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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

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Today we finally made love. It was actually incredible. I finally got to connect with him on this amazing level."

What Our Patients Have to Say


Testimonial by S.P., Age 26

I would like to start off by thanking Heather Jeffcoat for educating me and curing me of Vaginismus. I had been married for almost three years before I was referred to Heather. I never knew about Vaginismus until almost three years into my marriage. I knew something was wrong when I went on my honeymoon and came back a Virgin. I had always imagined how magical my first night would be but boy was I wrong.

Read more: Testimonial by S.P., Age 26

Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

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Testimonial by M.M.

A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

Read more: Testimonial by M.M.

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

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Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

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Testimonial by J.H.

My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

Read more: Testimonial by J.H.

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