Toileting Behaviors Related to Urination in Women: A Scoping Review.

Chen Wu,Mary H Palmer,Kaikai Xue

doi:10.3390/ijerph16204000

Abstract

This scoping review explores the state of science regarding women’s toileting behaviors, gaps in knowledge, and areas for future research. Online databases were searched to identify papers published in English between January 2010 through July 2019; the search identified 25 articles. The Toileting Behaviors–Women’s Elimination Behaviors scale has been published in four validated language versions and used in 17 of the 25 studies. The most frequent behaviors include concern about public toilet cleanliness, delaying urination when busy or away from home, and using different toileting postures at and away from home. Determinants of toileting behaviors include environmental factors, chronic health conditions, and cognitive/psychological factors. Associations were found between toileting behaviors and lower urinary tract symptoms and between toileting postures and uroflowmetric parameters and post-void residual volume. Strategies that address modifiable determinants of toileting behaviors should be developed and tested in future research. Furthermore, little is known about the toileting behaviors and bladder health in older women and women from developing countries. Rigorous studies are needed to better understand the underlying mechanisms of toileting behaviors, the nature of associations between toileting behaviors and lower urinary tract symptoms, and effects of the environment on women’s toileting behaviors.

Highlights

Urination is an essential bodily function and the behaviors that are used to fulfill this function can be instrumental in maintaining women’s health
Inclusion criteria for the articles reviewed were (1) adult women 18 years old and older were study participants; (2) information about the timing of urination and the place and posture/position for urination and/or nature of urination is included; (3) the study methods used are qualitative and/or quantitative; and (4) the studies were published in English-language peer-reviewed journals
Until recently, toileting behaviors that women use to meet urinary elimination needs when they are at home and away from home had been an under-studied area in women’s urologic health

Summary

Introduction

Urination is an essential bodily function and the behaviors that are used to fulfill this function can be instrumental in maintaining women’s health. Toileting behaviors that are related to both storing and emptying urine are primarily intra-individual cognitive and emotional processes that are influenced by multiple factors (e.g., interpersonal, social, environmental, and cultural factors), of which the awareness or sensation of a full bladder is only one. Women can feel vulnerable to physical and emotional circumstances that are related to removing or adjusting clothing and/or assuming a toileting posture, especially in unfamiliar places outside the home. In such environments, women may decide to delay urination despite the sensation of the need to urinate. Exposure to odors and others’ urine, feces, and/or menstrual blood can create feelings of disgust and increase the sense of vulnerability to being exposed to germs or disease and, as a result, women may alter their usual toileting behaviors

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