Medical practitioners, especially nurses, appear predisposed to develop urinary dysfunction, presumably through the adoption of unhealthy bladder behaviors, such as urine holding or delayed voiding, in response to restrictions on toilet access at work. However, the existing science for this is largely limited to cross-sectional studies of medical personnel. Therefore, the aim of this study was to pilot the feasibility of recording daily toilet burden (i.e. perceptions of toilet limitations at work) in healthcare workers using a cellular, text-based survey tool. We hypothesized that those who perceived higher occupational interference to restroom (RR) use would report fewer daily voids.

We recruited a cohort of 21 healthcare professionals (70% female, 90% Caucasian) at our academic center from 4 different occupational settings: outpatient clinic (n = 5); inpatient floor unit (n = 5); operating room (OR) (n = 5); and MD providers (n = 6). Every day for 14 days, participants received a daily text message at the end of the workday with a link for a REDCap electronic survey. If they worked that day, they answered questions related to their RR use from the current workday, including responses for: work interference with RR use (0 – 10); inconvenience to use RR at work (0 – 10); number of voids at work. Additional variables were included to control for other potential predictors of number of voids: urinary symptoms (urgency, pain, incontinence), fluids consumed, any fluid restrictions, hours worked, number of breaks including for meals, number of bowel movements at work, and provider status (MD vs. others). Our primary outcome was times voided at work.  We first examined contributors to daily toilet burden in a linear mixed effects model that allowed us to model the effects within a given day accounting for variation between respondents and trends across days. Following, we performed a backward stepwise regression to assess for the presence of the effect of toilet burden among control variables.

Ages were similar in each group (median years [IQR]): outpatient (50 [35-57]); inpatient (23 [25-28]); OR (36 [27-49]); and MDs (34 [33-37]).  Overall, 15 participants completed all daily surveys, while 6 completed a median of 12 surveys. Of the completed surveys (n = 280) 55% represented workdays for the respondents. Typical workday hours ranged between 8 and 12 for all groups. 81% reported that completing the daily survey was easy, while 88% reported that participation in the study did not interfere at all with work.

We found that a model of perceived daily toilet burden significantly predicted times voided, X2(2) = 8.44, p = .01. In this model, inconvenience of RR use was a better predictor of times voided than work interference (Table 1). When considered among control variables, inconvenience remained a significant predictor. An optimal stepwise model across all possible predictors retained inconvenience, fluid restrictions, urgency, and number of breaks as most related to times voided during the day (Table 2; Figure 1).

In this pilot study we demonstrated that healthcare providers would complete a daily text message survey about their RR use at work and provisionally confirmed our hypothesis that increased work burden (i.e. increased inconvenience for using the restroom at work) would result in fewer voids per day.

Interference with using the restroom at work may result in toileting behaviors and habits that could predispose healthcare workers to develop urinary symptoms and conditions in the future. Further investigation is warranted to confirm and expand upon these preliminary results.