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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Infecting the food supply, the show (based on a video game) infers that the fungi cordyceps have mutated and quickly spread to humans.

What are cordyceps?

Cordyceps (specifically Ophiocordyceps unilateralis in the show) are a group of fungi which has hundreds of species. Cordyceps can infect certain insects, like ants and tarantulas, by becoming parasites. They can even be parasitic to other fungi as well. The cordyceps fungus is known to cause insects to behave erratically, searching for a place with more sunlight and warmth. When the insect dies, a fungal growth emerges from its head, releasing spores and looking for its next victim.

“The Last of Us” tells the story of a fungal infection zombie apocalypse. Is this scenario realistic? Sharjeel Ahmad, MD, an infectious disease specialist with OSF HealthCare, dives into that question. The short answer is “no.” But a more complex perspective is needed, Dr. Ahmad stresses. It should include being aware of common fungal infections that are possible in humans.

The first thing to provide viewers with peace of mind comes down to mammals’ body temperature.

Body temperatures’ protection

"Our body temperature is quite high, and many of these fungi can't survive in those body temperatures. So that's one way we're protected," Dr. Ahmad says.

Certain fungal infections can happen in people with pre-existing lung damage (smoking, prior lung damage from infection or occupational exposure) or have a weakened immune system. Instead of losing sleep about cordyceps, Dr. Ahmad says histoplasmosis is much more common in the Midwest and is cause for more concern. 

"If you're living in Illinois, you've been exposed to it."

The Centers for Disease Control & Prevention (CDC) says histoplasmosis is a lung infection, or pneumonia. It happens in only one to two people per 100,000 who breathe in spores from the fungus Histoplasma outside.

It's the same with blastomycosis, a lung infection caused by a soil-based fungus, blastomyces, which is located in roughly half of the United States. CDC’s estimated areas map shows blastomyces likely living throughout the Midwest and across the entire East Coast. Blastomycosis symptoms include fever, sweating, shortness of breath and cough.

Candida auris: a bigger concern

Candida auris (C. Auris) is an emerging fungal infection which has attracted clinical attention, Dr. Ahmad says. It's a multi-drug-resistant yeast that spreads from person to person, especially in medical facilities.

"Candida auris was first discovered in the ear canal of a 70-year-old Japanese woman in Tokyo back in 2009. Now we have had this infection in many different countries, even in the U.S.," Dr. Ahmad says. "It's one of those species that can survive between 98.6 degrees Fahrenheit and 104 degrees." 

C. auris can cause different kinds of infection. Symptoms can mimic bacterial infections with symptoms being dependent on where in your body the fungus infects. CDC says people can have C. auris on their skin, but not have symptoms at all, meaning it's possible for the fungus to spread on touched surfaces and to other people. Those affected are normally experiencing serious underlying medical conditions and using a device such as a breathing or feeding tube, or a catheter.

Dr. Ahmad says that the overuse of antibiotics has also played a role in the development of the threat of drug-resistant fungal infection. Excessive use of broad-spectrum antibiotics can increase the risk of a fungal infection. He points out that the agricultural use of antifungal pesticides (similar to medical antifungal drugs) can contribute to the development of drug-resistant fungal strains.

“The Last of Us” situation is unlikely

Viruses are simpler creatures, Dr. Ahmad says, which means they can mutate more easily, adapt and spread from species to species. On the other hand, fungi are more complex so there are specific parameters needed to be met for them to infect a host. 

"That jump theoretically could be possible but it's not like we're going to wake up one day and just like “The Last of Us,” and it goes through a contaminated food supply. I don't see that happening," Dr. Ahmad says.

Many fungal infections are not known to jump from human to human. They normally happen due to people being outside and inhaling spores which can come from things such as decaying logs, fallen trees, birds' nests, bat or bird droppings, and really any soil. The University of Minnesota Extension says common fungi in yards and gardens only live on decaying plant matter, so they do not impact living plants. 

If there is a concern for fungal infection, it is important to get seen quickly to figure out what's going on per Dr Ahmad. Outdoor workers including farmers, or those on a construction site can be infected, as the spores can aerosolize during demolition and cleanup projects.

"Sometimes we have a patient who is a smoker, and they come in for a low-dose CT lung cancer screening. They have zero symptoms, but a spot is found on the lungs that wasn't seen before. Through testing, the spot is found to be due to Histoplasmosis,” Dr. Ahmad says.

Coccidioidomycosis (pronounced cahk-sid-ee-oy-doh-my-KOH-sis), commonly known as valley fever, can be found in the Southwestern United States in desert environments. While everyone is likely exposed to these spores, only a few will be impacted. It is more commonly seen in the Southwestern U.S. and South America, but it was also found in Washington State in 2015. 

Increasing temperatures or changing weather patterns can evolve the geography of where fungi can affect people. People moving to new regions of the world, along with poorer living conditions can also play a role. Extreme weather events such as storms, heat waves, droughts and wildfires can promote the growth and spread of spores. Flooding can cause mold not just outside, but also inside people's homes. 

Why don’t fungal infections take over human brains?

"The human mind is very, very complex and is a different beast than an insect's brain. That kind of specialization, for the fungi to adapt and parasitize a human mind, controlling something as complex as the human cerebral cortex versus the brain of an insect, needs a high degree of adaptation and evolution. That does not happen quickly," Dr. Ahmad says. 

Does spring worsen the risk?

Spring is here and fungal infections may impact more plants, but warmer weather does not necessarily mean humans should be worried about getting a fungal infection. Throughout the year, activities which can increase the risk of exposure to fungal spores, such as gardening can be dangerous for individuals with weakened immune systems. While wearing masks outside could provide some protection, Dr. Ahmad says it won’t take away the threat completely.

“The Last of Us” season two premieres on Max on April 13. Dr. Ahmad says while the show is fictional, the increased attention to the rising threat of fungal infections overall is a positive thing.

"It makes for really good television, and it brings good awareness around fungal infections."

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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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