The present study aimed to investigate the association of self-reported toileting behavior, lifestyle habits, and health conditions with symptoms of stress urinary incontinence (SUI) and urgency urinary incontinence (UUI), among young women.

This was an observational study in a sample of nulliparous women, aged 15-30 years, with body mass index between 15.8 and 24.9 kg/m2 and with no comorbidities. Data were collected by auto-administered questionnaire between November 2014 and October 2015. The questionnaire included sociodemographic (age), lifestyle habits (smoking, alcohol beverages consumption and exercise practice), medical history (constipation, urinary infection, family history of urinary incontinence (UI), anthropometric (weight, height), and toileting behavior (voiding posture (sit down on the toilet seat for voiding), premature voiding, empty the bladder completely, delayed voiding and micturition frequency) questions. The International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) was applied to assess UI symptoms. Positive responses to involuntary loss of urine associated with coughing, sneezing, physical activity, or exercise were classified as symptoms of SUI. Involuntary loss of urine before reaching the toilet was classified as a symptom of UUI 1. Sports were classified as low impact sports (involve activities where one foot is always in touch with the ground, e.g., roller hockey, swimming, water polo) or high-impact sports (characterized by hops or jumps in which the athlete’s legs temporarily leave the ground, e.g., ball games and sprint).
According to the presence or not of SUI and UUI symptoms, participants were compared for socio-demographic, health conditions, and toileting behaviors using the Chi-square test for categorical variables or the Mann-Whitney test for continuous variables. Bivariable and multivariable logistic regression models were conducted to identify the independent factors associated with SUI and UUI (dependent variables). Odds ratio (OR) and respective 95% confidence intervals (CI) were calculated. The following characteristics were considered in the multivariable procedure: smoking status [dichotomic: smoker, non-smoker (reference)]; alcoholic beverages consumption [categorical: <1/week (reference), 1-3/week, ≥4/week]; sport impact [categorical: no sport (reference), low impact, high impact]. Results were considered significant when p<0.05.

The sample comprised 669 young (median age: 19 years) and healthy women. From those, 137 (20.5%) reported overall UI. Ninety-five (14.2%) and 48 (7.2%) women reported SUI and UUI symptoms, respectively. Differences were found in the proportions of women presenting SUI regarding smoking status, alcoholic beverages consumption, and sports practice, compared to those not presenting SUI symptoms (p<0.05). It was also found differences in sports practice, voiding position (sitting posture), and delayed voiding for women presenting UUI vs. women not presenting UUI symptoms (p=0.001). 

After adjustment for potential confounders, delayed voiding (many times/always) and micturition frequency lower than 4 times a day, were identified as a risk factor for SUI symptoms. Delayed voiding (sometimes, many times/always) and sit down on the toilet seat for voiding (sometimes) were also identified as risk factors for UUI symptoms (Table 1).

The results of the present study, suggest that lifestyle factors, such as alcoholic beverages consumption, smoking habits, and high impact sports are associated with SUI. This finding has been reported in other studies. The finding that delayed voiding was associated with UUI was in line with a previous study 2.
Unhealthy toileting behaviors such as delayed voiding, not sit on the toilet seat for voiding, and lower daytime frequency micturition can have a negative impact on continence. Delayed voiding and not sit on the toilet seat for voiding is reported by many women and is more common in incontinent than continent women 3. Contrary to expectations, never or rarely sit for voiding was not identified as a risk factor in the present study, neither for SUI nor UUI symptoms. Little is known about the association between toileting behaviors and types of UI in young and healthy women. The present results increase knowledge in this matter.

Unhealthy daily micturition habits can have a negative impact on lower urinary tract function in young women. The fact that the identified risk factors are modifiable was an interesting finding and could have important clinical implications. The education about healthy micturition habits from health care professionals, particularly in community setting interventions, could positively impact the development of lower urinary tract symptoms.

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