Lower urinary tract symptoms are common in women and presumably related to four recognized domains of toileting behaviors, including 1) place, 2) timing, 3) position, and 4) style (1). However, little is still known about the associations between abnormal or dysfunctional toileting behaviors and urinary symptoms. Our aim was to investigate our hypothesis that increased lower urinary tract symptoms, specifically overactive bladder (OAB), are correlated with dysfunctional toileting behaviors in a community-based sample of women.

In this cross-sectional study, we recruited community women to complete online, validated questionnaires, including the Toileting Behavior Scale (TBS) and International Consultation on Incontinence Questionnaire-Overactive bladder (ICIQ-OAB). Toileting behavior questions were grouped by place preference, premature voiding (voiding without the need to urinate), delayed voiding, and straining to void. Pearson correlation coefficient was computed to assess the relationship between ICIQ-OAB and toileting behavior scores.  Linear regression modeling was performed to analyze the effects of toileting behaviors on OAB, adjusting for age.

A total of 6,695 women aged 18-89 (mean: 41.4 ± 15.1) completed the questionnaires. Ninety-four percent (n=6,282) of women empty their bladder before leaving home at least sometimes, with 12.7% (n=853) always avoiding public toilets.  Delaying voiding as long as possible at least sometimes was reported by 53% (n=3,552).  To completely empty the bladder, straining to void at least sometimes was reported by 31.4% (n=2,099). There were significant positive correlations between ICIQ-OAB score and all toileting behavior scores (place preference: r= 0.129, p<0.0001; premature voiding: r=0.343, p<0.001; delayed voiding: r=0.07, p<0.0001; straining to void: r=0.221, p<0.0001). Figure 1 displays the correlation between OAB and premature voiding.  After adjusting for age, all toileting behaviors were associated with higher ICIQ-OAB scores (Table 1).

This work demonstrates the first association of toileting behaviors with overactive bladder in adult women.  Overall, there was a positive correlation between OAB and toileting behaviors.  Worsening severity of OAB symptoms correlated with more abnormal toileting behaviors.

Nearly all women in our sample endorsed dysfunctional toileting behaviors with voiding.  There was significant correlation of toileting behaviors and lower urinary tract symptoms. Further exploration on the effects of toileting behaviors on the development of worsening of lower urinary tract symptoms in adult women is needed.

Wang K and Palmer MH. Women’s toileting behavior related to urinary elimination concept analysis. J Adv Nurs 2010;66:1874-1884.