we shall consider here. The Origin of Toilet Paper dates back, in China, during the Zhou Dynasty (618-907 AD), era during which an Arab traveler described that the Chinese used paper to wipe themselves instead of washing themselves. At that time the rest of the world used either water, natural materials (leaves, stones) or manmade materials (cloth, stick). In Rome they used a sponge mounted on a stick (tersorium) dipped in water to wipe the butt, in Greece they used the three stone technic and in India and Pakistan water was and is still being used. Afterwards paper technology spread from China through the middle-east to medieval Europe in the 13th century. In US, toilet paper was introduced in 1857 and by 1920s it was commercially sold under the brand name Gayety’s Medicated Paper (credited to its inventor Joseph Gayety). Most countries and cultures gradually shifted towards the use of toilet paper over water. While some people consider the use of water more hygienic for cleaning after relieving themselves, other people hesitate over it for mere reason that there is direct contact between the hands and feces. For this reason the bidet, since its invention in France in the 1710s, has been evolving with main purpose to make it easier to clean oneself by reducing the contact between hands and feces. Water, at low or medium pressure and warm temperature, flows directly from a nozzle to the anal region,washing away the feces. Today high tech bidet, the Japanese Toto wash let, is present in 70% of all Japanese houses [1].More house over Asia are having toilet with attached water hose. The idea behind is to encourage more people to wash their butt with water rather than wiping with tissue paper.

Whether one is using water or tissue paper, the technic of cleaning is important. While water washes the feces thoroughly, tissue paper tends to move it along direction of wiping. In men, any direction of wiping, back-to-front, front-to-back, side-to-side is just fine. In women, a front-to-back is the recommended direction of wiping for preventing infection due to proximity of vagina and urethra to anal region. As advised by doctors, the action should be gentle around the anal region and not too hard or too fast which can cause skin irritation or anal fissure. Another important point is whether to sit or stand for cleaning. Standing will just hide some poops somewhere around or stuck in hairs around the anus while washing will make a splash around the anus [2]. The best way is to sit, with the buttock cheeks wide apart and do the wiping or washing.

Water is considered more hygienic since all feces and urine are washed off and leaves no bad smell in underwear whereas wiping does leave residual smell behind no matter how much one scrubs with toilet paper. Water washes away feces particle that may get stuck in hairs around our bums which is not the case for wiping. In women during their menses, water is recommended by doctors as being more hygienic than wiping to avoid the risk of infection after pooping. Washing the butt and genital with water will keep them free of germs thus preventing infection in case of injury oranal intercourse. However some people do complain that it leaves the feeling of wetness in underwear which is quite uncomfortable. For this water followed by drying with tissue is the solution. With water, there is less friction against the skin. Water can cause infection if the skin is moist over a long time but this is rare as the bacteria are washed during a shower.

The main advantage of wiping is that it avoids the direct contact between poop and hands, which is also true for bidet. Toilet paper is easy to carry and can be used anywhere. It is true that it leaves an awful smell in underwear after a trip to the washroom and has to be use in the proper direction to avoid infection, especially in women. Provided proper technic is used, cleaning is quick and the person has no feeling of moistness as associated with washing. If the paper is dry, soft paper can be used or more conveniently wet wipes can be used.

Wiping will leave stinky residue in perineum region. As cited by the author of The Big Necessity Rose George “there are millions of people walking with dirty anuses while they think they are clean”.Toilet paper removes the feces, leaving residue, but water washed everything around thoroughly. If washing with bare hands is the problem, then one can use wet wipes or the bidet. Dr Ekwaro Obuku president of Uganda Medical Association advocates the use of both toilet paper and water for cleaning. Dr Vincent Karuhanga of Friends Polyclinic in Kampala emphasizes that washing the hands after visiting the washroom and this is essential both for wiping or washing. Many people using toilet paper don’t wash their hands after visiting the washroom, therefore carrying germs and ready to give someone a handshake.

Toilet paper is marketed under different brand names but the raw materials and finish products are similar. They are made either from trees or recycled cellulose fibers. Chemical substances are added to improve the quality of finished products. If the paper is scented, fragrances such as cinnamicaldehyde and cinnamic alcohol are present. Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a commonly used preservative in most brands of toilet paper. In the United States, cases of allergic contact dermatitis (ACD) have been reported ever since the toilet paper was immercialized. Patients have complained of perianal and perineal ACD upon use of toilet paper which resolved once they discontinued the paper [3]. A survey has showed that toilet paper do contain several organic substances such as bleaching agents, dyes, anti-foaming agent and binding agents that do have considerable toxicological value [4]. Whether it is a baby’s bum or adult’s bum, the risk of ACD exists with each wipe. With each visit to the washroom thearea affected just keep increasing in size and if fissures do occur, then risk of infection through skin increases.

Wiping should be done in a proper way to avoid injury, anal fissure or aggravating hemorrhoids. The toilet paper used should not be dry as these cause irritation or anal fissure that can take up to eight weeks to heal. Most doctors nowadays explained that their patients complained of irritation of anal region because they either wipe too fast or too hard, to whom the doctors recommend using wet wipes. Other patients have complained of hemorrhoids and anal abscess which were very painful when wiping. The following condition may get aggravated by use of toilet paper instead of water – rectal itching, hemorrhoids, anal fissure, fistula, and abscess and pilonidal cyst.

Wiping may result in localized irritation or abrasion to skin and mucosa around the anus. There is also residual contamination of external body surface and if people wipe from back-to-front, they are pulling bacteria from the anus towards the front of the body. In men this direction is fine but for women this increases the risk of urinary tract infection (UTI) due to proximity of their urethra. Most gynecologists agree that 70 per cent of bacteria causing UTI are from the anus origin, with E.coli bacteria as the most common cause of UTI [5].Water may carry the bacteria in some cases but wiping just move the feces from back to front with residual feces which get stuck in hairs. For women to avoid this they can use water or wet wipe but in a direction away from vagina, not vice versa as proposed by Dr Charles Kiggundu, a gynecologist at Mulago Hospital. Here at The first affiliated hospital of Zhengzhou University, the statistic shows that UTI in women are mostly due to bacteria from anal region which was due to improper technic of wiping by patients and toilet hygiene.

The anal region has an abundance of nerve ending that make anal sex pleasurable for many people, be it homosexual or heterosexual. This presents a risk of spreading infection, including sexually transmitted diseases, hepatitis viruses and intestinal parasite, between partners. If an anal tear exist, blood contact multiplies the risk of fecal-blood transmission, then fecal-oral transmission. Wiping your butt with toilet paper leaves a stinky residue and licking isn’t appealing. It is obvious that wiping is not the best choice of cleaning the butt prior to anal intercourse. On the contrary, washing with water is the preferred way to freshen the anal opening and remove most germs.

Countries and culture may be the reason to one’s practice of cleanliness which cannot be changed overnight. If we can wash our body with soap and water, then why cannot we wash the buttsimilarly. I personally prefer the wipe, wash and dry with toilet paper technic. I would rather be walking with moist underwear but a clean bottom, than carrying my dry stinky anus around thinking it is clean. Finally I conclude that cleanliness lies in the anus of the beholder.

1. Stevenson S. I tried a Japanese wonder toilet. Americans need to drastically rethink the way we clean our butts. 6: 2014.
2. Lemco T. You’ve Been Wiping Your Ass Wrong Your Entire Life - Here’s The Correct Way. 2016.
3. Gardner KH, Richardson DM, Pittelkow MR. The hazards of moist toilet paper: allergy to the preservative methylchloroisothiazolinone /methylisothiazolinone. Arch Dermatol. 2010; 146: 886-890.
4. AnneAbildgaard SHM, Stuer-Lauridsen F. Survey of Chemical Substances in Paper Handkerchiefs and Toilet Paper. 2003.
5. Frideman S. Do You Even Know How to Wipe Your Own Butt? Men's Health. 2017.