Are Hot Tubs Bad for You? Here’s How To Soak Safely

That steamy hot tub is calling your name after a long day. And those muscle aches you’ve got? They sure could use the tension relief. But are hot tubs safe for everyone? And are you sure you’re not immersing yourself in a tub of hot germs? Integrative medicine physician Irina Todorov, MD, explains how to use hot tubs with your health in mind.

Are hot tubs safe?

Immersing yourself in hot water feels good because it relaxes muscle tension and relieves joint pain.

“Soaking in a hot tub may even boost your mental health,” says Dr. Todorov.

But that doesn’t mean everyone should take a dip.

“Hot tubbing can have risks, depending on your health,” cautions Dr. Todorov. “Even if you don’t have health issues, you can get sick from a dirty hot tub. And the water needs to be a safe temperature so you don’t get burned or overheated.”

Who should avoid hot tubs?

Ask your healthcare provider before using a hot tub if you deal with any of the following:

Heart disease

Hot tubs feel good because they raise your body temperature slightly. But if you have cardiovascular disease, this rise in temperature could stress your heart.

“As your body heats up, your blood pressure drops,” explains Dr. Todorov. “Your heart responds by beating faster, like what you might experience with exercise. If your provider has told you to avoid strenuous activity, skip the hot tub, too.”

Pregnancy

Pregnancy can do a number on your back, but don’t look for relief in a hot tub.

“Using a hot tub during pregnancy may harm a developing fetus,” warns Dr. Todorov. “Avoid hot tubs or saunas when you’re pregnant, especially during the first trimester.”

If you decide to soak in your second or third trimester, consider using your home bathtub instead.

“With your own tub, you can make sure it’s not too hot,” she adds. “And you won’t be exposed to chemicals that can irritate sensitive skin during pregnancy.”

Seizures

Having a seizure in a hot tub can lead to drowning if you don’t have someone nearby who can help.

“If you have epilepsy or a seizure disorder, only use a hot tub with a trusted partner,” Dr. Todorov advises. “Your partner should know what to do if you have a seizure and be able to pull you out of the hot tub.”

If a person has a seizure in a hot tub:

• Get them out of the water.
• Gently lay them on the ground and roll them onto their side.
• Put something soft and flat under their head, like a folded towel or a life jacket.
• Call 911.

Alcohol and other substances

Drinking alcohol or smoking marijuana or using other mind-altering substances can decrease your awareness, which isn’t safe when you’re hot tubbing.

“If you’re intoxicated, you might not realize that you’re overheating,” notes Dr. Todorov. “These substances may also make you more likely to fall asleep in the hot tub. Only use a hot tub if you’re fully awake and aware so you can get out when you need to.”

Medications that cause drowsiness

Falling asleep in a hot tub sounds relaxing, but it’s dangerous.

“People assume only children drown in hot tubs, but this isn’t the case,” Dr. Todorov states. “Adults drown in hot tubs, too, and it often happens when they fall asleep in the water. Taking medications that make you tired greatly increases this risk. If your medication says ‘may cause drowsiness’ on the label, don’t get in the hot tub after taking it.”

Hot tubs and germs

Hot tubs and swimming pools can also make you sick if they’re not clean and treated with the right germ-killing chemicals. But even a clean, treated hot tub can be a germ hot spot.

“Properly balanced chlorine kills a lot of germs, but it can’t kill everything,” says Dr. Todorov.

Germs that can lurk in hot tubs include:

• Cryptosporidium: This parasite causes cryptosporidiosis (crypto), an infection that can cause severe diarrhea. You can get crypto if you swallow even a tiny amount of contaminated hot tub water.
• Giardia: This parasite can spread via contaminated hot tubs and swimming areas. It can cause giardiasis infection, which leads to vomiting, diarrhea and stomach cramps.
• Legionella: This bacteria causes Legionnaires’ disease, a potentially serious lung infection. The bacteria can live in a hot tub’s steam. When you breathe the steam, you can get sick — even if you never swallow the water.
• Norovirus: This virus causes “stomach flu,” and can spread in hot tubs from an infected person’s fecal matter. It only takes a microscopic amount of the virus to get sick if you swallow contaminated water. Plus, people typically have small amounts of fecal matter on their bodies without ever knowing it.
• Pseudomonas aeruginosa: This bacteria causes “hot tub folliculitis,” which leaves your skin itchy and red, sometimes with small pus-filled blisters.

Prevent hot tub illnesses

You don’t have to let germs keep you away from hot tubbing. You can minimize your risk of getting sick — and making others sick — if you:

• Check your skin: Stay out of hot tubs if you have an open cut or sore. Bandages won’t keep germs from getting in or out of skin wounds.
• Follow cleaning and maintenance guidelines: If you own a hot tub, follow the manufacturer’s directions for keeping it clean. Owning a hot tub involves regularly checking the pH, chemical balance and cleanliness.
• Look it over: Avoid hot tubs that don’t look clean or have signs of mold, slime or a film on the sides.
• Sit upright: Keep your face above the surface and avoid swallowing any water.
• Skip if you’ve been sick: Don’t use a hot tub or go swimming if you’ve been vomiting or had diarrhea in the past five days.
• Wash up: Take a shower and thoroughly wash your hands before and after hot tubbing.

How long can you sit in a hot tub?

Cap your hot tub time at 15 minutes — or shorter if you start to feel woozy or dehydrated. If you soak for longer than this, you risk overheating or experiencing a dangerous drop in your blood pressure. And if you’re soothing a muscle injury, hot tubbing too long can increase inflammation and make the injury worse.

Be choosy about your hot tub

If you’re in good health and not pregnant, you don’t have to abstain from hot tubbing. You can maximize your safety if you keep the temperature below 104 degrees Fahrenheit (40 degrees Celsius) and listen to your body. Get out if you feel nauseated or dizzy or get a headache.

“Hot tubbing feels great, which is why so many people enjoy it,” says Dr. Todorov. “Taking a few precautions and checking for cleanliness will help you safely enjoy a nice soak.”