Toileting Behaviors of Adult Women: What Is Healthy?
abstract
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Access this abstract nowPURPOSE
The objective of this study was to assess toileting behaviors in community-dwelling adult women.
MATERIALS AND METHODS
Women age 18 years or older were recruited through a national registry of research volunteers, and asked to complete validated questionnaires assessing urinary symptoms and toileting behaviors, specifically place preference for voiding, convenience voiding, delayed voiding, straining during voiding, and position preference for voiding. The patient perception of bladder condition (PPBC) assessed the participant's impression of their bladder health. Analyses determined the prevalence of each toileting behavior (reported to occur "sometimes" or more often), and differences in toileting behaviors between women with and without self-perceived bladder problems based on their PPBC response.
RESULTS
The 6695 women completing the questionnaires ranged in age from 18-89 (mean 41.4 ±15 years), with 79.9% identifying as white and 71.0% college-educated. Almost all women (98.8%, n=6613) reported place preference for voiding. Women reporting a bladder problem (n=3552, 53.1%) were more likely to report convenience voiding, delayed voiding, and strained voiding behaviors. While 99.4% (n=6657) of women reported sitting to void at home, only 76.2% (n=5108) of women reported sitting when using public toilets.
CONCLUSIONS
Certain toileting behaviors, some of which may be considered unhealthy, were common in this sample of adult women, and most were associated with a perception of bladder problems. Voiding positions other than sitting were frequently used when away from home. These data have important implications for defining bladder health and for implementing behavior-based interventions for women with lower urinary tract symptoms.
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Toileting Behaviors of Adult Women: What Is Healthy?
J Urol 2018 Jul 24;[EPub Ahead of Print], CG Kowalik, A Daily, S Delpe, MR Kaufman, J Fowke, RR Dmochowski, WS ReynoldsFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The relationship between lower urinary tract symptoms, dysfunctional voiding (developed during childhood or acquired later in life), and toileting behaviors is incompletely understood. In this study, the authors attempt to shed light on the relationship between nonoptimal voiding behaviors (eg, holding urine until a more convenient time or place or squatting while using public toilets) and bother from lower urinary tract symptoms.
The authors recruited 6995 community-dwelling women to participate in an online survey. The 6% response rate increases the potential for bias, and the population was disproportionately Caucasian and college-educated, perhaps compromising generalizability. Nevertheless, the findings are informative.
Nearly 90% of women with and without perceived bladder problems (defined in this study as Patient Perception of Bladder Condition score >1) reported concern for the cleanliness of public toilets, presumably contributing to over 60% reporting efforts to completely avoid public toilets and 25% to avoid sitting when they are unable to avoid public toilets, a behavior associated with poorer emptying. Over 80% delay voiding, with roughly half waiting until they “cannot hold urine any longer.” Even among those without perceived bladder problems, one-third reported waiting too long to void at work, resulting in a strong urge to void or even leakage.
As a cross-sectional rather than longitudinal study, the authors’ work perhaps raises more questions than it answers. For example, women reporting no bladder problems were more likely to be younger—within this population, are those who engage in nonoptimal toileting behaviors destined to develop bothersome symptoms or is age primarily responsible? Are those with minor bother who engage in “better” behavior less likely to progress than those who do not? To what degree can impacting toileting behaviors reduce preexisting bother and prevent bother from arising? The answers to these questions and others may be the impetus for improved education efforts directed at both affected and yet-to-be affected women of all ages.