Answer:

Regarding cleaning effectiveness, water generally outperforms dry paper. Based on the fundamental principles of personal hygiene, water can dissolve and wash away dirt and microorganisms adhering to the skin's surface. In contrast, dry paper primarily offers a mechanical action of absorption and wiping, which can easily leave behind residue and bacteria.

Numerous microbiological studies comparing residual bacteria after using both methods indicate that "washing with water significantly reduces bacterial density on the skin compared to wiping with paper alone". Similar to how healthcare professionals prioritize water and soap over dry wiping for hand hygiene, using water for the anal area ensures a higher standard of cleanliness.

For individuals with hemorrhoids, anal fissures, or perianal inflammation, dry toilet paper can increase the risk of damage due to friction. A 2022 study noted that approximately 70% of people with anal conditions experienced bleeding after wiping with paper, accompanied by a stinging sensation.

Experts at Stanford University and the University of California (USA) recommend rinsing or spraying with water after defecation as a measure to help reduce irritation and limit damage to the skin and mucous membranes. This is particularly beneficial for those with chronic inflammatory bowel disease (Crohn's, ulcerative colitis) or who have frequent bowel movements throughout the day, as continuous friction from paper can exacerbate perianal dermatitis.

Currently, there is no medical evidence indicating that toilet paper is harmful if used correctly, such as wiping gently from front to back and avoiding excessive rubbing. However, for individuals who frequently experience itching, irritation, or have a history of hemorrhoids, many doctors prioritize recommending bidet sprays, adhering to certain principles:

Spray direction: Always from front to back.

Water temperature: Use cool or moderately warm water (37-40°C), avoiding water that is too hot, which can cause burns or damage to mucous membranes.

Drying after spraying: Use a clean, soft towel or light blotting paper to prevent skin damage.

Equipment hygiene: The bidet nozzle should be regularly cleaned and disinfected with a specialized solution.

If a bidet spray is unavailable, toilet paper can still be used, but one should wipe gently from front to back, limiting repeated wiping to avoid skin abrasion.

Toilet paper and bidet spray equipped in a restroom. Photo: Le Phuong

In summary, both toilet paper and bidet sprays are safe when used correctly. The choice of method depends on an individual's health status and personal habits. If, after adjusting hygiene practices, itching, burning, or recurrent infections persist, one should consult a gastroenterologist or gynecologist to identify the cause and receive appropriate treatment.

Doctor Vo Hong Minh Cong

Deputy Director, Nhan Dan Gia Dinh Hospital