Toileting Behaviours and Their Association with Lower Urinary Tract Symptoms in Women: A Scoping Review
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Abstract
Lower urinary tract symptoms (LUTS) are common among women and have been associated with demographic, behavioural, environmental, and occupational factors. Toileting behaviours (TB) have emerged as potentially modifiable contributors to bladder health; however, the scope and characteristics of the existing evidence remain unclear. We conducted a scoping review to synthesize evidence on toileting behaviours and their associations with lower urinary tract symptoms among women. The review followed Joanna Briggs Institute methodology and was reported in accordance with Preferred Reporting Items for Systematic reviews and meta-Analysis Scoping Reviews guidelines. A comprehensive systematic literature search was conducted across four databases, including PubMed, Scopus, ScienceDirect, and Google Scholar to ensure inclusion of diverse studies published between 2006 and 2025. Eligible studies included qualitative, quantitative, and mixed-methods research examining toileting behaviours in relation to lower urinary tract symptoms among women aged ≥18 years. Data were extracted using a structured charting form and synthesized narratively, with methodological quality appraised descriptively using Joanna Briggs Institute tools. Thirty-two studies were identified, predominantly cross-sectional in design. Reported lower urinary tract symptoms prevalence ranged from 9.9% to 97.1%, reflecting heterogeneity in populations and measurement approaches. Unhealthy toileting behaviours including delayed voiding, convenience voiding, straining, and toilet avoidance were associated with greater symptom burden. Occupational and environmental constraints, particularly restricted toilet access and poor sanitation, were frequently described as influencing factors. Overall, the findings suggest consistent associations between toileting behaviours and lower urinary tract symptoms; however, longitudinal and interventional studies are needed to clarify causal pathways and inform prevention strategies.
Keywords:
Lower urinary tract symptoms; Urinary incontinence; Toileting behaviours; Bladder health, Women
Article Details
How to Cite
CALEB IDOWU, Oluwasegun; BELLO, Oluwasomidoyin Olukemi.
Toileting Behaviours and Their Association with Lower Urinary Tract Symptoms in Women: A Scoping Review.
Medical Research Archives, [S.l.], v. 14, n. 4, may 2026.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7449>. Date accessed: 27 june 2026.
doi: https://doi.org/10.18103/mra.v14i4.7449.
Keywords
Lower urinary tract symptoms, Urinary incontinence, Toilet behaviours, Bladder health, Women
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5(5):CD007471. doi:10.1002/14651858.CD0 07471.pub4
3. Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int. 2011;108(7): 1132-1138. doi:10.1111/j.1464-410X.2010.09993.x
4. Coyne KS, Sexton CC, Thompson CL, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009; 104(3):352-360. doi:10.1111/j.1464-410X.2009.08427.x
5. Bajunirwe F, Stothers L, Berkowitz J, Macnab AJ. Prevalence estimates for lower urinary tract symptom severity among men in Uganda and sub-Saharan Africa based on regional prevalence data. Can Urol Assoc J. 2018;12(11):E447-E452. doi:10.5489/cua j.5105
6. Huang J, Chan CK, Yee S, et al. Global burden and temporal trends of lower urinary tract symptoms: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2023;26(2):421-428. doi:10.103 8/s41391-022-00610-w
7. Kok G, Kocaoz S, Guvenc G, Akyuz A. Prevalence of lower urinary tract symptoms in nurses and civil servants working at a hospital: a cross-sectional study. Afr Health Sci. 2021;21(1):220-229.
8. Portman DJ, Gass MLS, Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063-1068. doi:10.1097/GME.0000000000000329
9. Palmer MH, Willis-Gray MG, Zhou F, Newman DK, Wu JM. Self-reported toileting behaviors in employed women: Are they associated with lower urinary tract symptoms? Neurourol Urodyn. 2018; 37(2):735-743. doi:10.1002/nau.23337
10. Wang K, Palmer MH. Women's toileting behaviour related to urinary elimination: concept analysis. J Adv Nurs. 2010;66(8):1874-1884. doi:10.1111/j.1365-2648.2010.05341.x
11. Zhang X, Li M, Dong W, et al. Prevalence and influencing factors of lower urinary tract symptoms in female nurses: a cross-sectional study based on TARGET. Front Public Health. 2023;11:1201184. doi:10.3389/fpubh.2023.1201184
12. JBI. JBI Scoping Review Network | JBI. 2020. Accessed February 27, 2026.
https://jbi.global/scoping-review-network
13. Tricco A, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation - PubMed. 2018. doi:10.7326/M18-0850
14. Peters MDJ, Godfrey C, McInerney P, et al. Best practice guidance and reporting items for the development of scoping review protocols. JBI Evid Synth. 2022;20(4):953-968. doi:10.11124/JBIES-21-00242
15. Reynolds WS, Kowalik C, Delpe SD, Kaufman M, Fowke JH, Dmochowski R. Toileting behaviors and bladder symptoms in women who limit restroom use at work: A cross-sectional study. J Urol. 2019; 202(5):1008-1013. doi:10.1097/JU.0000000000000315
16. Newman DK, Burgio KL, Cain C, et al. Toileting Behaviors and Lower Urinary Tract Symptoms: A Cross-sectional Study of Diverse Women in the United States. Int J Nurs Stud Adv. 2021;3:100052. doi:10.1016/j.ijnsa.2021.100052
17. Berry A, Brady SS, Burgio KL, et al. Associations Between U.S. Women's Toileting Behaviors and Lower Urinary Tract Symptoms: A Cross-Sectional Analysis of RISE for HEALTH Study Data. J Womens Health. 2025;34(5):653-664. doi:10.1089/jwh.2024.0743
18. O'Connell KA, Nicholas TB, Palmer MH. Toileting behaviors, urinary cues, overactive bladder, and urinary incontinence in older women. Int Urogynecology J. 2023;34(3):707-716. doi:10.100 7/s00192-022-05228-z
19. Daily AM, Kowalik CG, Delpe SD, Kaufman MR, Dmochowski RR, Reynolds WS. Women With Overactive Bladder Exhibit More Unhealthy Toileting Behaviors: A Cross-sectional Study. Urology. 2019; 134:97-102. doi:10.1016/j.urology.2019.08.038
20. Brady SS, Bilger A, Burgio KL, et al. Theory Guided Analysis of Women's Toileting-Related Beliefs, Behaviors, and Bladder Health. Nurs Res. Published online December 2025. doi:10.1097/nn r.0000000000000877
21. Wan X, Wu C, Xu D, Huang L, Wang K. Toileting behaviours and lower urinary tract symptoms among female nurses: A cross-sectional questionnaire survey. Int J Nurs Stud. 2017;65:1-7. doi:10.1016/j.ijnurstu.2 016.10.005
22. Zhou F, Xue K, Liu Y, Zhuo L, Tu S, Palmer MH. Toileting behaviors and factors associated with urinary incontinence in college-aged female students in China. Int Urogynecology J. 2020;31(5):961-971. doi:10.1007/s00192-019-04043-3
23. Xu D, Chen L, Wan X, Zhang Y, Liu N, Wang K. Toileting behaviour and related health beliefs among Chinese female nurses. Int J Clin Pract. 2016;70(5):416-423. doi:10.1111/ijcp.12798
24. Rao Y, Wu C, Xu D, et al. Nursing Workloads and Lower Urinary Tract Symptoms Among Chinese Female Nurses: The Mediating Role of Delayed Voiding Behaviors. J Urol. 2024;211(5):699-706. doi:10.1097/JU.0000000000003862
25. Toprak Celenay S, Düşgün ES, Karaaslan Y, Uruş G, Karadag M, Özdemir E. Lower urinary tract symptoms and toileting behaviors in Turkish adult women. Women Health. 2023;63(8):577-586. doi:10.1080/03630242.2023.2248516
26. Karaaslan Y, Korkut Z, Yilmaz H, Guneyligil Kazaz T, Toprak Celenay S. Lower Urinary Tract Symptoms, Toileting Behaviors, and Pelvic Floor Health Knowledge in Younger and Older Women. Int Urogynecology J. 2024;35(7):1457-1468. doi:10.10 07/s00192-024-05831-2
27. Yakit Ak E, Şen MA, Aydin A. The Prevalence and Factors Affecting Lower Urinary Tract Symptoms in Young Female University Students. Int J Urol Nurs. 2025;19(2):e70012. doi:10.1111/ijun.70012
28. Culha Y, Seyhan Ak E, Akyurek P, Aksoy K, Culha MG, Otunctemur A. Examination of the relationship between toilet behaviors and recurrent urinary system infection in women. Rev Assoc Médica Bras. 2025;71(12):e20250836.
29. Nasiri M, Sigaroudi AE, Moghadamnia MT, Leili EK. Lower Urinary Tract Symptoms and Related Factors in Iranian Female Nurses. Iran J Nurs Midwifery Res. 2022;27(4):280-286. doi:10.4103/ijnmr.ijnmr_126_21
30. Liao YM, Dougherty MC, Biemer PP, et al. Prevalence of lower urinary tract symptoms among female elementary school teachers in Taipei | International Urogynecology Journal | Springer Nature Link. February 27, 2026. Accessed February 27, 2026. https://link.springer.com/article/10.1007/s00192-006-0293-5
31. Mohammed G, Mousa NA, Alhaj SS, Saddik B. Investigating the Risk Indicators of Urinary Incontinence Among Young Nulligravid Women: A Cross-Sectional Study. Womens Health Rep. 2025; 6(1):546-555. doi:10.1089/whr.2025.0004
32. Sjögren J, Malmberg L, Stenzelius K. Toileting behavior and urinary tract symptoms among younger women. Int Urogynecology J. 2017;28(11):1677-1684. doi:10.1007/s00192-017-3319-2
33. Fehintola AO, Erinfolami EO, Ajiboye AD, et al. Urinary Incontinence among Women in a Resource-Poor Setting: A Study of Urinary Behaviours and Other Predisposing Factors. Open J Obstet Gynecol. 2025;15(11):1916-1927. doi:10.4236/ojog.2025.15 11160
34. Kowalik CG, Daily A, Delpe S, et al. Toileting Behaviors of Women—What is Healthy? J Urol. 2019;201(1):129-134. doi:10.1016/j.juro.2018.07.044
35. Reynolds WS, Kowalik C, Kaufman MR, Dmochowski RR, Fowke JH. Women's perceptions of public restrooms and the relationships with toileting behaviors and bladder symptoms: A cross-sectional study. J Urol. 2020;204(2):310-315. doi:10.1097/JU.0000000000000812
36. Palmer MH, Wu JM, Marquez CS, Rupp B, Conover MM, Newman DK. "A secret club": focus groups about women's toileting behaviors. BMC Womens Health. 2019;19(1):44. doi:10.1186/s12905-019-0740-3
37. Wyman JF. Bladder Training. Evid-Based Phys Ther Pelvic Floor-E-Book Evid-Based Phys Ther Pelvic Floor-E-Book. Published online 2023:250.
38. Low LK, Williams BR, Newman DK, et al. The many facets of perceived bladder health in women: Absence of symptoms and presence of healthy behaviors across the life course. Continence. 2025; 13. doi:10.1016/j.cont.2024.101726
39. Perlow A, Joyce CJ, Bennis S, Mueller ER, Fitzgerald CM. Toileting behaviors and lower urinary tract symptoms among female physicians and medical students. Urogynecology. 2023;29(8):678-686.
40. Palmer MH, Newman DK. Women's toileting behaviours: an online survey of female advanced practice providers. Int J Clin Pract. Published online 2015. doi:10.1111/ijcp.12592
41. Angelini KJ, Hutchinson MK, Sutherland MA, Palmer MH, Newman DK. College Women's Experiences With Urinary Storage Symptoms. J Nurse Pract. 2020;16(5):371-377. doi:10.1016/j.nur pra.2020.02.004
42. Brock C, Elliott S, Miller S, Polomsky R, Shoemaker B, Sullivan M. Examining workplace behaviors in adult women with urinary incontinence: A pilot study. Womens Health. 2024;20. doi:10.1177/174550572 41249865
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