Back to school season means youngsters spending time in locker rooms and college students doing the same in dormitory bathrooms. Despite everyone’s best efforts, the floors in those spaces have a reputation of not being the cleanest. Quickly doing your business while barefoot may seem like no problem. But lingering on the floor may be a virus that causes painful plantar warts.

“Plantar warts are one of the most common skin lesions we’ll see in our office,” says Marc Leonard, DPM, an OSF HealthCare podiatrist.

What are plantar warts?

Dr. Leonard says plantar warts (also called plantar verruca) are caused by a virus that gets into the bottom of your foot. The warts can spread easily.

“It looks like a callus. You see little growths. Sometimes they even satellite out, and we’ll get other little growths around that original lesion,” Dr. Leonard explains.

So, Dr. Leonard’s advice is to treat the issue early. If you see a wart, make an appointment with a podiatrist. Treatment is generally two steps. First, a provider will shave off the excess skin. Then, they will apply acid to the feet.

“It’s an acid that almost blows up that outer layer of tissue. Then we decompress it,” Dr. Leonard says. “Even with that, it still takes several treatments.”

Dr. Leonard says your feet will be sore for a couple weeks after treatment. So, you’ll want to stay off your feet if possible.

Left untreated, Dr. Leonard says plantar warts can cover the entire bottom of both feet and even your hands if you touch the warts. Walking will be painful, and so will treatment.

Prevention

If wart-covered feet and multiple acid treatments don’t sound like fun, there are easy prevention steps.

For dirty places like bathrooms and locker rooms, wear a slip on-type shoe like a shower shoe or flip flop. When you’re done, dry the shoes off or let them dry in front of a fan so they’re ready for the next use. Then, put on your sturdy, everyday shoes. In other words, don’t see this as an excuse to wear flip flops all day. Dr. Leonard and other podiatrists will tell you that your feet need more support.

Also, clean your feet, socks and shoes regularly. Don’t walk around in dirty or wet socks and shoes. If you sweat a lot, have extra pairs of socks to change into. And use a disinfectant wipe to clean your nail clippers.

Learn more

Learn more about keeping your feet healthy on the OSF HealthCare website.

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• Distance from home: If long drives are tough (perhaps you have a disability, childcare concerns or live in an area with rough weather year-round), consider sacrificing quality for proximity.
  
  “I’m a checklist person. So write it down and make it one thing you can check off for your day,” Spires says about finding the spark to make the drive to the gym. “Set an alarm on your phone. Have someone to go with you and motivate you. Give yourself a prize at the end of the week [for meeting workout goals].”
   
• Equipment: Some people might just need a treadmill. Some might just want weights. Others might want everything. More amenities typically mean a bigger gym and a higher cost, Spires says.
   
• Hours: Do you work odd hours and need a gym open at night? Checking the facility’s hours before you sign up is a must, Spires says. But, she says, there’s a flip side to a gym open 24/7. If you can go anytime, there might be less motivation as opposed to the urgency of “I need to get there before 5 p.m.”
   
• Privacy and crowds: Are you comfortable with communal locker rooms and showers, or do you want privacy? Ask to look at these areas on a tour. Ask about options to store your belongings. Are there lockers? If so, are they free?
  
  Or, do you get anxious in large crowds? Ask gym staff about peak hours and typically how many people are present then.

• Cleanliness: The last thing you want is an illness or infection to derail your fitness journey.
  
  “Are the locker rooms and bathrooms clean? Do you see staff going around and cleaning equipment? Are they dusting?” Spires says.
   
• Price: Do your research, Spires says. Some gyms offer the first week or month free, and you can see if it’s a good fit without breaking the bank. Or, ask if the gym offers discounts, such as for seniors, military, students or low-income residents.
  
  But, be wary of day passes, Spires says. It might be the way to go if, for example, you’re on vacation. But for your home gym, it might be better savings-wise to just get the long-term membership.
• Signing up and canceling: We’ve all seen the headlines about how meticulous it is to fill out gym contracts. In fact, several states have passed laws to make the process easier.
  
  “Talk about that up front with gym staff. Read the fine print,” Spires suggests. “If you go to a smaller, locally-owned gym or a recreation center [as opposed to big chain gyms], those are going to be easier to pay month-to-month.”
   
• Word of mouth: Take everything you see online with a grain of salt, but it can’t hurt to read gym reviews and even bring those up when touring with staff. Friends and family might also have advice.

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Bathrooms are filled with germ-breeding objects, and your toilet isn’t the sole culprit. 

Showers, toothbrushes, soap dispensers and any surface can be added to the germy list, according to Kaylin Heinz, an infection preventionist RN with OSF HealthCare. Heinz offers some cleaning tips for the different areas of your bathroom.

Shower Cleaning tips 

"When you're cleaning, go from top to bottom," Heinz says. “If you start cleaning your tub and then you clean your shower walls, you're going to have to re-clean the tub. When you're getting out of the shower, think about the moisture that's there. That's where the bacteria and fungus are going to grow, so you're going to want to get rid of that moisture if you can.”

The moisture buildup isn’t limited to linens, Heinz says. She recommends wiping down any moisture seen in the shower before getting out. Use a Squeegee, towel or paper towel to dry the area.

Normally, you should clean your shower at least once a week. If many people use the shower on a daily basis, or if someone is sick, Heinz says it is best to clean it every day.

Charles Gerba, PhD, a microbiology professor at the University of Arizona, told Reader’s Digest that bathmats and other fabrics are some of the dirtiest items, because people step on them with dirty shoes, and they stay wet and damp the longest.

Bathtubs’ path to bacterial and fungal infections

If you have a cut on your body, you can introduce bacteria or fungus to the area during a shower. 

"You can get athlete's foot or a staph infection just through the tub and not cleaning," Heinz says. She adds the film on the bottom of the shower or bathtub is a clear sign of where bacteria is living. Make sure to scrub the area, clean it and let it dry completely. If you notice discoloration in your shower or bathtub, Heinz recommends cleaning it immediately.  

Bathroom cleaning tips

"Your toilet can aerosolize and throw germs up onto surfaces within about five feet," Heinz says. “With flat surfaces, it can collect dust or other things that are in the air, so make sure you're wiping those down frequently. At least weekly, if not daily.”

Heinz recommends cleaning areas of your bathroom twice. The first time is for cleaning, the second time is for disinfecting. And don’t forget about the soap dispenser! Heinz says since this is one of the first places people reach to clean their hands, it’s one of the dirtiest places in the bathroom.

The Centers for Disease Control and Prevention (CDC) recommends the surface you’re wiping stays wet the entire time of contact to make sure germs are killed. You should clean surfaces with water and soap and scrub them before sanitizing or disinfecting them.

According to the CDC, “Cleaning removes most germs, dirt and impurities from surfaces. Clean with water, soap and scrubbing. Sanitizing reduces germs to levels public health codes or regulations consider safe. Sanitizing is done with weaker bleach solutions or sanitizing sprays. Clean surfaces before you sanitize them. Disinfecting kills most germs on surfaces and objects. Disinfecting is done with stronger bleach solutions or chemicals.”

Don't mix multiple chemicals

"With any products that you're going to be using, I'd make sure you're looking at the warning labels. I would definitely not mix chemicals," Heinz says. “If you are going to use one chemical and then use another, I'd make sure that you're rinsing thoroughly, making sure it dries, and then you can use the next product.”

If you’re diluting a chemical-based product, the CDC says to only use water at room temperature. Adding that an extra safety precaution is to wear eye and skin protection (like gloves) and store chemicals out of children’s reach.

Don’t forget your toothbrush!

Does your toothbrush hang out on the bathroom counter? You might want to rethink that.

"If you keep your toothbrush on the counter, it likely has fecal matter on it. So, put your toothbrush away or switch it often and clean it,” Heinz says.

Stop the spread | Toilet style

Here’s a habit change you can consider. Instead of flushing the toilet and just walking away, close the lid before you flush and keep the germs inside.

"Make sure when you're flushing the toilet, go ahead and close the lid. That's going to minimize the number of germs that are spraying all over your bathroom and aerosolizing," Heinz says.

Heinz adds another fun fact about the dirtiness of toilets – the minerals in the water. She says the minerals in toilet water can get stuck to the toilet bowl, which can also be a breeding ground for germs.

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Emily Isom has a resolution for kids and their parents: pledge to keep your hands clean and away from your face to prevent the spread of illness.

Isom, a certified medical assistant in pediatrics at OSF HealthCare, often sees young people biting dirty fingernails and not washing their hands properly. Here’s a primer:

Nail hygiene

Isom says people of all ages should trim their nails regularly. Once a week for fingernails and once or twice a month for toenails is a good rule of thumb. In between trimmings, watch for dirt and other filthy matter caught under the tip of the nail. Some nail clippers come with a scraper tool to remove that debris. But don’t use your mouth to clean your nails.

“Our nails carry so many germs and bacteria. That’s how people keep getting sick and spreading illness,” Isom warns, referring to putting fingernails in your mouth or on your face. You can also chip teeth and get facial warts and pimples from putting nails on your face, she says.

Some people have long nails, either real or artificial. In these cases, use a nail brush to regularly wipe the nails clean. If you’re at work or school and don’t have a brush, wash the nails thoroughly. Lather warm water and soap on the palms of your hands. Take your fingertips and scratch against the palm of the other hand to get the soap in the fingernail. Do that for 20 seconds. Then, pull down the fingertips to the palm of the same hand and massage the soap in further. Put your hands upside down under hot running water to rinse.

Hand washing

Isom says most people concentrate on their palms when hand washing.

“You need to get in between the fingers, underneath the nails, on the back of the hands, rub your knuckles together and scrub your wrists,” Isom says.

After wetting your hands, scrub all those areas in soap for 20 seconds. Find a song that has a 20-second chorus and hum it while you scrub. Then, rinse under warm water, and dry your hands with a clean, dry towel. Isom also suggests wrapping a paper towel around your hand when touching dirty surfaces on your way out of the bathroom. Use the towel to shut off the faucet and open the door, then throw the towel away after you exit.

If a hand dryer is what’s available, run your hands under the warm air until they are completely dry. Resist the urge to dry halfway and walk out. Isom says that may do more harm than good and attract bacteria faster.

“Bacteria want to live on wet surfaces. They’re attracted to moistness,” she points out.

If a soap and sink aren’t available, Isom says to use sanitizer or wipes that are at least 60% alcohol based. The same process applies – lather or wipe all parts of your hand and wrist thoroughly.

If you have a cut or wound on your hand, like a paper cut, wash with care.

“Get a washcloth wet with warm water. Put soap on it. Then, clean around the cut or wound,” Isom says. “Don’t put [soap] directly into the cut. That could really irritate it.”

Convincing kids

Isom is a pediatrics provider and a mother. So, she knows getting kids to wash their hands and mind their nails is easier said than done. Her advice: make it fun.

“When handwashing, sing the ABCs for 20 seconds. Or have them sing to you.” Isom suggests. “Make a chart. Every time they wash their hands, have them put a sticker on the chart. They are going to fall in love with it and want to wash their hands over and over again.”

And remember Simon Says? Isom says it works with her daughter.

“Simon says don’t touch your face,” Isom says with a smirk.

Learn more

Read more about how to keep your hands clean and prevent the spread of illnesses on the OSF HealthCare and the United States Centers for Disease Control and Prevention websites.

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“Mom! I have to go!”

“Hold it!”

It's an exchange you probably had as a kid on long car rides. But Uwais Zaid, MD, says it’s not just a funny vacation story. A person of any age or profession can find themselves holding their urine for a long time.

“In the medical field, we see this all the time,” says Dr. Zaid, a urologist who sees patients at OSF HealthCare. “When you’re rushing from patient to patient, doctors, nurses and technicians might not go to the bathroom as much as they should. They hold their urine the whole day.”

Dr. Zaid is sharing his playbook: why this phenomenon happens, how to fix it and what can happen if you don’t.

Why do we hold our pee?

Dr. Zaid says some people hold their urine simply based on the situation. They’re on a long car ride, and stopping will make them late. Or they might be at a dinner party and don’t want to seem rude by leaving the table.

“Then there’s another subset of people who just don’t have the desire to urinate. There’s something medically wrong,” Dr. Zaid explains. “As we get older, we can get dementia and be forgetful. So sometimes people just forget they need to urinate. Sometimes, you can have lack of bladder sensation from neurological conditions like multiple sclerosis. Or they might have had their bladder stretched for so long due to things like an enlarged prostate or scar tissue in the urethra.”

The consequences

In the short term, holding your pee will make you feel uncomfortable and antsy. We all know the feeling. Dr. Zaid has even heard from patients, “The feeling doesn’t bother me that much. What’s the problem?”

A few problems, the doctor says.

“It does increase your risk of urinary tract infections [UTIs]. Your bladder is almost like a swamp instead of flowing like a river. You have stagnation of urine,” Dr. Zaid says. “It can increase the risk of bladder stones. Also, the bladder is connected to the kidneys. It’s one fluid column. So if your bladder gets really distended, it can back up and hurt your kidneys. You can get kidney swelling.

“And when the bladder is chronically distended, you can get pouches called bladder diverticuli. Those pockets can hold on to urine and be sources for infection,” Dr. Zaid adds. Over time, these pouches can also lead to worse urinary control and even the inability to pass urine.

If holding your urine and not getting treatment for it lead to, for example, the kidney issues Dr. Zaid outlined, serious health problems and, rarely, even death are possible. Dr. Zaid says that shouldn’t scare people into drastically altering their bathroom habits. But it is something to be aware of.

Prevention and treatment

So what should be the best practices when we start thinking about the toilet?

• Before you even head for the bathroom, Dr. Zaid urges you to take care of your bladder and kidneys by staying hydrated. The U.S. Centers for Disease Control and Prevention (CDC) says daily water intake recommendations vary by person. So it’s a conversation you should have with your primary care provider. But, the CDC has general tips about staying hydrated and the dangers of drinking sugary or caffeinated drinks often.
   
• Plan ahead. For example, if you have a long commute, leave early to make time for rest stop breaks, and avoid drinks like soda. If you have a busy day at work, make a promise to yourself that you’ll take breaks to use the restroom. You can set a reminder alarm on your phone to nudge you.
   
• Try the “double void.”
  
  “You get to the toilet. You get done peeing. Wait 30 seconds, and then try to get a little more out,” Dr. Zaid suggests. “But don’t bear down and push because that creates trauma for your pelvic floor.”
   
• For older adults who might simply forget to use the bathroom, make sure they have someone checking in on them. Make sure they are empowered to speak up about their health. Setting an alarm reminder and having a clear path to the toilet can also help.

If someone consistently avoids or forgets to urinate or experiences symptoms like frequent UTIs, discomfort or difficulty emptying the bladder, it’s time to see a doctor.

Dr. Zaid says the first thing a urologist would do is look for anything blocking the urine. For men, this could be an enlarged prostate, scar tissue in the urethra, a bladder stone or tumor or trauma to the bladder area. For women, it could be a prolapse, when the bladder falls through the vagina.

“We can look inside the bladder with a camera. We can do a urodynamic study, which tells us about bladder function,” Dr. Zaid says.

Doctors would then form a treatment plan depending on what’s found. For example, bladder stones could be a “wait and see” situation. Or, a doctor could perform a procedure to remove the stones or break them apart and allow them to pass. Dr. Zaid says this is sometimes done with a laser in a minimally invasive procedure.

Dr. Zaid says in some more serious cases, the bladder stops working entirely.

“It’s something we can’t often fix. It’s really frustrating,” Dr. Zaid says.

Those people, he says, would need a catheter. It could be a short-term one to help drain the bladder or a long-term one to help correct the problem for a while.

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Now, health professionals are warning the public about a number of health concerns that can come with sitting on the toilet too long and scrolling on your cell phone.

Leave the phone at the door

Many people have gotten into the habit of taking their phone into the bathroom with them and scrolling TikTok or Instagram while they do their business. Kaylin Heinz, an infection preventionist RN at OSF HealthCare, recommends making the mental decision to not even take your phone with you.

"With you sitting on your phone and looking through TikToks, everyone probably knows that with social media, you look at it for a minute, and next thing you know it's been 30 minutes or an hour. So, I think it's a good idea to just not bring your phone in. Or if you are, just keep it to a minimum," Heinz says.

She adds if your phone tags along to the toilet with you, wipe it down with disinfectant wipes.

Bacteria, fungi and viruses, oh my!

A simple flush doesn’t get rid of the nastiness that is common in the restroom. Especially with bathrooms that have showers and bathtubs in them, the moisture in the room can lead to bacteria, fungi and virus growth, not just inside the toilet, but on all bathroom surfaces. Heinz calls these surfaces a “breeding ground” for germs.

Heinz says it’s important to consider every step of the process, from entering the bathroom to flushing the toilet to washing your hands. Where can the germs be? Are you really cleaning your hands?

"With sitting and scrolling, you're sitting there for long periods. Your hands are probably dirty before you go to the bathroom, because you're typically not washing your hands before you go to the bathroom. Then when you're sitting on the toilet, you're probably setting your phone down on a surface area that has germs," Heinz says. “Then you'll wash your hands, which you'll typically think your hands are clean, but they're not. Then you wash your hands and pick up the phone that was on the surface with germs, and now your hands are dirty again. And you're picking up the germs, taking them elsewhere, and spreading them to other people.”

Save the toothbrushes!

Does your toothbrush hang out on the bathroom counter? You might want to rethink that.

"If you keep your toothbrush on the counter, it likely has fecal matter on it. So, I would definitely put your toothbrush away or switch it often and clean it,” Heinz says.

Stop the spread | Toilet style

Here’s a habit change you can consider. Instead of flushing the toilet and just walking away, close the lid before you flush and keep the germs inside.

"Definitely make sure when you're flushing the toilet, go ahead and close the lid. That's going to minimize the number of germs that are spraying all over your bathroom and aerosolizing," Heinz says.

Heinz adds another fun fact about the dirtiness of toilets -- the minerals in the water. She says the minerals in toilet water can get stuck to the toilet bowl, which can also be a breeding ground for germs.

Clean up, clean up, everybody do their share!

Heinz recommends cleaning your bathroom at least once a week. If someone is sick, she says to clean it once a day, including using disinfectant wipes on all surfaces.

If you’re sick with a virus, your urine and feces can have the virus in them, which keeps the virus living and growing in the toilet longer.

Heinz recommends researching different products and reading over the spray labels, as some can interact with dust or debris, causing them to go into the air. She says if you prefer using wipes but only have spray at the moment, spray a paper towel first and then wipe the surface. She suggests using products with bleach in them, but to never mix chemicals.

“If you’re uncertain about a product, consider spot testing it first, as some finishes can be damaged,” Heinz adds.

The Centers for Disease Control and Prevention (CDC) recommends the surface you’re wiping stays wet the entire time of contact to make sure germs are killed. You should clean surfaces with water and soap and scrub them before sanitizing or disinfecting them.

According to the CDC, “Cleaning removes most germs, dirt, and impurities from surfaces. Clean with water, soap and scrubbing. Sanitizing reduces germs to levels public health codes or regulations consider safe. Sanitizing is done with weaker bleach solutions or sanitizing sprays. Clean surfaces before you sanitize them. Disinfecting kills most germs on surfaces and objects. Disinfecting is done with stronger bleach solutions or chemicals.”

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It can be an embarrassing ailment, but experts say it’s time to talk about it.

Urinary incontinence is when a person leaks urine by accident.

Uwais Zaid, MD, a urologist at OSF HealthCare in Alton, Illinois, says urinary incontinence can wreak havoc on a person’s social life and intimacy with partners. In other words, you can’t go out and have a good time with friends if you don’t know when you’re going to suddenly “go.”

“It can be associated with medications. It can be associated with aging,” Dr. Zaid says. “It can be associated with certain surgeries. A lot of our cancer survivors, whether they're from prostate cancer, cervical cancer, uterine cancer…they can have effects to their urinary control.

“Things as normal as having children,” Dr. Zaid adds as a cause.  “Over time [childbirths] can wreak havoc on the pelvic floor and on the urinary sphincter, and you can have urinary accidents as a result.”

While incontinence is often associated with older people, Dr. Zaid says all those precursors apply to any age.

Dr. Zaid says urinary incontinence breaks down into four groups.

• Stress: This is when the bladder sphincter does not work as well. Simple things like coughing, sneezing, laughing or bending over could provoke a release of urine.
• Urge: “When the bladder has a mind of its own,” Dr. Zaid remarks. This is when you have to go and you just can’t make it to the bathroom in time. Dr. Zaid adds that hearing or seeing certain triggers like running water or jingling of keys as you rush to enter your home might provoke urge incontinence.
• Overflow: This occurs when your bladder is full. This is the opposite of urge incontinence, Dr. Zaid says, and is associated with infections and kidney issues.
•  Functional: This applies to someone who may have normal bladder control but can’t get to the toilet in time due to physical limitations like arthritis.

A health care provider will ask you about your symptoms and health history to see which type of urinary incontinence is ailing you. Testing would typically follow. Each type of incontinence, generally, has its own treatment plan.

• Stress: A provider may recommend pelvic floor physical therapy as treatment. For women, a small device can be inserted to stop leaks. Surgery is also an option.
• Urge: You may be told to cut back on caffeinated food and drink, spicy food and alcohol. Medicine and surgery are also options.
• Overflow: “That's where we need to make sure we're not missing anything like a blockage - for women, a prolapse and for men, an enlarged prostate.” Dr. Zaid says.  “A stone in the bladder. A tumor in the bladder. And we also need to make sure the kidneys are functioning okay.”
• Functional: Since people with this type of incontinence may have a normal bladder, external solutions are necessary. For example, keeping your route to the bathroom clear of obstacles like chairs and doors. For older adults with physical limitations, have a walker handy for when the need to go arises.

Other tactics include urgency suppression, when you distract yourself from thinking about urinating. You could take long, relaxing breaths or sit completely still.

Timed voiding is when you schedule times to urinate. Dr. Zaid says this can work in both directions. If you are urinating too frequently, set a timer on your phone to go every hour. Then when you get comfortable, you can increase the time. If you are holding on to your urine too long, set a plan, get comfortable then decrease the time.

The bottom line: if something seems off about your bathroom visits or if friends or family remark “You’re sure in there a lot,” see a doctor.

“If you’re chronically wet down below, it increases your risk of fungal infections and skin breakdowns,” among other serious health issues, Dr. Zaid says.

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Previous coverage

Gotta go? Try these six bladder tips

To paraphrase George Carlin: It’s 50% universal.

At some point in their life, many men will have to think about benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate. BPH often means the flow of urine from the bladder is blocked by the prostate gland growing inward, leading to frequent and annoying trips to the bathroom. But BPH can also lead to more serious problems of the bladder, urinary tract and kidneys.

According to the National Kidney and Urological Disease Information Clearinghouse, the most common prostate problem for men over 50 is prostate enlargement. By age 60, more than half of men have BPH, according to the American Urological Association. By age 85, the number climbs to 90%.

Luckily, BPH is treatable.

Ronan Lev, MD, is a urologist who provides care through OSF HealthCare in Alton, Illinois. His practice was recently designated as a Center of Excellence by UroLift®, an organization that introduced a quick, minimally-invasive procedure to deal with an enlarged prostate and allow for an easier recovery with fewer complications such as erectile dysfunction. The Center of Excellence designation is provided to individual physicians who have achieved a higher level of training and experience with the UroLift system. In Dr. Lev’s case, he has performed more than 200 UroLift procedures.

Dr. Lev says minimally-invasive procedures such as UroLift signal a shift in BPH strategy toward bladder preservation.

“In the past, we were very happy about symptoms relief. Everything was focused on symptoms relief. And if you said, ‘I'm feeling better, took a pill,’ that was fine for us,” Dr. Lev says. “What we learned over time is that it was causing some damage to patients because as medications were failing, their bladders were making up the difference. Because the bladder is a very, very strong muscle, and we can’t appreciate how strong our muscle is working.”

Dr. Lev’s message to men: See a doctor if something doesn’t seem right down there.

“Men have a tendency to pare down their issues and say, ‘Oh, it's not an issue. It's not a problem,’” Dr. Lev says. “But if they really think about it, I would say most men compare themselves to yesterday. They don't compare themselves to what it was a year ago. If they would think about that, they would realize that it's a lot worse than they really think.

“If we can do a procedure in the office under very mild sedation and improve your quality of life,” Dr. Lev explains. “When you're 90, every day counts, not what's going to happen in a couple of years. So we if we can improve your quality of life, that's really crucial.”

At OSF HealthCare in Alton, the UroLift procedure will be done on an outpatient basis. However, UroLift is not yet available in every community served by OSF HealthCare. You can learn more about urology and find an OSF HealthCare urologist here.

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