Newman Diane K, Burgio Kathryn L, Cain Charles, Hebert-Beirne Jeni, Low Lisa Kane, Palmer Mary H, Smith Ariana L, Rickey Leslie, Rudser Kyle, Gahagan Shelia, Harlow Bernard L, James Aimee S, Lacoursiere D Yvette, Hardacker Cecilia T, Wyman Jean F
Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania.
Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham and Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Department of Veterans Affairs, Birmingham, AL.
Int J Nurs Stud Adv. 2021 Nov;3. doi: 10.1016/j.ijnsa.2021.100052. Epub 2021 Nov 10.
Toileting behaviors are increasingly recognized as factors potentially contributing to development of lower urinary tract symptoms (LUTS).
To examine adult women's toileting behaviors and LUTS across age and race/ethnicity groups and relationships between toileting behaviors and LUTS.
Planned secondary analysis of questionnaire data collected in a focus group study on bladder health.
Questionnaires were completed at the conclusion of focus groups conducted in community settings affiliated with seven research centers across the United States.
Community-living women regardless of LUTS status.
Forty-four focus groups were conducted with 360 adolescent and adult cisgender women. After each focus group, participants completed questionnaires to assess toileting behaviors (Toileting Behaviors-Women's Elimination Behaviors Scale (TB-WEB)) and their experience of LUTS (Lower Urinary Tract Symptom Tool), This analysis includes quantitative data from the subgroup of 316 participants who completed the questionnaires.
Participants ranged in age from 18-93 years (Mean=50.2 years). A significant effect for age was found for delayed voiding behavior, reported by 76.5% of women ages 18-25 years and 21.9% of those 75+ years (<0.001). Conversely, reports of premature voiding were lowest in the youngest and higher in the oldest three age groups (=0.022). Racial/ethnic differences were found for three domains of toileting behavior. Black and Hispanic women expressed a stronger preference for voiding at home rather than away from home (98.9%, 93.5%, respectively) compared to White women (90.4%, =0.041), were more likely to void prematurely (37.6%, 33.3% vs. 21.2%, p=0.048) and to crouch, squat, or stand rather than sit to void when away from home (69.9%, 58.3% vs. 41.3%, p<0.001). Four toileting behavior domains were significantly associated with LUTS. Premature voiding was associated with any bothersome LUTS (OR=2.5; 95% confidence interval [CI]=1.3-4.8) and any bothersome storage LUTS (OR=2.9; CI=1.5-5.5). Delayed voiding was associated with bothersome emptying symptoms (OR=2.8; CI=1.1-6.6). Straining to void was associated with bothersome storage symptoms (OR=2.0; CI=1.0-3.7), bothersome emptying symptoms (OR=3.7; CI=1.9-7.3), and any bothersome LUTS (OR=2.3; CI=1.2-4.3). Preference for non-sitting positions to void when away from home was associated with bothersome emptying symptoms (OR=2.5; CI=1.3-4.8) and any bothersome LUTS (OR=1.8; CI=1.0-3.2).
These findings highlight the need for research to understand underpinnings of age and racial/ethnic differences in toileting behaviors and identify mechanisms by which toileting behaviors might influence development of LUTS over time. Understanding causal pathways is important in the development of public health interventions to encourage toileting behaviors that support bladder health.
排尿行为越来越被认为是可能导致下尿路症状（LUTS）发生的因素。
研究成年女性在不同年龄和种族/族裔群体中的排尿行为及下尿路症状，以及排尿行为与下尿路症状之间的关系。
对一项关于膀胱健康的焦点小组研究中收集的问卷数据进行计划中的二次分析。
在美国七个研究中心附属的社区环境中进行焦点小组讨论后，参与者完成问卷。
无论是否有下尿路症状的社区居住女性。
对360名青少年和成年顺性别女性进行了44个焦点小组讨论。每个焦点小组讨论结束后，参与者完成问卷以评估排尿行为（排尿行为-女性排尿行为量表（TB-WEB））及其下尿路症状体验（下尿路症状工具）。本分析包括316名完成问卷的参与者亚组的定量数据。
参与者年龄在18 - 93岁之间（平均 = 50.2岁）。发现年龄对延迟排尿行为有显著影响，18 - 25岁女性中有76.5%报告有延迟排尿行为，75岁及以上女性中这一比例为21.9%（<0.001）。相反，过早排尿的报告在最年轻的年龄组中最低，在最年长的三个年龄组中较高（=0.022）。在排尿行为的三个领域发现了种族/族裔差异。与白人女性（90.4%）相比，黑人和西班牙裔女性更倾向于在家中排尿而不是在外出时排尿（分别为98.9%、93.5%，=0.041），更有可能过早排尿（37.6%、33.3%对21.2%，p = 0.048），并且在外出时更倾向于蹲着、蹲或站着排尿而不是坐着排尿（69.9%、58.3%对41.3%，p < 0.001）。四个排尿行为领域与下尿路症状显著相关。过早排尿与任何令人烦恼的下尿路症状（比值比[OR]=2.5；95%置信区间[CI]=1.3 - 4.8）和任何令人烦恼的储尿期下尿路症状（OR = 2.9；CI = 1.5 - 5.5）相关。延迟排尿与令人烦恼的排尿症状相关（OR = 2.8；CI = 1.1 - 6.6）。排尿时用力与令人烦恼的储尿期症状（OR = 2.0；CI = 1.0 - 3.7）、令人烦恼的排尿症状（OR = 3.7；CI = 1.9 - 7.3）以及任何令人烦恼的下尿路症状（OR = 2.3；CI = 1.2 - 4.3）相关。外出时倾向于非坐姿排尿与令人烦恼的排尿症状（OR = 2.5；CI = 1.3 - 4.8）和任何令人烦恼的下尿路症状（OR = 1.8；CI = 1.0 - 3.2）相关。
这些发现凸显了开展研究以了解排尿行为中年龄和种族/族裔差异的潜在原因，并确定排尿行为可能随时间影响下尿路症状发生发展的机制的必要性。了解因果途径对于制定公共卫生干预措施以鼓励支持膀胱健康的排尿行为非常重要。
