Changes in Bladder Health over Time: A Longitudinal Analysis of Adult Women in the Boston Area Community Health Survey

Abstract

Purpose:Our goal was to describe changes in bladder health, defined as “a complete state of physical, mental, and social well-being related to bladder function that permits daily activities, adapts to short-term stressors, and allows optimal well-being,” in women over time.Materials and Methods:We used data on 15 lower urinary tract symptoms (LUTS) and interference from urinary experiences assessed at the baseline and 5-year followup interviews of the BACH (Boston Area Community Health) Survey to estimate changes in bladder health over time in women. Associations between baseline and followup bladder health (defined as the maximum frequency of LUTS or interference at each time point) were calculated by ordinal logistic regression and generalized linear models.Results:A total of 2,526 women provided complete information on bladder health at baseline and followup. Over the 5-year followup, 6.5% of women maintained optimal bladder health (no LUTS or interference), 33.6% developed worse bladder health (including 10.4% who transitioned from optimal to less than optimal health), 31.4% maintained their less than optimal bladder health status and 28.7% improved. Despite these changes, women with poorer bladder health at baseline were still more likely to have poorer bladder health 5 years later (eg multivariable-adjusted relative risk=3.27, 95% confidence interval: 2.49–4.29 for severe LUTS/interference at followup among those with severe LUTS/interference at baseline).Conclusions:Findings from our large secondary analysis of BACH Survey data suggest considerable variability in bladder health over time, and underscore the importance of bladder health promotion to prevent the initial onset and progression of poor bladder health in women.

This Month in Adult Urology

“…In this issue of The Journal of Urology ®, Sutcliffe et al (page 1086) in a multicenter study explore these concepts of bladder health in women using Boston Area Community Health survey data. 1 They report considerable variability in bladder health over time: over 5-year followup, approximately a third of women developed worse bladder health, whereas a similar amount improved. They include a measure of bladder interference, in addition to LUTS, which is a significant addition to the literature.…”

RISE FOR HEALTH: Rationale and protocol for a prospective cohort study of bladder health in women

“…These analyses indicated a wide spectrum of bladder health among women, with only a small percentage classified as having optimal bladder health at baseline (~20%) 11,12 and even fewer after 5 years of follow-up (~5%). 13 Importantly, some women's bladder health improved over time, demonstrating the potential for secondary prevention interventions. 13…”

Can Lower Urinary Tract Symptoms and Urinary Incontinence in Women Be Prevented?

“…Conversely, a third of women maintain their original (less than optimal) bladder health status, a third develop worse bladder health and a third improve their bladder health. 4…”

“…Conversely, a third of women maintain their original (less than optimal) bladder health status, a third develop worse bladder health and a third improve their bladder health. 4 Interestingly, the authors demonstrate that moving from bad to worse is more likely than moving in the opposite direction. More specifically, women who have worse LUTS or a higher level of interference at baseline are more likely to have persistent or worsening LUTS and interference at 5year followup.…”

“…3 In this issue of The Journal, Sutcliffe et al (page 1086) investigate the epidemiology of various bladder states along the bidirectional continuum of health and disease. 4 Extrapolating from the World Health Organization's definition of health, the authors and members of the Prevention of Lower Urinary Tract Symptoms Research Consortium define bladder health as "a complete state of physical, mental and social well-being related to bladder function and not merely the absence of lower urinary tract symptoms (LUTS)." They then apply this definition to describe the prevalence of health, or lack thereof, across the different roles of the bladder, including its storage, micturition and bioregulatory functions.…”