Bladder Health and Maladaptive Toileting Behaviors in High School and Collegiate Women

Objectives: This study aimed to compare toileting behaviors, lower urinary tract symptoms (LUTS), and fluid intake in high school and collegiate female athletes compared to their non-athlete female peers.

Methods: High school and collegiate English-speaking nulliparous females aged 13-23 were recruited and excluded if they had history of neurogenic bladder. Participants completed the Toileting Behaviors: Women’s Elimination Behaviors Scale (TB-WEB), Bristol Female LUTS Questionnaire (BFLUTS), and Beverage Questionnaire (BEV-Q). The statistical analysis included descriptive statistics (demographics), two pair t-tests (age and body mass index), Chi-square or Fisher’s exact tests (TB-WEB and BFLUTS), and Wilcoxon rank sum tests (Bev-Q). Univariable comparisons were performed as well as multivariable comparisons adjusting for age and fluid intake. This study was funded by a National Institutes of Health Prevention of Lower Urinary Tract Symptoms Consortium (NIH PLUS) supplement grant.

Results: 100 athletes and 98 non-athletes participated (mean age 20±2, 74% Caucasian, mean BMI 23±4). Non-athletes were slightly older (19.6±1.7 vs 20.7±1.4, p < 0.001). Athletes’ sports were predominantly high impact and included: cross country/track (39%), softball (17%), volleyball (17%), swimming (9%), lacrosse (7%), basketball (5%), other (6%). Non-athletes were more likely to report dysmenorrhea and anxiety (p < 0.01), whereas athletes were more likely to report stress fractures (p < 0.001). Athletes consumed lower total fluids (81 vs 101 oz, p = 0.03), but overall water intake was not significantly different (p = 0.16). (Table 1). Maladaptive toileting behaviors were prevalent overall including: emptying the bladder before leaving home (95.4%), delaying emptying the bladder when busy (85%), hovering over the toilet away from home (74%), pushing to empty the bladder faster (64%), avoiding public toilets (60%). Non-athletes were more likely to hold urine until they got home (p = 0.04) and empty away from home without feeling the need (p = 0.04). LUTS were also prevalent overall including: frequency (34.2%), hesitancy (33.3%), urgency (32.8%), stress incontinence (15.3%), and urgency incontinence (11.8%), among others. Athletes were more likely to have urgency (p = 0.06) and stress incontinence (p = 0.047), and their incontinence sub-score was higher on univariable analysis (2.2±2.2 vs 1.6 ± 2.2, p = 0.03) but not significantly so on multivariable analysis controlling for age and beverage intake (p =0.07). (Table 2).

Conclusions: High school and collegiate females, regardless of athletic status, have a high prevalence of maladaptive toileting behaviors and LUTS. Athletes have more stress urinary incontinence and a trend toward urgency compared to their non-athlete peers. These findings support future work toward enhancing bladder health screening, education, LUTS prevention, and early intervention in all high school and collegiate females.