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BLADDER HEALTH IN US WOMEN: POPULATION-BASED ESTIMATES FROM THE RISE FOR HEALTH STUDY

Background: Bladder health encompasses total bladder well-being and not merely the absence of urinary symptoms. While much is known about the prevalence of urinary symptoms in women, little is known about the distribution of bladder health (e.g., optimal to poor).

Objective: We report the distributions of multiple dimensions of bladder health and function in a population-based sample of community-dwelling women, overall and separately in women without urinary symptoms to begin to explore bladder health dimensions that may precede the onset of symptoms.

Study Design: RISE FOR HEALTH is a regionally-representative cohort study of US women aged 18 and older. Baseline surveys included the validated Bladder Health Scales/Bladder Function Indices, the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index, and additional study items. Bladder well-being was assessed across 10 scales and bladder function across six indices. Bladder Health Scale scores were adjusted for adaptive/coping behaviors (e.g., using/carrying pads, staying close to a toilet) to account for the perceived impact of urinary symptoms on well-being. Scores for scales and indices ranged from 0 (poor well-being/function) to 100 (optimal well-being/function). We calculated summary statistics for each scale (with and without adaptive behavior adjustment) and each index in the full study population and subset of women without urinary symptoms.

Results: The mean age of 3,027 eligible participants was 49.8 years (SD 17.9). The median global Bladder Health Scale score was 72 (IQR: 56, 84) before adjustment for adaptive/coping behaviors and 55 (IQR: 34, 78) after adjustment. Median scores for the other scales ranged from 75-100 before and 61-72 after adjustment. Sixty-nine percent of participants reported using adaptive/coping behaviors, including using pads (40%), toilet mapping (58%), and staying close to a toilet (3%). The median overall Bladder Function Index score was 77 (IQR: 63, 89); individual median scores ranged from 63-68 for frequency, sensation, continence, and emptying indices to 100 for biosis/urinary tract infection and comfort indices. Among participants without reported urinary symptoms (n=700), scores were higher across all scales (unadjusted medians=88-100 and adjusted medians=82-100) and indices (medians=93-100), indicating better, but not optimal health; however, 38% of asymptomatic women reported using adaptive/coping behaviors: 11% using pads, 30% toilet mapping, and 2% staying close to a toilet.

Conclusion: We observed a wide range of bladder well-being and function in RISE participants, and high utilization of adaptive/coping behaviors. Bladder health variability and utilization of adaptive/coping behaviors was also observed in women without urinary symptoms, highlighting bladder health dimensions not captured by traditional urinary symptom tools and potentially identifying a group of women with “sub-clinical” symptoms who may be at greater risk of developing urinary symptoms. Future prospective analyses should investigate this novel group of women further.

Ariana L. SMITH, MD1 ∙ Chloe FALKE, BS2 ∙ Kyle D. RUDSER, PhD2 ∙ Gerald McGWIN, PhD3 ∙ Sonya S. BRADY, PhD4 ∙ Linda BRUBAKER, MD5 ∙ Kimberly KENTON, MD6 ∙ D. Yvette LaCOURSIERE, MD, MPH7 ∙ Cora E. LEWIS, MD8 ∙ Lisa K. LOW, PhD9 ∙ Jerry L. LOWDER, MD10 ∙ Emily S. LUKACZ, MD11 ∙ Elizabeth R. MUELLER, MD12 ∙ Diane K. NEWMAN, DNP13 ∙ Jesse NODORA, DrPH14 ∙ Alayne MARKLAND, MD15 ∙ Sara PUTNAM16 ∙ Leslie M. RICKEY, MD, MPH17 ∙ Todd ROCKWOOD, PhD18 ∙ Melissa A. SIMON, MD, PhD19 ∙ Ann STAPLETON, MD20 ∙ Camille P. VAUGHAN, MD21 ∙ Jean F. WYMAN, PhD22 ∙ Siobhan SUTCLIFFE, PhD23 ∙ for the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium
 
  1. Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
  2. Falke: Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, MN
  3. McGwin: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
  4. Brady: Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
  5. Brubaker: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA
  6. Kenton: Section of Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL
  7. LaCoursiere: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Diego, La Jolla, CA
  8. Lewis: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
  9. Low: School of Nursing, University of Michigan, Ann Arbor, MI
  10. Lowder: Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
  11. Lukacz: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA
  12. Mueller ER: xDepartments of Urology & Obstetrics/Gynecology, Loyola University Medical Center, Loyola University Chicago, Chicago, IL
  13. Newman: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
  14. Nodora: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
  15. Markland: Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, and the Geriatric Research, Education, and Clinical Center at the Birmingham Veterans Affairs Health Care System; Birmingham, AL
  16. Putnam: Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, MN
  17. Rickey: Departments of Urology and Obstetrics, Gynecology & Reproductive Sciences; Yale School of Medicine, New Haven, CT
  18. Rockwood: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
  19. Simon: Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
  20. Stapleton: Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, WA
  21. Vaughan: Division of Geriatrics & Gerontology, Department of Medicine, Emory University and the Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA
  22. Wyman: School of Nursing, University of Minnesota, Minneapolis, MN
  23. Sutcliffe: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
Source: Smith, A. Brubaker, Linda et al. BLADDER HEALTH IN US WOMEN: POPULATION-BASED ESTIMATES FROM THE RISE FOR HEALTH STUDY. American Journal of Obstetrics & Gynecology. 2024. DOI: 10.1016/j.ajog.2024.10.044