While terminology and definitions for female bladder dysfunction are well described [1,2], corresponding definitions for healthy bladder functions do not exist. The objectives of this work are to describe our novel framework for describing healthy bladder function and propose terminology and definitions for bladder health.

A transdisciplinary research consortium comprised of expert investigators in urology, female pelvic medicine and reconstructive surgery, nursing, adolescent medicine, pediatrics, geriatrics, obstetrics, gynecology, physical medicine and rehabilitation, preventive medicine, psychology, medical sociology, behavioral science, epidemiology, community health science, and biostatistics was assembled to identify “bladder health” (BH) as a state to preserve and protect. [3] A subgroup of these investigators developed the following definition of bladder health that was refined and adopted by the entire consortium: “A complete state of physical, mental, and social well-being related to bladder function, and not merely the absence of lower urinary tract symptoms.  Healthy bladder function permits daily activities, adapts to short term physical or environmental stressors, and allows optimal well-being (e.g. travel, exercise, social, occupational or other activities).”[4] Specific terminology and definitions for healthy bladder functions were developed using the existing understanding of the storage and emptying functions of the bladder. These functions were cross-examined against accepted International Continence Society definitions of lower urinary tract symptom (LUTS).[1] The elements of bladder function that correspond to both BH and LUTS were refined using an iterative process balancing the need to be descriptive, while understandable to a non-clinical population. The novel concept of a “bioregulatory” bladder function was also acknowledged and definitions proposed. A comprehensive table of bladder health and dysfunction definitions was developed and structured by bladder function (Storage, Emptying, Bioregulatory) and elements of each function. This table was revised in an iterative process by the subgroup and then reviewed, approved and adopted by the entire consortium.

Table 1 is an excerpt of the full working version and demonstrates definitions for the 7 “Storage,” 7 “Emptying,” and 4 “Bioregulatory” elements of function for bladder health proposed by the consortium. 

Table Legend
*Each element of function definition is qualified with the following statement: “…and does not impact daily activities on a routine basis, is adaptable to short term physical or environmental stressors, and allows a woman to pursue her optimal well-being (e.g. travel, exercise, social, occupational or other activities).”
**Each element of function definition is qualified with the following statement: “…and is adaptable to short term physical or environmental stressors, and is able to recover from disruption without long term or persistent sequelae.”

These BH definitions represent a transdisciplinary approach to standardizing terminology and definitions for the elements of bladder function from the perspective of bladder health.  These were systematically developed and revised in an iterative process for the purposes of studying bladder health promotion and LUTS prevention.  This work provides a framework of bladder function and definitions of BH for research, clinical practice, and public health promotion. These definitions are being used to develop novel instruments to measure BH across a broad socio-demographic of women and girls.

This work provides a framework of bladder function and definitions of bladder health for research, clinical practice, and public health promotion.

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A.The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol. 2002 Jul;187(1):116-26
Haylen et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. (2010) Neurourology and Urodynamics 29:4–20.
Harlow BL, Bavendam TG, Palmer MH, Brubaker L, Burgio KL, Lukacz ES, Miller JM, Mueller ER, Newman DK, Rickey LM, Sutcliffe S, Simons-Morton D. The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium: A Transdisciplinary Approach Toward Promoting Bladder Health and Preventing Lower Urinary Tract Symptoms in Women Across the Life Course. J Women’s Health (2017) DOI: 10.1089