A small literature suggests that in comparison to other types of occupations, occupations with high manual labor demands and occupations classified as sales or service increase the likelihood of experiencing urinary incontinence (UI) [1]. Potential mechanisms include physical demands at work (e.g., heavy lifting) and limited access to toilets in the workplace due to time or environmental constraints. Some scholars have posited that specific occupations – most notably nursing and teaching – place individuals at risk for lower urinary tract symptoms (LUTS) due to limited time to void [2,3] The Coronary Artery Risk Development in Young Adults (CARDIA) study provides a unique opportunity to examine whether women’s occupation, measured twice between the ages of 20-42 years, is associated with LUTS and their impact, a composite variable measured at ages 45-57 years. It was hypothesized that employment in occupations characterized by manual labor, sales, service, nursing, and teaching would be associated with greater odds of experiencing more severe LUTS with greater impact in comparison to employment in managerial and professional occupations.

CARDIA is a prospective cohort study of the development of cardiovascular disease (CVD) that recruited 5,115 Black and White women and men aged 18-30 years at baseline (1985-86) from the populations of four United States (U.S.) cities (Birmingham, Alabama; Minneapolis, Minnesota; Chicago, Illinois; Oakland, California). In 1987-88 and 1995-96, women were asked several questions about their current or most recent job activity. Responses were used to code jobs to the following U.S. census categories: managerial/professional, technical/sales/support, service, farming/forestry/fishing, precision/craft/repair, and operators/fabricators/laborers. The latter three categories were considered to be manual jobs. For the present research, technical, sales, and support categories were examined separately. In addition, two new occupation categories were created to correspond to professions that have been linked to LUTS in the literature: nurses/health assistants/health aides and K-12 teachers/assistants/child care workers. Codes corresponding to these occupations were removed from managerial/professional, technical/sales/support, and service categories and instead grouped with new occupation categories. In 2012-13, self-reported data on LUTS and their impact were collected for the first time. The outcome variable was previously developed through a cluster analysis of four constructs: UI severity, UI impact, other LUTS severity, and other LUTS impact. Women were classified into bladder health (44%) versus mild (31%), moderate (20%), or severe (5%) symptoms/impact clusters. “Greater LUTS/impact” was defined as membership in a more symptomatic LUTS category with greater burden. The analytic sample was comprised of women with complete data for predictor and outcome variables (n=1,006). Logistic regression analyses were conducted with the LUTS/impact outcome variable dichotomized to compare a combined bladder health and mild LUTS/impact category to a combined moderate and severe LUTS/impact category. For all analyses, covariates included age, race, and parity by Year 2010-11. In sensitivity analyses, education and financial hardship were included as additional covariates.

Marked differences in the percentages of women who held specific occupations (e.g., managerial/professional, service) were observed across LUTS/impact cluster categories (see Table 1). Logistic regression analyses showed that compared to women in managerial/professional positions, women employed in sales or as an operator/fabricator/laborer in 1987-88 or 1995-96 had roughly twice the odds of being categorized into the moderate or severe LUTS/impact cluster category versus the bladder health or mild LUTS/impact cluster category in 2012-13 (see Table 2). Compared to women in managerial/professional positions, women employed in service positions in 1987-88 or 1995-96 had roughly three times and four times the odds, respectively, of having greater LUTS/impact in 2012-13. Other associations between 2012-13 LUTS/impact cluster category and specific occupations were observed for one of the two assessments at which occupation was assessed.  Compared to women in managerial/professional positions in 1987-88, women employed in support positions were more likely to later be categorized into the moderate or severe LUTS/impact cluster category versus the bladder health or mild LUTS/impact cluster category in 2012-13 (OR=1.85). Compared to women in managerial/professional positions in 1995-96, women who were employed as nurses, health assistants, or health aides were more likely to have greater LUTS/impact in 2012-13 (OR=1.83). Additional adjustment for education and financial hardship attenuated only 3 of 8 significant associations. Some occupations did not differ from managerial/professional positions with respect to LUTS/impact cluster category membership. These occupations included technical positions; K-12 teachers, assistants, and child care workers; and precision/craft/repair positions.

Observed associations between occupation and LUTS/impact were largely consistent with hypotheses. Among CARDIA women, managerial and professional positions in early adulthood were associated with bladder health up to 25 years later. In contrast, specific positions – employment in sales or service positions at either occupation assessment, employment in support positions at the earlier assessment, and employment in nursing positions at the later assessment – were associated with greater LUTS/impact. While some observed associations were attenuated by adjustment for education and financial hardship, the majority of the associations remained significant. This suggests that features of the workplace for women in sales, service, support, and nursing positions were associated with LUTS/impact over and above socioeconomic position in the present sample of women. Contrary to hypothesis, employment in teaching and precision/craft/repair positions were not associated with LUTS/impact. Some manual labor positions (operators/fabricators/laborers) were associated with greater odds of experiencing LUTS/impact. These associations became non-significant after adjustment for education and financial hardship, suggesting that manual labor did not increase risk for LUTS/impact over and above socioeconomic position in the present sample of women. A notable limitation of the present study is that LUTS and impact were not assessed during the first 25 years of the CARDIA cohort study, which was designed to study the etiology of cardiovascular disease. It is conceivable that some women in the CARDIA cohort experienced LUTS earlier in their lives, changed occupations, and then maintained or experienced a worsening of LUTS. In this scenario, some of the variance in LUTS/impact attributed to specific occupations could instead be attributed to earlier, unmeasured LUTS/impact.

Future research should examine different characteristics of workplaces and occupations that may promote or constrain bladder health. Studied characteristics should include workplace factors that may lead to adaptive or maladaptive patterns of voiding (e.g., time, autonomy, and infrastructure to void when desired). This research is needed to inform prevention interventions designed to promote the current and future bladder health of employees.

Kim, Y., & Kwak, Y. (2017). Urinary incontinence in women in relation to occupational status. Women & Health, 57(1), 1–18. https://doi.org/10.1080/03630242.2016.1150387
Xu, D., Zhu, S., Li, H., Gao, J., Mou, H., & Wang, K. (2019). Relationships among occupational stress, toileting behaviors, and overactive bladder in nurses: A multiple mediator model. Journal of Advanced Nursing, 75(6), 1263–1271. https://doi.org/10.1111/jan.13940
Liao, Y.-M., Dougherty, M. C., Biemer, P. P., Liao, C.-T., Palmer, M. H., Boyington, A. R., & Connolly, A. (2008). Factors related to lower urinary tract symptoms among a sample of employed women in Taipei. Neurourology & Urodynamics, 27(1), 52–59.