Women With Overactive Bladder Exhibit More Unhealthy Toileting Behaviors: A Cross-sectional Study

doi:10.1016/j.urology.2019.08.038

Urology

Volume 134, December 2019, Pages 97-102

https://doi.org/10.1016/j.urology.2019.08.038 Get rights and content

Abstract

Objective

To determine whether women overactive bladder symptoms would report more frequent unhealthy toileting behaviors.

Methods

A community-based sample of adult women was electronically recruited to complete the Toileting Behavior Scale and the International Consultation on Incontinence Questionnaire – Overactive Bladder module, as well as clinical and demographic questionnaires. The associations between overactive bladder and toileting behavior subscales were assessed as continuous variables using Spearman's rank correlation and as dichotomous variables with multivariable logistic regression.

Results

Of the 6562 adult women included in the analytic sample, 1059 (16.1%) were classified as having overactive bladder. Of the toileting behavior subscales, convenience voiding had the highest, positive association with overactive bladder score (r = 0.301, P < .0001). On multivariable logistic regression, women with overactive bladder (OAB) were more likely to report behaviors of convenience voiding (odds ratio [OR] 1.13, confidence intervals [CI] 1.11-1.15), delayed voiding (OR 1.05, CI 1.02-1.08), straining to void (OR 1.05, CI 1.03-1.07), and position preference (OR 1.13, CI 1.08-1.18).

Conclusion

OAB symptoms were associated with specific toileting behaviors of convenience voiding, delayed voiding, straining to void, and position preference. Further investigation is needed to determine if toileting behaviors are a risk factor for OAB or a compensatory adaptation to mitigate symptoms.

Section snippets

MATERIALS AND METHODS

This is a secondary analysis of a prior, IRB-approved, cross-sectional questionnaire study, in which women aged 18 years or older were recruited by a single email advertisement between October and December 2017 from 2 study recruitment resources at our institution.¹³ ResearchMatch is a national registry of volunteers created by several academic institutions and supported by the U.S. National Institutes of Health as part of the Clinical Translational Science Award program. ResearchMatch has

RESULTS

Of the 6562 subjects, 1059 (16.1%) were classified as having OAB. These women were older (47.6 ± 15.1 vs 40.1 ± 14.8) while the control group was more likely to be white (80.8% vs 74.4%) and college educated (74.1% vs 56.7%). Women with OAB had a higher rate of obesity, diabetes, and mobility impairments. They also had higher mean scores for each toileting behavior subscale (Table 1).

All toileting behavior subscales had a statistically significant, positive Spearman's correlation coefficient

DISCUSSION

In this large sample of women, convenience voiding, delayed voiding, straining to void, and position preference were found to have a significant positive association with OAB after adjusting for demographic and clinical comorbidities. Convenience voiding had the strongest correlation with ICIQ-OAB scores. Given the frequency of these behaviors within the population and their relation to OAB, there may be substantial opportunity for behavior-based interventions.

While there is limited

CONCLUSION

In conclusion, this work demonstrated an association of toileting behaviors with OAB symptoms. Further study is needed to investigate if these behaviors may be a risk factor for OAB or are a compensatory adaptation to mitigate symptoms. The wide prevalence of certain toileting behaviors in women and the mounting association with outcomes such as OAB suggests a need to further understand why women adopt these behaviors and what can be done to support healthy voiding habits.

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Toileting behaviors and lower urinary tract symptoms: A cross-sectional study of diverse women in the United States
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Citation Excerpt :
Behaviors such as premature voiding and delayed voiding (i.e., holding) have been associated with urinary incontinence (Palmer and Newman, 2015; Willis-Gray et al., 2017). In a cross-sectional study of 6562 community-living adult women (Daily et al., 2019), overactive bladder symptoms were associated with premature voiding, delayed voiding, straining to void and position preference. Evidence suggests that women who limit use of restrooms when they are at work have a higher prevalence of LUTS (Reynolds et al., 2020).
Toileting behaviors are increasingly recognized as factors potentially contributing to development of lower urinary tract symptoms (LUTS).
To examine adult women's toileting behaviors and LUTS across age and race/ethnicity groups and relationships between toileting behaviors and LUTS.
Planned secondary analysis of questionnaire data collected in a focus group study on bladder health.
Questionnaires were completed at the conclusion of focus groups conducted in community settings affiliated with seven research centers across the United States.
Community-living women regardless of LUTS status.
Forty-four focus groups were conducted with 360 adolescent and adult cisgender women. After each focus group, participants completed questionnaires to assess toileting behaviors (Toileting Behaviors-Women's Elimination Behaviors Scale (TB-WEB)) and their experience of LUTS (Lower Urinary Tract Symptom Tool), This analysis includes quantitative data from the subgroup of 316 participants who completed the questionnaires.
Participants ranged in age from 18 to 93 years (Mean= 50.2 years). A significant effect for age was found for delayed voiding behavior, reported by 76.5% of women ages 18–25 years and 21.9% of those 75+ years (p < 0.001). Conversely, reports of premature voiding were lowest in the youngest and higher in the oldest three age groups (p = 0.022). Racial/ethnic differences were found for three domains of toileting behavior. Black and Hispanic women expressed a stronger preference for voiding at home rather than away from home (98.9%, 93.5%, respectively) compared to White women (90.4%, p = 0.041), were more likely to void prematurely (37.6%, 33.3% vs. 21.2%, p = 0.048) and to crouch, squat, or stand rather than sit to void when away from home (69.9%, 58.3% vs. 41.3%, p < 0.001). Four toileting behavior domains were significantly associated with LUTS. Premature voiding was associated with any bothersome LUTS (OR= 2.5; 95% confidence interval [CI]= 1.3–4.8) and any bothersome storage LUTS (OR = 2.9; CI= 1.5–5.5). Delayed voiding was associated with bothersome emptying symptoms (OR=2.8; CI= 1.1–6.6). Straining to void was associated with bothersome storage symptoms (OR=2.0; CI= 1.0–3.7), bothersome emptying symptoms (OR= 3.7; CI= 1.9–7.3), and any bothersome LUTS (OR= 2.3; CI= 1.2–4.3). Preference for non-sitting positions to void when away from home was associated with bothersome emptying symptoms (OR= 2.5; CI= 1.3–4.8) and any bothersome LUTS (OR= 1.8; CI= 1.0–3.2).
These findings highlight the need for research to understand underpinnings of age and racial/ethnic differences in toileting behaviors and identify mechanisms by which toileting behaviors might influence development of LUTS over time. Understanding causal pathways is important in the development of public health interventions to encourage toileting behaviors that support bladder health.
Prevalence of nocturnal enuresis among children of Aseer region in Saudi Arabia
2024, Urology Annals
Toileting behaviors, urinary cues, overactive bladder, and urinary incontinence in older women
2023, International Urogynecology Journal
Compensatory coping and depression in women with interstitial cystitis/bladder pain syndrome
2023, Neurourology and Urodynamics
The effect of toileting behaviors on risk of urinary incontinence among the young women without pregnancy
2022, Chinese Journal of Nursing Education
Compensatory bladder behaviors (“coping”) in women with overactive bladder
2022, Neurourology and Urodynamics

: Financial Support: This work was supported by the Office of Medical Student Research at Vanderbilt University School of Medicine, the Vanderbilt Institute for Clinical and Translational Research by CTSA award number UL1 TR002243 from the National Center for Advancing Translational Sciences, and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number 1K23DK103910-01A1.

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Female Urology, Urodynamics, Incontinence, and Pelvic Floor Reconstructive SurgeryWomen With Overactive Bladder Exhibit More Unhealthy Toileting Behaviors: A Cross-sectional Study

Abstract

Objective

Methods

Results

Conclusion

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

Eur Urol

Urology

Urology

Am J Med

Eur Urol

Am J Obstet Gynecol

Urology

J Urol

Int J Nurs Stud

Aust N Z J Public Health

Prevalence and burden of overactive bladder in the United States

World J Urol

Female Urology, Urodynamics, Incontinence, and Pelvic Floor Reconstructive Surgery
Women With Overactive Bladder Exhibit More Unhealthy Toileting Behaviors: A Cross-sectional Study