Toileting behaviors and lower urinary tract symptoms: A cross-sectional study of diverse women in the United States

Background: Toileting behaviors are increasingly recognized as factors potentially contributing to development of lower urinary tract symptoms (LUTS). Objectives: To examine adult women's toileting behaviors and LUTS across age and race/ethnicity groups and relationships between toileting behaviors and LUTS. Design: Planned secondary analysis of questionnaire data collected in a focus group study on bladder health. Settings: Questionnaires were completed at the conclusion of focus groups conducted in community settings affiliated with seven research centers across the United States. Participants: Community-living women regardless of LUTS status. Methods: Forty-four focus groups were conducted with 360 adolescent and adult cisgender women. After each focus group, participants completed questionnaires to assess toileting behaviors (Toileting Behaviors-Women's Elimination Behaviors Scale (TB-WEB)) and their experience of LUTS (Lower Urinary Tract Symptom Tool), This analysis includes quantitative data from the subgroup of 316 participants who completed the questionnaires. Results: Participants ranged in age from 18 to 93 years (Mean= 50.2 years). A significant effect for age was found for delayed voiding behavior, reported by 76.5% of women ages 18–25 years and 21.9% of those 75+ years (p < 0.001). Conversely, reports of premature voiding were lowest in the youngest and higher in the oldest three age groups (p = 0.022). Racial/ethnic differences were found for three domains of toileting behavior. Black and Hispanic women expressed a stronger preference for voiding at home rather than away from home (98.9%, 93.5%, respectively) compared to White women (90.4%, p = 0.041), were more likely to void prematurely (37.6%, 33.3% vs. 21.2%, p = 0.048) and to crouch, squat, or stand rather than sit to void when away from home (69.9%, 58.3% vs. 41.3%, p < 0.001). Four toileting behavior domains were significantly associated with LUTS. Premature voiding was associated with any bothersome LUTS (OR= 2.5; 95% confidence interval [CI]= 1.3–4.8) and any bothersome storage LUTS (OR = 2.9; CI= 1.5–5.5). Delayed voiding was associated with bothersome emptying symptoms (OR=2.8; CI= 1.1–6.6). Straining to void was associated with bothersome storage symptoms (OR=2.0; CI= 1.0–3.7), bothersome emptying symptoms (OR= 3.7; CI= 1.9–7.3), and any bothersome LUTS (OR= 2.3; CI= 1.2–4.3). Preference for non-sitting positions to void when away from home was associated with bothersome emptying symptoms (OR= 2.5; CI= 1.3–4.8) and any bothersome LUTS (OR= 1.8; CI= 1.0–3.2). Conclusions: These findings highlight the need for research to understand underpinnings of age and racial/ethnic differences in toileting behaviors and identify mechanisms by which toileting behaviors might influence development of LUTS over time. Understanding causal pathways is important in the development of public health interventions to encourage toileting behaviors that support bladder health.