Bladder health shows wide variability; many women use coping behaviors.

Background

Bladder health encompasses physical, mental, and social well-being related to bladder function—not merely the absence of lower urinary tract symptoms (LUTS). Prior work largely measured LUTS and bladder-related quality of life using instruments designed for symptomatic patients. The PLUS Consortium created and validated the Bladder Health Scales (BHS) and Bladder Function Indices (BFI) to capture broader bladder health dimensions in the general population.

Patients

Community-dwelling US women (assigned female at birth), aged 18+, recruited by probability sampling across 9 academic sites (50 counties) from May 2022 to May 2023.

• Eligible participants analyzed: n=3027; mean age 49.8 years (SD 17.9)
• Race/ethnicity: 62.9% non-Hispanic White; 12.3% non-Hispanic Black; 15.3% Hispanic; 5.9% non-Hispanic Asian
• Urban residence: 97.8%

Intervention

No therapeutic intervention. Baseline assessment using validated instruments:

• Bladder Health Scales (BHS): 10 well-being scales (0–100; higher is better), with scores adjusted for adaptive/coping behaviors (e.g., pad use, toilet mapping, staying close to a toilet).
• Bladder Function Indices (BFI): 6 function indices (0–100; higher is better): UTI/biosis, frequency, sensation, continence, comfort, emptying (unadjusted for behaviors).

Control

Descriptive comparison with a predefined asymptomatic subgroup (n=700) without LUTS or bladder conditions:

• LURN SI-10: daytime frequency <8/day; nocturia ≤1/night; “never” for other LUTS items in past 7 days
• Negative history for recurrent UTIs (≥3/year) and bladder cancer

Outcome

• Distribution of BHS (global and 9 domain scales) with and without adaptive-behavior adjustment
• Distribution of BFI (6 indices and overall)
• Prevalence of adaptive/coping behaviors
• Subgroup analyses in women without LUTS
• Associations of known LUTS risk factors with bladder health/function

Study Design

Population-based, regionally representative cohort (RISE FOR HEALTH); this analysis is cross-sectional at baseline using mailed/web surveys. Linear regression assessed associations with known risk factors (robust variance; Holm correction for multiple comparisons).

Level of Evidence

Level III (observational cohort; cross-sectional baseline analysis for prevalence/distribution).

Follow up period

Baseline only (cross-sectional); no longitudinal follow-up reported in this analysis.

Results

Primary outcome: Distribution of global bladder well-being (BHS)

• All participants: Median global BHS 72 (IQR 56–84) unadjusted; 55 (IQR 34–78) after adjustment for adaptive behaviors.
• Asymptomatic subgroup: Median global BHS 88 (IQR 78–91) unadjusted; 82 (IQR 66–92) after adjustment—indicating good but not optimal well-being even without LUTS.

Secondary outcomes

• BHS domain distributions (all participants): Higher unadjusted medians for intimacy, social/occupational, physical activity, emotion (≈90–100); moderate for travel and perceived efficacy (≈85–87); lower for freedom and holding (≈75–82). All domains decreased after behavior adjustment but retained similar rank order.
• BFI (all participants): Median overall BFI 77 (IQR 63–89). Median indices: frequency, sensation, continence, emptying ≈63–68; UTI/biosis and comfort ≈100.
• BFI (asymptomatic subgroup): Median overall BFI 93 (IQR 86–100); individual indices typically 93–100.
• Adaptive/coping behaviors: 69% of all participants reported any behavior (pads 40%, toilet mapping 58%, staying close to a toilet 3%). Among asymptomatic women, 38% reported behaviors (pads 11%, toilet mapping 30%, staying close 2%).
• Risk factor associations (all participants): Worse BHS/BFI with higher BMI (especially obesity), greater vaginal parity, current/former smoking, diabetes, neurologic disease, depression/anxiety, postmenopausal status, and higher comorbidity burden; relatively better scores among non-Hispanic Asian participants. These associations were not significant in the asymptomatic subgroup.
• NNT: Not applicable (descriptive study; no interventional comparison).

Limitations

• Cross-sectional baseline analysis cannot infer causality or trajectories.
• 7.9% response rate; underrepresentation of rural and less-educated women may limit generalizability.
• Self-reported measures may misclassify LUTS status and omit asymptomatic bladder conditions (e.g., bacteriuria, microscopic hematuria).
• Definition of asymptomatic based on recent (7-day) LUTS may miss prior or intermittent symptoms; behavioral outcomes could reflect non-bladder drivers (e.g., caregiving, anxiety).
• Adaptive behavior adjustment assumes global influence of coping on perceived well-being; may overcorrect some domains.

Funding

US National Institutes of Health: NIDDK cooperative agreements (U24DK106786, U01DK106853, U01DK106858, U01DK106898, U01DK106893, U01DK106827, U01DK106908, U01DK106892, U01DK126045); additional support from the National Institute on Aging and the NIH Office of Research on Women’s Health.

Citation

Smith AL, Falke C, Rudser KD, et al; for the PLUS Research Consortium. Bladder health in US women: population-based estimates from the RISE FOR HEALTH study. American Journal of Obstetrics & Gynecology. 2025;232:538.e1–13. doi:10.1016/j.ajog.2024.10.044. ClinicalTrials.gov: NCT05365971.