Hypothesis / aims of study
The term “toileting” is widely used in clinical and research contexts in continence care, yet there is no consensus definition of the term, and it does not feature in the International Continence Society glossary (1). This lack of clarity may affect how toileting is assessed, documented, and described in clinical practice and research, affecting communication across disciplines. This original study is the first to explore how healthcare professionals conceptualize and define the term “toileting,” and to identify common components that may inform development of a standardized definition.
Study design, materials and methods
An international cross-sectional survey of healthcare professionals and experts involved in continence care, research, and related clinical fields was conducted. Participants were recruited through professional mailing lists and networks associated with continence research and clinical practice (approximately 949 invited). The survey comprised Yes/No responses assessing whether specific activities were considered part of toileting, Likert-scale items assessing agreement with definitions described in previous studies (2), and open-ended questions exploring the conceptual components of toileting. Demographic information, including professional role, speciality, geographic region, and years of clinical experience were collected to describe participant characteristics. Open-ended responses were analyzed using a thematic process to identify recurring concepts related to the term “toileting.” Quantitative data was summarized using descriptive statistics. Informed consent was obtained from all participants, and ethical approval was obtained from the University of Alberta Research Ethics Board 2 (REB 2).
Results
A total of 68 professionals participated in the survey, yielding a response rate of approximately 7% and generating 660 open-text responses reflecting participants’ understanding of the term “toileting.” Participants represented multiple clinical disciplines, most commonly nursing (45.6%) and urology (22.1%), with additional contributions from physiotherapy, geriatrics, and other health professions across 20 countries. Several activities were strongly endorsed as components of toileting, including the use of assistive devices (89.7%), clothing and garment management (85.3%), post-elimination hygiene (85.3%), caregiver assisted toileting activities (83.8%), and elimination of urine or feces (79.4%). Cognitive recognition and sensory urge to eliminate were endorsed by 70.6% of participants. Other areas showed less agreement. Less than half of participants considered toileting to include the use of incontinence products (45.6%), indwelling catheters (41.2%) and requirement of a bathroom setting (45.6%). Agreement with previously proposed definitions varied, with the highest agreement for conceptualizing toileting as a fundamental activity of daily living requiring physical and cognitive abilities (mean 3.79 ± 1.46). Open-ended responses described toileting as a multi-step process involving recognition of the need to eliminate, accessing an appropriate setting, elimination, and post-elimination care. However, variation was noted in whether urge recognition is required, particularly in the context of prompted or assisted toileting. Disagreement also existed regarding inclusion of incontinence management, catheter use, and toileting outside a designated bathroom setting.
Interpretation of results
These findings demonstrate significant variation in how healthcare professionals and related experts interpret the term “toileting.” While core physiological and functional activities are widely recognized, other aspects of toileting were inconsistently interpreted. This variability highlights the absence of a shared conceptual definition, and likely contributes to differences in clinical documentation, interventions, and research terminology in continence care.