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Lower Urinary Tract Symptoms and Toileting Behaviors | Image Courtesy of Mick Haupt via Unsplash
Lower Urinary Tract Symptoms and Toileting Behaviors | Image Courtesy of Mick Haupt via Unsplash

How do you know if you have lower urinary tract symptoms and an overactive bladder?

Over ¾ of women report that they have experienced one or more Lower Urinary Tract Symptoms (LUTS)1.  More than ½ of American women report urinary incontinence (UI), and approximately 17% of women over the age of 18 years report symptoms of overactive bladder (OAB)2, 3. It is also believed that most women underreport their bladder symptoms due to embarrassment and false notions that it is a normal part of aging4, 5, 6.

Lower urinary tract symptoms include incomplete bladder emptying, urine dribbling after you finish urination, persistent drip of urine after completion of urination and/or urinary incontinence.  Overactive bladder symptoms consist of urinary urgency (the need to get to a restroom quickly), with or without incontinence, urinary frequency, and frequent nighttime urination (waking more than 1x/night). These symptoms can negatively impact a woman's life. One study found that women with Lower Urinary Tract Symptoms reported several impacts on quality of life including decreased sleep, work productivity, and physical/sexual activity7.

What can I do about it? 

There is a link between toileting behaviors and Lower Urinary Tract Symptoms as well as bladder dysfunction. These links include premature urination (urinating without a need or urge), straining to initiate urination or to urinate faster, or delaying urination until able to access a prefered toilet.  Many women worry about the cleanliness of public restrooms and will either delay their urination or will do a “just in case” pee before leaving their home. Also many women report when having to use a public restroom they hover over the toilet to avoid touching the seat, which does not allow for full bladder emptying. This is because the pelvic floor muscles are unable to fully relax when in this partial squat position.  Another common toileting behavior is straining in order to push urine out faster and to avoid time spent on the toilet8, 9, 10. If these behaviors could be corrected early it could stop the progression of these symptoms and reduce the negative health outcomes that can develop over time9.

In a survey, 78.4% of women denied talking to their health care provider about urinary or bladder symptoms and 61.1% denied that their provider asked about changes in urination at their last visit11. It is important that women feel comfortable discussing their urinary and bladder symptoms with their providers so they are able to seek help. It is also important that healthcare providers are screening for bladder health as well as providing a secure environment for patients to feel comfortable discussing their concerns. If you have any of the above symptoms seek out a pelvic floor physical therapist. This is what we do all day and love talking about these topics! Contact us here for an in-office or Telehealth session.


1. 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.

2. Markland AD, Richter HE, Fwu CW, et al. Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008. J Urol 2011;186(2):589–593

3. National Association for Continence. Overactive bladder. 2015. Available at https://www.nafc.org/overactive-bladder. Accessed November 19, 2017.

4. Irwin DE, Kopp ZS, Agatep B, et al. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int 2011;108(7):1132–1138.

5. Milsom I, Abrams P, Cardozo L, et al. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 2001;87(9):760–766.

6. Wallner LP, Porten S, Meenan RT, et al. Prevalence and severity of undiagnosed urinary incontinence in women. Am J Med 2009;122(11): 1037–1042

7. Coyne KS, Sexton CC, Kopp ZS, et al. The impact of overactive bladder on mental health, work productivity and health-related quality of life in the UK and Sweden: results from EpiLUTS. BJU Int 2011;108(9):1459–1471.

8. Wang K, Palmer MH. Women’s toileting behaviour related to urinary elimination: concept analysis. J Adv Nurs 2010;66(8):1874–1884

9. Sjogren J, Malmberg L, Stenzelius K. Toileting behavior and urinary tract symptoms among younger women. Int Urogyn J 2017;1677–1684. 

10. Moore KH, Richmond DH, Sutherst JR, et al. Crouching over the toilet seat: prevalence among British gynaecological outpatients and its effect upon micturition. BJOG 1991;98(6):569–572.

11. Angelini, K. J., Newman, D. K., & Palmer, M. H. (2019). Psychometric Evaluation of the Toileting Behaviors. Female Pelvic Medicine & Reconstructive Surgery, 1. doi:10.1097/spv.0000000000000711

What Our Patients Have to Say


Testimonial by A.M.

Months after giving birth, it was difficult for me to go from a sitting or lying position up to a full standing position without feeling that I had to remain hunched over until a bit of time had passed to get fully upright. However, after taking Heather’s course, I learned exercises to get my body back to normal. She also showed me correct ways to lift and carry my son as well as put him in/take him out of the carseat and stroller. This class was really beneficial and Heather is a wonderful teacher who made me feel very comfortable.

-- A.M.

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

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