Toileting Behaviors and Recurrent Urinary Tract Infections in Premenopausal Women: A Case-Control Study

To explore the association between dysfunctional toileting behaviors (TB) and recurrent urinary tract infections (RUTI) in premenopausal women using a validated behavioral assessment scale.

We conducted a case-control study at the American University of Beirut Medical Center between 2020 and 2023. A total of 294 premenopausal women were recruited, comparing 98 women with RUTI and 196 controls without RUTI. Participants completed a structured questionnaire, including demographic data and responses to the Toileting Behaviors-Women's Elimination Behavior (TB-WEB) scale, assessing five behavioral domains: place preference, premature voiding, delayed voiding, straining, and position preference. Statistical analysis involved t-tests, chi-square tests, and multivariable logistic regression adjusting for potential confounders.

Women with RUTI were more likely to prefer crouching rather than sitting on toilet seat during micturition, both at home and in public restrooms. Women with RUTI showed significantly higher mean scores for dysfunctional TB when compared to those without RUTI in the following domains: place preference for voiding, premature voiding, delayed voiding, and straining. At least 62.5% of women with RUTI reported that these behaviors had been habitual prior to their diagnosis suggesting that these practices could have contributed to the development of RUTI.

This study identifies a significant association between "dysfunctional" TB and RUTI in premenopausal women. The findings underscore the importance of further research to explore the causal mechanisms underlying this relationship and to develop targeted interventions aimed at modifying TB to try to curb the incidence of RUTI.