Associations of workplace toilet access, autonomy and the toilet environment with toileting habits and bladder function among adult women

Objective Barriers to toilet access and suboptimal toilet environments in workplaces and schools may contribute to unhealthy toileting behaviors and poorer bladder health in women, but quantitative evidence is limited. We examine associations between workplace toilet access, autonomy, and environment with women's toileting behaviors and test whether these behaviors mediate relationships with bladder function. Methods Data from 1772 women (mean age 51 years) in the RISE FOR HEALTH study were analyzed. Participants completed Toilet Environment and Access Scales (TEAS), Toileting Behaviors–Women's Elimination Behaviors (TB-WEB), and the Bladder Function Index (BFI). Regression and structural equation modeling tested associations among TEAS domains (access/autonomy and toilet environment), TB-WEB subscales, and BFI. Results Mean TEAS scores indicated high access and favorable environments (4.1 and 4.4 on a 0–5 scale). Greater access/autonomy and more favorable environments were associated with less delayed voiding (b = −0.26, −0.15), straining (b = −0.17, −0.15), and premature voiding (b = −0.13, −0.08). All unhealthy behaviors were associated with lower BFI scores, with delayed voiding showing the strongest association (b = −8.0). Higher TEAS scores were associated with higher BFI (b = 3.3–3.8 per unit). Mediation analyses indicated that toileting behaviors, particularly delayed voiding, partially mediated associations between TEAS domains and BFI. Conclusions Favorable toilet environments and greater toilet access and autonomy were associated with healthier toileting behaviors and better bladder function. Policies and practices that support toilet access and autonomy in workplaces and schools may promote bladder health by reducing unhealthy toileting behaviors.