Discomfort in a public toilet caused by the public nature of the premises is a phenomenon acknowledged only anecdotally and even then with reservation. This discomfort exists as a range from no discomfort at all at one end, to total inhibition at the other.

At one end of the scale are men and women who see voiding as a purely conscious action: it is an action that they can do without hesitation however crowded or public the situation. They cannot understand how anybody can have any difficulty voiding.

At the other end of the spectrum are individuals of both sexes who are severely inhibited in public situations to the extent of being unable to relieve themselves; there are two conditions: one is known as paruresis, or shy bladder syndrome; the other is parcopresis, or shy bowel syndrome. These are recognised as social anxiety conditions which result in a subconscious switching off of the voiding mechanism: however much the individual wishes to void, the body does not respond. Currently psychotherapy is advised: cognitive behaviour therapy being the current recommendation.

This document does not seek to address either of these two populations, though the proposals would significantly help those affected mildly by shy bladder and or shy bowel syndrome.

However in between these two extremes lies a population which is variously affected. This is something that is rarely talked about. This is backed up by psychological research; also UKPT has been in receipt of a wide range of anecdotal evidence. From now on this document refers only to men and women in this mid-range. The current cramped or inappropriate layouts of public toilets result in public discomfort, resulting in a reduction in throughput, which becomes negatively reinforcing i.e. if individuals take longer to relieve themselves, this increases the crowding, so causing individuals to take even longer.

For women the main issue is the insufficient number of cubicles, leading to queuing and thence to time pressure.

For both men and women, other issues revolve around:

1. lack of sound privacy
2. lack of some visual privacy caused by over large gaps at floor level, inadequate height of partitions and doors, and the gaps between panels when the overlap method of construction is used
3. inadequate or broken locks.

Men have a varying level of discomfort when

1. having to stand next to another man, or between two men.
2. the relatively narrow spacing of urinals results in elbow to elbow contact
3. there are no modesty screens between urinals, or the screens are inadequate
4. using troughs
5. there are queues
6. there is circulation going on behind them
7. in stark lighting conditions
8. in silent conditions.

Evidence is both documentary and anecdotal. It is estimated, based on feedback, that about one third of men exhibit such discomfort, but are reluctant to admit to it for fear of ridicule. See:

1. Psychological research.
2. the Urinal Quiz illustrating the concept of Urinal Etiquette.
3. the Big Issue cartoon of 7 June 2003 No 469

These are elaborated on below.

Middlemist, R. D., E.S. Knowles, and C.F. Matter. 1976. Personal space invasions in the lavatory: Suggestive evidence of arousal. Journal of Personality and Social Psychology 33:541-546.

(Note that arousal in this context refers to anxiety and not to sexual arousal. – Ed)

The hypothesis that personal space invasions produce arousal was investigated in a field experiment. A men's lavatory provided a setting where norms for privacy were salient, where personal space invasions could occur in the case of men urinating, where the opportunity for compensatory responses to invasion were minimal, and where proximity-induced arousal could be measured. Research on micturation indicates that social stressors inhibit relaxation of the external urethral sphincter, which would delay the onset of micturation, and that they increase intravesical pressure, which would shorten the duration of micturation once begun. Sixty lavatory users were randomly assigned to one of three levels of interpersonal distance and their micturation times were recorded. In a 3-urinal lavatory, a confederate stood immediately adjacent to a subject, one urinal removed, or was absent. Paralleling the results of a correlational pilot study, close interpersonal distances increased the delay of onset and decreased the persistence of micturation. These findings provide objective evidence that personal space invasions produce physiological changes associated with arousal.

The result is that the delayed initiation extends the time taken; the reduced voiding time results in incomplete voiding and hence in increased frequency of use of a toilet.

Although it has no association with shy bladder, this quiz demonstrates the unspoken behaviour pattern exhibited by many men, known as Urinal Etiquette.

This behaviour consists of:

1. maintaining maximum separation between 2 men
2. avoiding standing between 2 men
3. if forced to stand next to someone, and there is a choice between standing next to one person or next to a group of 2 or more, joining the group.
4. If these conditions cannot be met, either using a cubicle, or leaving and returning a bit later.

The result is that the usage of urinals is lower than that installed, so reducing throughput.

Performing a search on the internet using the term “Urinal etiquette” throws up 42,000+ hits, which indicates that this is not an isolated phenomenon.

The Big Issue magazine is sold on the High Street by unemployed vendors; its content is general news and matters related to unemployment. This cartoon (see Appendix B) shows 4 men elbow to elbow at a trough. A thought bubble above one of the men says” Sh*t.-sh*t! I can’t get started..!” The author contacted the cartoonist, who explained that he had been in that situation himself, he knew his mates had as well, but nobody spoke about it. Hence why he decided to bring it into the open via the medium of a cartoon.

The behaviours outlined in 2.4 – 2.6 above have been witnessed in operation many times. The irony is that spacing urinals close together reduces throughput because:

1. a proportion of men hold back and wait for a suitable space to become available and/or
2. voiding takes longer to initiate and to complete and/or
3. voiding frequency increases.

Appendix A shows how providing fewer urinals at a greater spacing provides more usable urinals than more urinals packed closer together.

Use ambient lighting that is soft in tone.

To eliminate total silence, provide where feasible a sound track, which can be relevant to the premises. The default could be the sound of waves. 

1. Use bowl urinal, not troughs. No-one likes their difficulty in starting to void to be evidenced by the lack of fluid in the trough. Nor do they wish to see other people’s urine.
2. spacing to be such as to avoid the feeling of touching elbow to elbow: the recommendation is 800mm. 
3. encourage a feeling of personal space and visual privacy by providing privacy screens between urinals. The bottom of the screen should be no more than 500mm off the floor, and to top to be a minimum height of 1700mm above the floor.
4. provide visual privacy by using privacy screening between the urinal area and other areas e.g. wash basins, hand dryers, entrance door; the sizing to be as above.
5. hand dryers and towels to be separated from urinals by 800mm, along with a privacy screen.

The area behind men standing at urinals should not be a gangway, nor an area for circulation e.g. a hand washing or drying area. Instead the preference is for the entrance to be into an area with cubicles on one side, and hand washing and drying on the other. Walking through this area is to lead to the far part of the room where the urinals are located, on both sides. Screening between the two areas to be a minimum of 1700mm.

Where hand washing and drying cannot be separated in this way, but has to be level with the urinals, then a 1700mm plus high screen should separate them: see JDWetherspoon pub in Macclesfield.

In large facilities urinals should be grouped in odds numbers e.g. fives or threes, with further high level screening between the groups

In these locations, the 2 urinals are presently often put side by side, often at the end of a narrow room. If there is space to achieve the correct separation of 800mm and a privacy screen, there is no problem; if not, they should instead be located at 45 degrees, one into each corner.

Other recommendations are to place them in different areas of the room, instead of side by side, so long as the other guidelines above are met.

A common mistake in small toilets e.g. 2 urinals and one cubicle, is for the hand dryer to require the user to stand in almost the same space as the urinal user, often a right angles. Again it is preferential to put the urinal side by side with the dryer or wash basin, with a 1 meter separation, and with a full height modesty screen between them.

Alternatively instead of the standard 2 urinals and one cubicle, provide one urinal and two cubicles.

The seat should be counterbalanced so that when not sat upon, the counterweight lifts the seat; if a seat cover is fitted, its weight should be adequate to overcome the counterweight of the seat. The aim is to ensure that the seat is always upright, to avoid getting wet when the pan is used standing.

The number of cubicles provided in female toilets should be based on quantitative data that takes into account:

1. the longer time needed to void due to clothing
2. the longer time needed to deal with menstruations issues
3. the increased frequency of urination compared to men, often due to e.g. childbirth weakening bladder control or pelvic girdle muscles
4. mothers with young children
5. any possibility that the premises could host an all-female population as opposed to a mixed population.

The experience of providers of portaloos to big events is that women take on average 3 times as long as men. This points to the need for 3 times as many units for urination. Hence if a male toilet contains say 10 urinals and 6 cubicles, the women’s toilet should contain 3 times the 10 urinals, plus the 6 cubicles i.e. 36 cubicles. The aim should be to eliminate queuing for women. If this provision seems high, the opinion of a range of women should be obtained!

Female toilets are sometimes located well away from well frequented areas; they should be located in the premises in a place where the users feel that they are within calling range for help.

Some female toilets are located down a corridor beyond the male toilet, so the women have to walk past men exiting the male toilet while zipping themselves up. The female toilets should be located so that this scenario is avoided.

In premises that can host populations ranging from all-male, to all-female, via a mixed of male and female, it can be uneconomic to provide the necessary numbers of separate male and female toilets to handle the 2 extremes. In such cases, the economic case may point towards the provision of unisex cubicles only; or a large proportion of unisex cubicles. In such cases, the use of the counter-balanced seat would improve hygiene. However the example of Italian and Spanish facilities could be followed, which is to provide both a pan and a urinal in each unisex cubicle.