Overactive bladder (OAB) is commonly diagnosed using patient-reported symptoms, voiding diaries, questionnaires, and urodynamic studies (UDS). A hallmark of OAB is detrusor overactivity (DO), which is not always detected in UDS, complicating diagnosis. This study explores the impact of toilet accessibility on OAB symptoms in patients without DO confirmation on UDS and assesses the influence of lifestyle factors.

A total of 23 patients (both men and women), aged 20 to 42 years (average 31.22 ±7.21 ) and engaged exclusively in intellectual work, were included in the study. To confirm OAB, each patient underwent clinical history evaluation, a 72-hour voiding diary, an OAB-specific questionnaire, uroflowmetry, urinalysis, bladder ultrasound, and UDS. All UDS results were negative for DO.
The 72-hour voiding diaries were analyzed by dividing the time into three periods:
1) Free toilet access (e.g., at home or office),
2) Limited toilet access due to activities (e.g., during meetings, teaching, long travel, or social events),
3) Sleeping time.
Since the durations of the 1st and 2nd phases varied among all patients, the shortest common time of 5 hours per day was selected for comparison. Therefore, only 15 hours from the total 3-day (72-hour) voiding diary of each patient were analyzed and compared. These 15 hours represented the period during which the patient was actively engaged in some activity and had unrestricted access to the toilet at any time.

In 16 out of 23 patients, the number of voids during periods of free access was higher (average: 18 ±1.34 voids) compared to limited-access periods (average: 8.65  ±1.02 voids). Conversely, the average voided volume was significantly lower during free-access periods (average 110 mL  ±34.89 vs 208 mL  ±51.69 ). The feeling of urgency was also more common in the first period.

The findings suggest that in patients with OAB but without DO, symptom severity is influenced by their environment, activity levels, and toilet accessibility. Usually OAB patients often attempt to remain at home or refrain from  various activities, although such behavior may impede their recovery or even worsen the manifestations of the illness.

Exploring the relationship between "frequent urination and restroom accessibility" in patients with OAB but without DO confirmation may be crucial in improving diagnosis and management.  This factor should be considered when developing individualized behavioral therapy. Further studies with larger sample sizes are needed to confirm these findings and support clinical recommendations.