Do abnormal toileting behaviors contribute to worse urinary symptoms in women?

Kowalik C G1, Daily A1, Delpe S1, Kaufman M R1, Dmochowski R1, Reynolds W S1

Research Type


Abstract Category

Overactive Bladder

Abstract 643
Overactive Bladder 2
Scientific Podium Short Oral Session 33
Friday 31st August 2018
14:35 - 14:42
Hall C
Female Overactive Bladder Questionnaire Voiding Dysfunction
1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

William Stuart Reynolds



Hypothesis / aims of study
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.
Study design, materials and methods
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).
Interpretation of results
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.
Concluding message
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.
Figure 1
Figure 2
  1. Wang K and Palmer MH. Women’s toileting behavior related to urinary elimination concept analysis. J Adv Nurs 2010;66:1874-1884.
Funding The research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number 1K23DK103910-01A1 and by the Vanderbilt Office of Clinical and Translational Scientist Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Clinical Trial No Subjects Human Ethics Committee Vanderbilt Institutional Review Board Helsinki Yes Informed Consent Yes
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