Revisiting the Spectrum of Bladder Health: Relationships Between Lower Urinary Tract Symptoms and Multiple Measures of Well-Being

Abstract

Background: Little research to date has investigated the spectrum of bladder health in women, including both bladder function and well-being. Therefore, we expanded our previous baseline analysis of bladder health in the Boston Area Community Health (BACH) Survey to incorporate several additional measures of bladder-related well-being collected at the 5-year follow-up interview, including one developed specifically for women. Methods: At follow-up, participants reported their frequency of 15 lower urinary tract symptoms (LUTS), degree of life impact from and thought related to urinary symptoms or pelvic/bladder pain/discomfort, and perception of their bladder condition. Prevalence ratios were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. The BACH Survey was approved by the New England Research Institutes Institutional Review Board and all participants provided written informed consent. Results: Generally similar findings were observed in the 5-year cross-sectional analysis as at baseline, irrespective of how we categorized LUTS or measured bladder-related well-being. Approximately one in five women (16.2%-18.0% of 2527 eligible women) reported no LUTS and no diminished bladder-related well-being, the majority (55.8%-65.7%) reported some LUTS and/or diminished well-being, and a further one in five (16.9%-26.6%) reported the maximum frequency, number, or degree of LUTS and/or diminished well-being. Measures of storage function (urinating again after <2 hours, perceived frequency, nocturia, incontinence, and urgency) and pain were independently associated with bladder-related well-being. Conclusions: Our similar distribution of bladder health and consistent associations between LUTS and bladder-related well-being across multiple measures of well-being, including a female-specific measure, lend confidence to the concept of a bladder health spectrum and reinforce the bothersome nature of storage dysfunction and pain.

Keywords: bladder; health; women.

FIG. 1.

Joint distribution of LUTS in the past month and degree of impact from urinary symptoms, pain or discomfort in the pelvic or bladder area in a community-based sample of 2527 women; Boston Area Community Health Survey, 2008–2010. All values were weighted according to the sampling weights of the Boston Area Community Health Survey. Maximum frequency of LUTS across 12 LUTS (urinating again after <2 hours; perceived frequency; nocturia; any incontinence [in the past year]; dribbling/wet clothes after urination; urgency/difficulty postponing urination; pain, burning, discomfort in the pubic/bladder area; straining/difficult to begin voiding; weak stream; intermittency; incomplete emptying; and urinary tract infection [in the past year]). Number of LUTS experienced at least rarely in the past month (out of the 12 LUTS described above). Maximum degree of impact across seven activities or aspects of life. Represents the percentage of women who reported the highest category of LUTS and impact. Represents 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). Calculated by summing the degree of life impact (0–3) with each of the five activities and two emotional health items (range: 0–21). Calculated 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 21/59 to obtain the same range as the impact score (range: 0–21). Calculated as the sum of the LUTS and life impact scores (range: 0–42). IIQ, Incontinence Impact Questionnaire; LUTS, lower urinary tract symptom.