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.

Is the juice worth the squeeze? Transdisciplinary team science in bladder health

“…PLUS investigators recognized the need for upfront time to develop a positive transdisciplinary culture, and that this would likely delay short‐term productivity when judged by traditional metrics (eg, publications, presentations, and abstracts at national meetings). These short‐term delays have already been offset by progress with conceptual work and research that promises a significant health impact, including 11 peer‐reviewed papers, 1,9,10,15‐22 26 peer‐reviewed abstracts, 23‐47 and 15 invited presentations to date. PLUS has formalized key strategic initiatives informed by the shared language, critical awareness, and transdisciplinary orientation developed over the past 4 years.…”

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

“…This score was calculated as the sum of standardized scores for LUTS (sum of the frequency of 12 LUTS [scales from 0 to 4/5]) and interference (sum of the frequency of interference with 7 activities [scales of 0e4] 12 ) for a combined score ranging from 0 (best) to 56 (worst bladder health). 6 To investigate whether baseline bladder health is associated with changes in bladder health over time, we used ordinal logistic regression and generalized linear models to calculate crude-and multivariable-adjusted odds ratios (ORs) and relative risks (RRs), respectively. We also performed stratified analyses by age group and sensitivity analyses excluding women with: 1) known past or current bladder conditions/treatment (current LUTS medications, previous incontinence or bladder surgery, chronic indwelling catheterization and bladder cancer), as their exact position on the bladder health distribution was assumed, not known based on their untreated LUTS/wellbeing and 2) nonbladder conditions that might contribute to LUTS or interference (genitourinary cancers besides bladder cancer, prolapse of the uterus, "bladder, or rectum", congenital urinary tract abnormalities [many of which are renal 17,18 ], endometriosis, pelvic inflammatory disease, chronic pelvic pain, vulvodynia and diabetes).…”

“…This score was calculated as the sum of standardized scores for LUTS (sum of the frequency of 12 LUTS [scales from 0 to 4/5]) and interference (sum of the frequency of interference with 7 activities [scales of 0–4] 12 ) for a combined score ranging from 0 (best) to 56 (worst bladder health). 6…”

Converging on Bladder Health through Design Thinking: From an Ecology of Influence to a Focused Set of Research Questions

“…Lower urinary tract symptoms (LUTS) affect a substantial number of women and girls in the United States (U.S.) and across the globe [1][2][3][4][5][6][7][8]. Nearly one in four women over the age of 30 in the U.S. experience poor bladder health, based on the frequency and impact of LUTS, with increasing prevalence over the lifecourse [6]. Much research on LUTS in women and girls has focused on identifying and treating those who are already suffering from symptoms.…”