Toileting behaviors, urinary cues, overactive bladder, and urinary incontinence in older women

Abstract

Introduction and hypothesis: Overactive bladder (OAB) and urinary incontinence (UI) are prevalent in older women. We investigated relations of toileting behaviors and urinary urge cues to OAB and UI in women ≥ 65 years. We tested mediation hypotheses that toileting behaviors lead to higher sensitivity to urinary urge cues (the mediator), which leads to both OAB and UI.

Methods: An e-panel was recruited to respond to an electronic survey that included demographic information, Urinary Cues Scale version 2, Toileting Behaviors-Women's Elimination Behaviors (TB-WEB) scale, and the International Consultation on Incontinence Questionnaire Short Forms for Urinary Incontinence (ICIQ-SF-UI) and Overactive Bladder (ICIQ-SF-OAB). Descriptive statistics were conducted; correlation matrices were created to explore relationships among major variables. Regression analyses were conducted to test our mediation hypotheses.

Results: There were 338 respondents with average age 70.9 (SD + 5.55) years. Most were white, overweight or obese, and had UI. Urinary urge cues fully mediated the relationship of TB-WEB with OAB. Urinary urge cues partially mediated the relationship of TB-WEB with UI; the direct effect of toileting behaviors on UI remained significant. Age and body mass index had significant partial correlations with UI but not with OAB.

Discussion: Toileting behaviors appear to contribute to sensitivity to urinary cues, which are related to both OAB and UI. Toileting behaviors have indirect effects on OAB and both indirect and direct effects on UI. Interventions to change toileting behaviors and extinguish urinary cues are needed.

Conclusions: Behavioral and conditioning factors contribute to UI in older women.

Keywords: Aged; Cues; Female; Overactive bladder; Surveys; Urinary incontinence.

Fig. 1.

CONSORT flow diagram showing participant recruitment, exclusion, and participation

Fig. 2.

Models of mediation analyses for OAB and UI. Two path diagrams model the relationships of Toileting Behavior scores to Overactive Bladder scores in the upper half and to Urinary Incontinence scores in the lower half. The C and C' Paths show the standardized regression coefficient for Toileting Behavior with Overactive Bladder as the outcome variable (upper portion of figure) and with Urinary Incontinence as the outcome variable (lower portion of figure). The regression models in the two C Paths include the covariates Age, Self-Rated Health, and BMI; they show Toileting Behavior as a significant (p < 0.001) predictor of both outcomes. The regression models in the two C' Paths also include the Urinary Cues score along with the covariates. In the model for Overactive Bladder, Toileting Behavior is a nonsignificant predictor after controlling for Urinary Cues. For Urinary Incontinence, Toileting Behavior becomes a less significant (p < 0.05) predictor after controlling for Urinary Cues. These reductions in significance are a sign of complete mediation in the case of Overactive Bladder and partial mediation in the case of Urinary Incontinence. Mediation also requires the significant relationships shown on the respective A and B Paths. The model in the A Paths predicts Urinary Cues using only Toileting Behavior: The resulting coefficient is significant (p < 0.001). The B Paths, like the C' Paths, include all predictors and in both cases show a significant (p < 0.001) coefficient for the Urinary Cues predictor. The mediation shown in these path diagrams suggests that Urinary Cues are an underlying mechanism through which Toileting Behaviors influence Overactive Bladder and Urinary Incontinence scores