Insight into bladder health: the relation between prevalent lower urinary tract symptoms and interference in women in the Boston Area Community Health Survey

Sutcliffe S1, Bavendam T2, Cain C3, Epperson C N4, Fitzgerald C5, Gahagan S6, Markland A7, Shoham D8, Smith A9, Townsend M10, Rudser K3, and the PLUS Research Consortium 11

Research Type

Basic Science / Translational

Abstract Category

Prevention and Public Health

Abstract 620
Epidemiology and Prevention
Scientific Podium Short Oral Session 30
Friday 31st August 2018
13:52 - 14:00
Hall C
Prevention Female Infection, Urinary Tract
1. Division of Public Health Sciences, Department of Surgery, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, 2. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, 3. Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 4. Departments of Psychiatry, and Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 5. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 6. Division of Child Development and Community Health, University of California, San Diego, CA, 7. Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine at the University of Alabama at Birmingham and the Birmingham Geriatric Research, Education, and Clinical Center at the Birmingham VAMC, Birmingham, AL, 8. Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 9. Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 10. Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, FL, 11. the PLUS Research Consortium

Siobhan Sutcliffe



Hypothesis / aims of study
Most research on lower urinary tract symptoms (LUTS) in women to date has focused on LUTS prevalence and treatment, whereas considerably less has focused on LUTS prevention and bladder health promotion. To address this gap, the Prevention of Lower Urinary Tract Symptom Research Consortium developed a framework for studying bladder health adapted from the World Health Organization definition of overall health: “A complete state of physical, mental, and social well-being related to bladder function [that] permits daily activities, adapts to short-term physical and environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational or other activities).” Although this framework represents a major step forward in conceptualizing bladder health, we do not yet have data to quantify and further refine this concept. Therefore, we took advantage of existing data from the Boston Area Community Health (BACH) Survey, a large population-based study of Boston residents, to explore this concept further, drawing upon its extensive collection of LUTS and rare collection of interference from LUTS with daily activities in women.
Study design, materials and methods
At baseline, participants reported their frequency of 16 LUTS, including storage, voiding, and incontinence symptoms, and lower urinary tract pain. Information on interference from urinary experiences, pain, or discomfort in the pubic area with seven activities was also collected, using an adapted version of the validated Epstein scale. Activities assessed were drinking fluids before travel; driving for two hours without stopping; going to places that may not have a toilet; playing sports outdoors such as golf; going to movies, shows, and church; drinking fluids before bed; and getting enough sleep at night. Prevalence estimates were weighted to account for the BACH sampling design, and prevalence ratios (PRs) were calculated by log-link generalized linear models with robust variance estimation, adjusting for known LUTS risk factors and each other individual LUTS. With a sample size of 2,697 participants, our study had at least 80% power to detect minimum detectable PRs ranging 1.20-1.35 for LUTS prevalence and interference estimates between 10 to 50%, and using two-sided tests and an α-level of 0.05.
2,697 women >30 years of age completed the BACH baseline visit and provided complete data. Of these women, 19.7% reported no LUTS or interference, whereas 48.1% reported LUTS at least rarely but no interference (see Table). Within the latter group, the breakdown of LUTS frequency was 13.7% for LUTS at least rarely, 15.0% for a few times, 7.9% for fairly often, and 11.4% for usually or almost always in the past month. Few women (2.2%) reported no LUTS but at least a little interference, and 30.0% reported some degree of both LUTS and interference. LUTS independently associated with interference were urgency incontinence (PR=1.4, 95% CI: 1.1-1.8), urgency (PR=1.3, 95% CI: 1.1-1.6), nocturia (PR=1.4, 95% CI: 1.1-1.7), perceived frequency (PR=1.5, 95% CI: 1.2-1.9), and weak stream (PR=1.2, 95% CI 1.0-1.5).
Interpretation of results
Our findings suggest that as few as one in five women could be considered to have optimal bladder health (no LUTS or interference), half of women could be considered to have intermediate health (some degree of LUTS or interference), and one third could be considered to have worse health (some degree of both LUTS and interference). Storage LUTS and weak stream contributed independently to interference in this population.
Concluding message
Findings from our large secondary analysis of BACH survey data begin to inform and quantify the spectrum of bladder health, demonstrating that only one in five women might be considered to have optimal bladder health, whereas the remaining 80% of women fall somewhere on the spectrum between intermediate and worse bladder health. This large percentage of symptomatic women highlights opportunities for both LUTS prevention and bladder health promotion.
Figure 1
Funding Funded by NIDDK grants: DK106786, DK106853, DK106858, DK106898, DK106893, DK106827, DK106908, DK106892 Clinical Trial No Subjects Human Ethics not Req'd This secondary data analysis was certified as not human subject study Helsinki Yes Informed Consent Yes