Most research on lower urinary tract symptoms (LUTS) in women to date has focused on LUTS prevalence and treatment, whereas considerably less has focused on LUTS prevention and bladder health promotion. To address this gap, the Prevention of Lower Urinary Tract Symptom Research Consortium developed a framework for studying bladder health adapted from the World Health Organization definition of overall health: “A complete state of physical, mental, and social well-being related to bladder function [that] permits daily activities, adapts to short-term physical and environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational or other activities).” Although this framework represents a major step forward in conceptualizing bladder health, we do not yet have data to quantify and further refine this concept. Therefore, we took advantage of existing data from the Boston Area Community Health (BACH) Survey, a large population-based study of Boston residents, to explore this concept further, drawing upon its extensive collection of LUTS and rare collection of interference from LUTS with daily activities in women.

At baseline, participants reported their frequency of 16 LUTS, including storage, voiding, and incontinence symptoms, and lower urinary tract pain. Information on interference from urinary experiences, pain, or discomfort in the pubic area with seven activities was also collected, using an adapted version of the validated Epstein scale. Activities assessed were drinking fluids before travel; driving for two hours without stopping; going to places that may not have a toilet; playing sports outdoors such as golf; going to movies, shows, and church; drinking fluids before bed; and getting enough sleep at night. Prevalence estimates were weighted to account for the BACH sampling design, and prevalence ratios (PRs) were calculated by log-link generalized linear models with robust variance estimation, adjusting for known LUTS risk factors and each other individual LUTS. With a sample size of 2,697 participants, our study had at least 80% power to detect minimum detectable PRs ranging 1.20-1.35 for LUTS prevalence and interference estimates between 10 to 50%, and using two-sided tests and an α-level of 0.05.

2,697 women >30 years of age completed the BACH baseline visit and provided complete data. Of these women, 19.7% reported no LUTS or interference, whereas 48.1% reported LUTS at least rarely but no interference (see Table). Within the latter group, the breakdown of LUTS frequency was 13.7% for LUTS at least rarely, 15.0% for a few times, 7.9% for fairly often, and 11.4% for usually or almost always in the past month. Few women (2.2%) reported no LUTS but at least a little interference, and 30.0% reported some degree of both LUTS and interference. LUTS independently associated with interference were urgency incontinence (PR=1.4, 95% CI: 1.1-1.8), urgency (PR=1.3, 95% CI: 1.1-1.6), nocturia (PR=1.4, 95% CI: 1.1-1.7), perceived frequency (PR=1.5, 95% CI: 1.2-1.9), and weak stream (PR=1.2, 95% CI 1.0-1.5).

Our findings suggest that as few as one in five women could be considered to have optimal bladder health (no LUTS or interference), half of women could be considered to have intermediate health (some degree of LUTS or interference), and one third could be considered to have worse health (some degree of both LUTS and interference). Storage LUTS and weak stream contributed independently to interference in this population.

Findings from our large secondary analysis of BACH survey data begin to inform and quantify the spectrum of bladder health, demonstrating that only one in five women might be considered to have optimal bladder health, whereas the remaining 80% of women fall somewhere on the spectrum between intermediate and worse bladder health. This large percentage of symptomatic women highlights opportunities for both LUTS prevention and bladder health promotion.