The Spectrum of Bladder Health: The Relationship Between Lower Urinary Tract Symptoms and Interference with Activities

Abstract

Background: Little research to date has focused on lower urinary tract symptom (LUTS) prevention and bladder health promotion in women. To address this gap, the Prevention of LUTS Research Consortium developed the following working bladder health definition: "A complete state of physical, mental, and social well-being related to bladder function [that] permits daily activities [and] allows optimal well-being." To begin to inform and quantify this definition, we used data from the Boston Area Community Health Survey, drawing upon its rare collection of information on LUTS and LUTS-specific interference with activities. Methods: At baseline, participants reported their frequency of 15 LUTS and interference with 7 activities. Prevalence ratios (PRs) were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. Results: Of the 3169 eligible participants, 17.5% reported no LUTS or interference, whereas the remaining 82.5% reported some frequency of LUTS/interference: 15.1% rarely; 21.7% a few times; 22.6% fairly often/usually; and 22.9% almost always. LUTS independently associated with interference were urgency incontinence, any incontinence, urgency, nocturia, perceived frequency, and urinating again after <2 hours (PRs = 1.2-1.5, all p < 0.05). Conclusions: Our findings suggest that bladder health exists on a continuum, with approximately one in five women considered to have optimal bladder health (no LUTS/interference), the majority to have intermediate health (LUTS/interference rarely to usually), and a further one in five to have worse or poor health (LUTS/interference almost always). These findings underscore the need for LUTS prevention and bladder health promotion.

Keywords: health promotion; incontinence; prevention; public health.

FIG. 1.

Joint distribution^a of prevalent LUTS and interference with activities from urinary experiences, pain, or discomfort in the pubic area in the past month in a community-based sample of 3169 women; BACH survey, 2002–2005. ^aAll values were weighted according to the sampling weights of the BACH survey. ^bIncludes 12 LUTS (UTI (in the past year); straining/difficult to begin voiding; pain, burning, discomfort in the pubic/bladder area; weak stream; dribbling/wet clothes after urination; intermittency; incomplete emptying; any incontinence (in the past year); urgency/difficulty postponing urination; nocturia; perceived frequency; urinating again after <2 hours). ^cRepresents the percentage of women who reported 8–12 LUTS at least rarely and interference at least a little of the time with 4–7 activities in the past month. ^dRepresents the percentage of women with self-reported current or past bladder conditions (i.e., use of current LUTS medications, previous incontinence or bladder surgery, chronic indwelling catheterization, or bladder cancer). ^eCalculated by summing the frequency of interference (0–4) with each of the seven activities (range: 0–28). ^fCalculated by summing the frequency (0–5, except for incontinence in the past year = 0–4) of 12 LUTS (range: 0–59) and then multiplying by 28/59 to obtain the same range as the interference score (range: 0–28). ^gCalculated as the sum of the LUTS and interference scores (range: 0–56). BACH, Boston Area Community Health; LUTS, lower urinary tract symptom.