Driving a bus might not be top of the list when most people think of hazardous occupations. Bus drivers aren’t rushing into burning buildings or handling downed electric wires. But it turns out driving a city bus eight or 10 hours a day can be one of the most dangerous jobs, from the standpoint of chronic health conditions. Much of it comes down to an inability to take bathroom breaks, constant stress, and the day-in, day-out vibration of operating a heavy motor vehicle.

Fifteen years ago, Susan Stoner was just days into a new job as a labor attorney for Portland-based Amalgamated Transit Union (ATU) Local 757 when she noticed something peculiar.

“At my first ATU meeting, within an hour I noticed that over half the people in the meeting were standing against the wall,” Stoner said. At the time, she just thought it was strange. Later, she realized it was because their backs were killing them.

“When you’re bouncing along in a vehicle all day, that’s what can happen,” Stoner said. “It trashes your spine. So many end up with bad backs, and people could barely stand or sit any more.”

A combination of union complaints and involvement by the Occupational Safety and Health Administration (OSHA) helped the industry face up to the problem. Better seats were developed, and now, adjustable seats with shock absorbers and hydraulics are the norm, so that drivers can be properly positioned and the seat can absorb more of the road shock.

Seats weren’t the only contributor to health problems.

“We process death benefits at the union,” Stoner said, “so we get a copy of the death certificates. It’s not just that they were too young. What people die of was kind of surprising.”

There seemed to be a high incidence of cardiovascular problems, and of cancers, especially urinary and gastroinstestinal cancers.

The union was lucky. The National Institutes of Health decided to produce a summary of studies of transportation industry health problems. From that, Local 757 generated a document for members to give to their doctors.

“Doctors often don’t understand what they’re looking at is caused by the job,” Stoner said.

The studies gave confirmation to what bus drivers knew already: Theirs is a stressful job. Not only do they operate a large vehicle safely and weave in and out of the farthest right lane in heavy traffic. They also must deal with hundreds of passengers a day, be courteous and helpful, announce stops, and aim to be on time but never early. At TriMet, bus drivers get in trouble if the bus is more than a minute early.

Stress contributes to hypertension, obesity, type II diabetes, gastric ulcers, and a variety of cardiovascular health conditions, all of which bus drivers suffer from in higher numbers than the general population. As for the bladder and urinary tract cancers, Local 757 leaders are convinced it has to do with inadequate bathroom breaks.

“When you hold it too long, eventually your bladder becomes so painful it spasms, and you urinate involuntarily,” Stoner said. Considering the shame and indignity of that, it’s not the kind of thing bus drivers might want to report.

“We decided to see if there was any evidence of that in terms of bus operator seats needing to be switched out.” Stoner said they found that over the course of the previous year, there had been about 30 maintenance reports showing seats being replaced because of urine. “Drivers are so mortified they don’t admit to it,” Stoner said. “But it’s a serious health and human dignity issue.”

Stories trickle into the union about drivers urinating and defecating on themselves, wearing adult diapers, or having to get off the bus and urinate in the bushes.

Some drivers try not to drink very much during their shift, so they won’t have to use the restroom. Such voluntary dehydration starves every organ in the body of water and is quite dangerous long term.

“Your whole body is functioning with insufficient water,” Stoner said. “Then when you do start to drink, it takes a long time to fill up those organs before it ever gets to your bladder. So people may think they have a big bladder, but that’s not really what’s going on.”

Truckers can face similar difficulty using a restroom, but many have enough privacy in their cab that they can urinate into a bottle.

Employers say bus drivers can stop any time and run into a McDonald’s or other public accommodation to use the restroom. But that can be embarrassing, and passengers get angry when they’re made to wait. The union wants employers to build breaks into the schedule, and make sure there are restrooms available.

“Throughout the industry it’s a problem,” said Local 757 President Jon Hunt. “Drivers have a uniform on, and they’re being scrutinized by the public all the time, so they never get a break unless they’re in a lunchroom behind a closed door.”

“If you pull a bus over when you have passengers who are trying to make a connection, they don’t see that as you pulling over to use restroom. They think you’re off screwing around.”

The problem can be worse among paratransit bus drivers, who transport the disabled. They have no designated break built into their route, because they have no fixed route: Dispatch continues to build their route while they’re driving. And they often have passengers who can’t be left alone on the bus while drivers take a bathroom break.

Some agencies are better than others. For example, the union hasn’t heard bathroom break complaints from drivers at Salem Area Mass Transit District. But at TriMet, the state’s biggest transit agency, it’s a constant battle. Shifts can run 10 hours, and traffic can make buses late to arrive at transit centers where drivers might have a chance to take a bathroom break. So both the employer and drivers need to insist that breaks are taken.

It has become a mantra in the monthly union newsletter: “Take your breaks.” It’s not that the union is encouraging sloth, as some managers may think — it’s about keeping members healthy.

OR-OSHA is looking into whether employers are enabling sufficient bathroom breaks, Stoner said, and seeking voluntary compliance.

“In a way, the most we’ve accomplished is to make people more aware of it,” Stoner said.

Stoner thinks employers are doing better at providing restrooms and scheduling breaks since the union started making the complaint. ATU took up the issue with Oregon Labor Commissioner Dan Gardner, and expects the new commissioner, Brad Avakian, will also help enforce the law requiring breaks.