Lower urinary tract symptoms (LUTS) are highly prevalent in women. Core instability and physical activity (PA) may be associated with LUTS. The study hypothesized that compared with healthy controls, women with LUTS would have differences in core stability scores, reduced PA levels, and LUTS symptom severity would correlate inversely with core stability. This cross-sectional cohort study recruited women aged 18–70 with and without LUTS. Participants completed demographics, Urinary Distress Inventory Short Form (UDI-6), Godin Shephard Leisure Time Exercise Questionnaire (Godin), a novel Resistance Activity Questionnaire (RAQ), and Core Score testing. Summary statistics were provided overall and by LUTS diagnosis. Wilcoxon rank sum tests compared median aerobic physical activity (aPA)/resistance physical activity (rPA) between groups. Regression analyses estimated the effects of LUTS and UDI-6 severity on core stability. A total of 48 women with LUTS and 49 women without LUTS participated (mean age 46 ± 12, BMI 32 ± 8). Women with LUTS were older (mean, SD 51, 12 vs 43, 13, p < 0.01) with higher parity (2, 1 vs 1, 1, p < 0.01), and higher constipation (n,

BACKGROUND:Physical activity (PA) and core stability levels are unknown for women with musculoskeletal chronic pelvic pain (CPP) compared to healthy women. At this time, there is no validated treatment method aimed specifically at CPP. OBJECTIVE:To elucidate the PA habits and core stability of women with and without CPP. We hypothesized that aerobic and resistance PA (aPA, rPA) and core stability would differ significantly. DESIGN:Prospective, cross-sectional study. Wilcoxon rank sum tests, simple and multiple linear regressions, and Pearson chi-square test were used for analysis. SETTING:Primary and specialty care outpatient physical medicine and rehabilitation, female pelvic medicine and reconstructive surgery, and gynecology clinics associated with a large tertiary center. PATIENTS:We recruited 91 women aged 18-70 years with and without CPP (defined by American College of Obstetricians and Gynecologists). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Physical activity, core stability scores. RESULTS:Women with CPP demonstrated lower overall core stability (p = .04). Having CPP predicted a 2-point decrease in overall core score (p < .01). Women with CPP demonstrated significantly worse scores for the supine bridge (p < .01) and prone bridge (p = .03). There were no significant differences in aPA or rPA between women with and without CPP. Pelvic floor muscle strength did not have a significant effect on core scores in women with CPP before or after adjusting for age, parity, and body mass index. CONCLUSIONS:This study reports a novel finding that women with CPP had significantly reduced core scores (suggestive of weaker core stability) but similar levels of physical activity (aPA and rPA) compared to women without CPP. Future directions will include larger, multicenter, randomized controlled trials to investigate the association between pelvic floor muscles and core stability as well as therapeutic interventions to include specific exercises targeted at improving overall core stability in women with CPP.

IMPORTANCE:In women with pelvic floor disorders, pelvic floor myofascial pain with palpation is associated with lower urinary tract symptoms, but the prevalence in community-dwelling women is unknown. OBJECTIVES:Our study describes the prevalence of pelvic pain with palpation in community-dwelling women and its association with bladder health and symptoms. STUDY DESIGN:A subset of adult women from a large population-based, regionally representative cohort across 8 geographic regions of the United States was examined for pain with palpation of the obturator internus and levator ani muscles. Participants were not excluded on the basis of pain or urinary symptoms at baseline. Bladder health and urinary symptoms were measured using validated questionnaires. Linear and Poisson regression were used to examine associations between baseline pain and changes in bladder health and symptoms at follow-up. RESULTS:Of 502 participants, 56% had pain (46% mild [1-3/10], 8% moderate [4-6/10], 2% severe [7-10]; mean 1.1±1.6) on examination. At baseline, higher pain scores were associated with worse bladder function (β, -1.4, CI, -2.6, -0.1), and greater urinary symptoms (β, 0.4, CI, 0.1, 0.8). Baseline pain on palpation was associated with the development of new bothersome urinary symptoms (β, 1.1, CI, 1.0, 1.2) and painful urinary symptoms (β, 1.2, CI, 1.0, 1.3) over 1-2 years. CONCLUSION:Pain with palpation of the pelvic floor musculature is common in community-dwelling women and is significantly associated with urinary symptoms at baseline and with new-onset urinary symptoms over time. Pelvic muscle pain with palpation may be important to consider in the assessment of factors associated with urinary symptoms and as a precursor to bladder pain.

Chronic pelvic pain (CPP) affects up to 24% of women worldwide, with musculoskeletal pain and dysfunction present in most cases yet often overlooked in traditional organ-focused approaches. Comprehensive musculoskeletal assessment, including movement pattern analysis, pelvic floor examination, and evaluation of hip, spine, and abdominal wall pathology is essential for accurate diagnosis. First-line treatment with pelvic floor physical therapy demonstrates significant efficacy, though multidisciplinary team-based care optimizes outcomes through coordinated treatment plans. Despite evidence supporting this integrated approach, barriers including insurance coverage gaps, limited specialists, and insufficient musculoskeletal education prevent widespread implementation, necessitating advocacy, curriculum expansion, and systematic changes prioritizing comprehensive patient-centered care.

INTRODUCTION AND HYPOTHESIS:Depressive and anxiety symptoms are known risk factors for lower urinary tract symptoms (LUTS). To inform prevention and treatment strategies, this research examined whether greater emotional support seeking weakened associations of affective symptoms with LUTS and poorer bladder health. METHODS:Data were collected from women in the USA who participated in the RISE FOR HEALTH study of bladder health. In this cross-sectional analysis (analytic sample n = 1444), self-reported LUTS, perceived bladder health, and perceived impact of bladder health on five domains of living (social and occupational activities, travel, physical activities, intimacy, and emotions) were separately regressed on depressive symptoms, anxiety symptoms, and emotional support seeking. Interaction tests examined whether emotional support seeking modified associations of affective symptoms with LUTS and bladder health. RESULTS:Report of worse depressive symptoms, worse anxiety symptoms, and lower levels of engagement in emotional support seeking were associated with more frequent LUTS, poorer perceived bladder health, and lower perceived positive impact of bladder health on each domain of living. Emotional support seeking was not associated with LUTS and bladder health outcomes when adjusting for affective symptoms, and did not modify associations of affective symptoms with LUTS and bladder health outcomes. CONCLUSIONS:Intervention research to prevent LUTS and promote bladder health can test strategies that include screening and providing timely treatment of affective symptoms. Health care providers treating women for LUTS can screen for affective symptoms and make referrals to ensure that both the physical health and the mental health needs of patients are being met.

Introduction:Women with multiple chronic conditions are more likely than women without them to report lower urinary tract symptoms (LUTS); understanding the association of common and coexisting chronic conditions with bladder health across adulthood may inform prevention efforts. Methods:Data were collected from May 2022 through December 2023 from a regionally representative cohort of community-dwelling adult women in the US. Chronic conditions were assessed by self-report and bladder health, and LUTS were measured using validated questionnaires. Analyses were limited to women aged 40 years or older and included multivariable linear and logistic regression models, adjusted for age, body mass index, physical function, and educational attainment. Results:Of 3,423 eligible participants, 2,016 were aged 40 years or older and responded to questions on multiple chronic conditions. Of these, 449 had no chronic conditions, 405 reported 1 chronic condition, 652 had 2 or 3 chronic conditions, and 510 had 4 or more chronic conditions. Hypertension (41.4%) and osteoarthritis (13.6%) were the most frequently reported coexisting conditions (9.7% had both). Across the 10-item Bladder Health Scales and 6-item Bladder Function Indices, women with 0 or 1 chronic condition reported better bladder health than women with multiple chronic conditions. In this cohort, frequent LUTS did not vary by the number of chronic conditions. Conclusion:The opportunity to promote bladder health among adult women with chronic conditions may precede the development of frequent LUTS. Additional research is needed to determine whether prevention strategies may differ according to common chronic conditions.

BACKGROUND:Poorer performance on standardized tests of cognitive function is associated with urinary incontinence (UI), overactive bladder, and poorer bladder health among people aged 40 and older. OBJECTIVE:To examine whether self-rated deficits in executive function domains (organization/problem solving, inhibitory control/self-restraint, self-regulation of emotions) are associated with lower urinary tract symptoms (LUTS), perceived bladder health and function, and adaptive behaviors to prevent or manage UI among adult women across the life course. METHODS:Surveys were administered as part of the RISE FOR HEALTH population-based study of women (19-100 years, mean = 50 years) in the United States. In this cross-sectional analysis, LUTS, perceived bladder health and function, and adaptive behaviors were regressed on individual executive function subscales and a composite measure (analytic sample n = 1,551). RESULTS:Self-rated deficits in all evaluated domains of executive function were significantly associated with greater numbers and frequency of LUTS, including urgency and urgency UI; poorer perceived bladder health and function; and a greater tendency to locate bathrooms when entering new places. Associations were of similar magnitude across age categories ranging from emerging to older adulthood. CONCLUSIONS:Findings demonstrate an association between self-rated executive function deficits and bladder function. Further research should test brain-bladder communication as a potential mechanism linking deficits in executive function to greater numbers and frequency of LUTS, poorer perceived bladder health and function, and greater engagement in adaptive behaviors to prevent or manage UI. Research is also needed to further evaluate whether associations between executive function and LUTS differ by life course stage.

Background:Women commonly experience lower urinary tract symptoms (LUTS), such as frequent urination, urgent urination, and urinary incontinence. Health education for women rarely focuses on LUTS prevention and promotion of bladder health. The Theory of Reasoned Action and the Theory of Planned Behavior have been used to explain and change a variety of health behaviors. Missing from the literature is an explicit test of whether constructs of these theories are associated with LUTS and bladder health, and whether toileting habits explain this association.Objectives:To inform prevention strategies, this investigation tested whether the Theory of Reasoned Action and Theory of Planned Behavior constructs (attitudes toward, perceived norms of, and perceived control over specific toileting behaviors) are associated with women's toileting habits, and whether these habits mediate associations of theoretical constructs and women's LUTS and bladder health.Methods:The Prevention of Lower Urinary Tract Symptoms Research Consortium developed theoretical constructs to match four toileting behavior domains (delayed voiding, straining, crouching/hovering over toilets when away from home, and avoiding public toilets) assessed by the validated Toileting Behaviors: Women's Elimination Behaviors scale. Using a population-based survey, data were then collected from women at nine sites in the United States. Cross-sectional regression analyses tested whether toileting habits in a given domain mediated associations of corresponding theoretical constructs with reported LUTS, bladder health, and bladder function.Results:The overall analytic sample included 1,472 women with a mean age of 48 years. Associations of norms favoring delayed voiding and low perceived control over timing of voiding with more frequent LUTS and poorer bladder health and function were partially mediated by delayed voiding habits. Favorable attitudes toward and norms of straining (i.e., pushing down to urinate) and avoiding public toilets were associated with more frequent LUTS through corresponding toileting habits.Discussion:Longitudinal research is needed to confirm study findings. Future prevention intervention research may include nursing and public health messaging designed to shape attitudes toward and perceived norms of specific toileting behaviors, as well as policies to enhance control over healthy toileting practices in public spaces, including schools and workplaces.

Introduction and HypothesisWomen with vulvovaginal or genital pain more commonly experience interstitial cystitis/bladder pain syndrome (IC/BPS) and urinary tract infections. However, the relationship between genital pain and bladder health is lacking.MethodsWomen in the Prevention of Lower Urinary Tract Symptoms Consortium's RISE FOR HEALTH population-based study answered questions about bladder health globally, and across nine bladder health domains of holding, efficacy, social-occupation, physical activity, intimacy, travel, emotion, perception, and freedom. Bladder function was assessed across six indices including urinary frequency, sensation, continence, comfort, emptying, and dysbiosis (e.g., urinary tract infections). Participants were grouped by no pain beyond transitory events (i.e., minor headaches, toothaches, or sprains), nongenital-related pain only, and any genital pain using a validated pain diagram. Mean adjusted scores and indices were compared using general linear modelling.ResultsOf 1,973 eligible women, 250 (12.7%) reported genital pain, 609 (30.9%) reported nongenital pain only, and 1,114 (56.5%) reported no pain. Women with any genital pain had lower (worse) adjusted mean scores across all bladder health scales (BHS; BHS global adjusted mean 47.5; 95% CI 40.8-54.1), compared with those with nongenital pain only (53.7; 95% CI 47.6-59.8), and no pain (59.3; 95% CI 53.3-65.4). Similarly, adjusted mean total Bladder Functional Index scores were lower for those with genital pain (63.1; 95% CI 58.4-67.9) compared with nongenital pain (72.1; 95% CI 67.7-76.5) and no pain (77.4; 95% CI 73.0-81.8).ConclusionsHeightened awareness of the relationship between genital pain and bladder health should prompt clinicians caring for women with genital pain to assess bladder health and function.

BACKGROUND:Studies have shown up to a 40% discordance between patients' preferred roles in decision-making before and their perceived roles after their visit. This can negatively affect patients' experiences; interventions to minimize this discordance may significantly improve patient satisfaction. OBJECTIVE:We aimed to determine whether physicians' awareness of patients' preferred involvement in decision-making before their initial urogynecology visit affects patients' perceived level of involvement after their visit. STUDY DESIGN:This randomized controlled trial enrolled adult English-speaking women presenting for their initial visit at an academic urogynecology clinic from June 2022 to September 2022. Before the visit, participants completed the Control Preference Scale to determine the patient's preferred level of decision-making: active, collaborative, or passive. The participants were randomized to either the physician team being aware of their decision-making preference before the visit or usual care. The participants were blinded. After the visit, participants again completed a Control Preference Scale and the Patient Global Impression of Improvement, CollaboRATE, patient satisfaction, and health literacy questionnaires. Fisher exact, logistic regression, and generalized estimating equations were used. Based on a 21% difference in preferred and perceived discordance, we calculated the sample size to be 50 patients in each arm to achieve 80% power. RESULTS:Women (n=100) with a mean age of 52.9 years (standard deviation=15.8) participated in the study. Most participants identified as White (73%) and non-Hispanic (70%). Before the visit, most women preferred an active role (61%) and few preferred a passive role (7%). There was no significant difference between the 2 cohorts in the discordance between their pre- and post-Control Preference Scale responses (27% vs 37%; P=.39) or whether their symptoms were much better or very much better following the visit (18% vs 37%; P=.06). However, when asked whether they were completely satisfied with the visit, those assigned to the physician awareness cohort reported higher satisfaction than those in the treatment as usual cohort (100% vs 90%; P=.03). CONCLUSION:Although there was no significant decrease in discordance between the patient's desired and perceived level of decision-making following physician awareness, it had a significant effect on patient satisfaction. All patients whose physicians were aware of their preferences reported complete satisfaction with their visit. Although patient-centered care does not always entail meeting all of the patients' expectations, the mere understanding of their preferences in decision-making can lead to complete patient satisfaction.

IMPORTANCE:Bladder health in high school and collegiate females is not well understood. OBJECTIVE:The objective of this study was to compare toileting behaviors, lower urinary tract symptoms (LUTSs), and fluid intake in female athletes and nonathletes. STUDY DESIGN:English-speaking nulliparous females aged 13-23 years were recruited. Participants completed the Toileting Behaviors: Women's Elimination Behaviors Scale, Bristol Female LUTS Questionnaire, and Beverage Questionnaire. Statistical analysis included univariable analyses and multivariable comparisons of athletes to nonathletes adjusting for age and fluid intake. RESULTS:One hundred athletes and 98 nonathletes participated (mean age 20 ± 2, mean body mass index 23 ± 4). Athletes' sports were predominantly high impact. Dysmenorrhea and anxiety were higher in nonathletes ( P < 0.01) versus more stress fractures in athletes ( P < 0.001). Problematic toileting behaviors were prevalent regardless of athletic status; nonathletes were more likely to hold urine until home and empty away from home without the urge (both P = 0.04). Lower urinary tract symptoms were prevalent regardless of athletic status, including frequency (34.2%), hesitancy (33.3%), urgency (32.8%), stress incontinence (15.3%), and urgency incontinence (11.8%). Athletes had significantly more stress incontinence and urgency and higher incontinence subscores on univariable analysis, although the difference was attenuated after multivariable adjustment. Athletes consumed lower total fluids ( P = 0.03). CONCLUSIONS:Problematic toileting behaviors and LUTSs were prevalent in high school and collegiate females, regardless of athletic status. Athletes had higher stress urinary incontinence and urgency and lower fluid intake. These findings support future work toward enhancing early bladder health interventions (screening, education, and LUTS prevention) among high school and collegiate females.

Suicide remains an urgent concern of the Department of Veterans Affairs (VA). Uridine is a novel treatment with a broad mechanistic overlap with ketamine and lithium, two drugs with anti-suicidal effects. The aims of this double blind randomized controlled clinical trial VA-funded study are to determine if uridine decreases suicidal ideation (SI) in Veterans, and to measure rapid changes in GABA, Glutamate, and Glutamate+Glutamine (Glx) associated with uridine compared to placebo.

In the past few years, very rapid advances have been made in determining the primary structure of protein tyrosine phosphatases (PTPases). PTPase genes have now been isolated from bacteria, viruses, yeasts and insects as well as vertebrates. The cytosolic PTPases have a catalytic domain associated with various accessory domains that are believed to be involved in protein-protein interaction or subcellular localization. The transmembrane PTPases have either one or two cytoplasmic PTPase domains and an extracellular receptor-like structure. The existence of a large number of structurally diverse PTPases suggests that they play specific and crucial roles in signal transduction. In this article, the structural features of the PTPases from higher eukaryotes are reviewed.

Purpose: We examined how antecedent sexual health factors affect lower urinary tract symptoms (LUTS) in adolescent women.Methods: We analyzed 1,941 adolescent women from the Avon Longitudinal Study of Parents and Children at age 19. At ages 15 and 17, participants reported use of oral contraceptives (OCs), history of sexual intercourse, number of sexual partners, and condom use. At age 19, The Bristol Female Lower Urinary Tract Symptoms questionnaire quantified the frequency over the past month: stress incontinence, any incontinence, urgency, sensation of incomplete emptying, bladder pain, and urinary tract infection. Multivariable regression models examined associations between sexual health behaviors reported at ages 15 and 17 and six LUTS reported at age 19, after controlling for covariates.Results: Commonly reported LUTS at age 19 were past-month stress incontinence (26.8%), bladder pain (26.3%), any urine leakage (22.1%), and urinary tract infection (15.4%). OC use by age 17 was associated with urgency (odds ratio [OR] 1/4 1.62, 95% confidence interval [CI] 1.19-2.20), incomplete emptying (OR = 1.62, 95% CI = 1.17-2.26), bladder pain (OR = 1.45, 95% CI = 1.15-1.83), and urinary tract infections (OR = 1.68, 95% CI = 1.28-2.21) at age 19 after adjustment for covariates. However, associations were attenuated after adjustment for condom use and number of sexual partners. Sexual intercourse by age 17 was associated with 1.53-2.65 increased odds of LUTs categories except incontinence, with lower confidence interval boundaries > 1.0. Associations were stronger among women with >= 3 sexual partners (vs. 0) by age 17.Discussion: We found longitudinally assessed associations between OC use, sexual intercourse, and number of sexual partners during adolescence and LUTS at age 19.(c) 2023 Society for Adolescent Health and Medicine. All rights reserved.

The magnitude of caregiver burden, defined as the negative sequelae of providing informal care, has not been well studied in urogynecology. Our primary aim was to determine the overall severity of burden experienced by the informal caregivers of patients with pelvic floor disorders. We also sought to quantify and correlate quality of life metrics with the degree of caregiver burden. We conducted a cross-sectional study of patients and their informal caregivers who presented to a urogynecology clinic. Subjects were included if each member of a patient/informal caregiver dyad was over 18 years old and able to complete the study questionnaires. The informal caregiver self-identified as providing emotional, financial, physical, or social support to the patient and indicated they did so without financial payment. Demographic information was collected from the patient's chart. Patients also completed three surveys: the Patient Reported Outcome Measurement Information System – 29 (PROMIS - 29) questionnaire, the Pelvic Floor Disability Index (PFDI), and the Patient Global Impression of Severity (PGIS). Informal caregivers completed the Zarit Burden Interview (ZBI), a validated tool used to measure caregiver burden. A one-sample t-test was used to test the observed ZBI mean against a historical mean of 55 points. Univariable and multivariable general linear models were used to measure the associations between patients' ZBI scores and their demographic information, PFDI scores, PGIS responses, and PROMIS domains. From May 2021 to April 2022, we studied 40 patient/informal caregiver dyads. The average age of the patient was 77.1 (SD = 11.9), with 83% (n = 33) identifying as white. Additionally, the patient population was 93% (n = 33) Non-Hispanic, and 58% (n = 23) had completed an Associate degree or higher in education. 65% (n = 26) characterizing the severity of disease as moderate or severe on the PGI-S. The average ZBI score of the caregiver was 18.3 (SD = 14.4), which was significantly lower than the historical average of 55 points (p < .001). Thirteen (33%) caregivers expressed mild to moderate burden on the ZBI, while only two (5%) expressed moderate to severe burden; only one (3%) caregiver expressed severe burden. On multivariable analysis, every 1-point increase in the PROMIS physical function score decreased the ZBI score by 0.60 (95% CI: -0.98 to -0.23) points (p = .003) even after controlling for a history of prolapse and presence of comorbidities. The negative impact of pelvic floor disorders on patients is well described, however there is a lack of information on the burden these disorders place on informal caregivers. In our sample, 40% of caregivers indicated a measurable amount of burden as indicated by the ZBI. Furthermore, improvement in the patient's physical function domain as measured by PROMIS was correlated with decreased caregiver burden.

Introduction and hypothesisLimited health literacy (HL) is a risk factor for poor patient outcomes, including pain. Chronic pelvic pain (CPP) is a prevalent disorder affecting up to 25% of women and coexists with multiple overlapping conditions. This study aimed to describe health literacy in women with CPP, primarily correlate HL to pain intensity and pain duration, and secondarily correlate HL to mood symptoms and pain catastrophizing. We hypothesized that women with CPP with higher HL would report lower levels of pain intensity and duration.MethodsThis was a prospective, cross-sectional study. Forty-five women with CPP were recruited from outpatient Physical Medicine & Rehabilitation and Female Pelvic Medicine & Reconstructive Surgery clinics. Validated questionnaires were administered to evaluate pain intensity and duration, pain disability, psychological symptoms, pain catastrophizing, and health literacy. Statistical analyses included descriptive statistics of patient characteristics and summary scores, as well as Spearman's rank correlation coefficients (rho) to assess the strength of associations between summary scores and health literacy.ResultsForty-five women with CPP were enrolled with mean age of 49 years, majority non-Hispanic White, and median chronic pelvic pain duration of 7 years. Possible or high likelihood of limited health literacy was identified in 20% women with CPP (11.1% and 8.9%, respectively). Limited health literacy was moderately correlated with pain intensity, depressive symptoms, and pain catastrophizing. Pain duration was not significantly correlated with health literacy. The remaining 80% of women with CPP were likely to have adequate health literacy.ConclusionsA majority of women with CPP in this single center study were likely to have adequate health literacy. Limited health literacy was seen in a minority of women with CPP but was moderately correlated with greater pain intensity, more depressive symptoms, and higher pain catastrophizing. This study identified that women with CPP were likely to have adequate HL, but underscores the importance of considering HL screening and interventions in those with higher pain intensity, depression, and pain catastrophizing.

OBJECTIVES:The objective of this study is to inform our hypothesis that the workplace toileting environment may impact lower urinary tract symptoms (LUTS); we examined the prevalence of LUTS across occupational groups in the Boston Area Community Health Survey. METHODS:At baseline, women (n = 3205) reported their occupation and frequency of 15 LUTS. Using the US Department of Labor's Standard Occupational Classification (SOC) system, we categorized women into 11 standard occupational groups. Prevalence ratios (PRs) were calculated by log-link generalized linear models, adjusting for age, race, education, fluid intake, and parity. Women classified in Office and Administrative Support were used as the reference group given their potential for fewer workplace toileting restrictions. RESULTS:Of the 3189 women with complete data, 68% of women reported any LUTS, ranging from 57% to 82% across the SOCs. Relative to women in Office and Administrative Support (n = 576), women in Computing, Engineering, and Science (n = 64) were more likely to report any LUTS (PR = 1.2, 95% confidence interval [95% CI]: 1.0-1.4) and urinating again in <2 h (PR = 1.7, 95% CI: 1.4-2.2), and women in Education, Legal, Community Service, Arts, and Media (n = 477), as well as Healthcare Practitioner and Technical Occupations (n = 162), were less likely to report perceived frequent daytime urination (PR = 0.6, 95% CI: 0.5-0.9 and PR = 0.6, 95% CI: 0.4-0.9, respectively). CONCLUSIONS:Our cross-sectional findings suggest that urination frequency varies across understudied occupational groups with various workplace toileting environments. Future studies should examine this relationship prospectively to inform the influence of workplace toileting environments on urination frequency, as well as the development and/or worsening of LUTS.

OBJECTIVE:The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium launched the RISE FOR HEALTH (RISE) national study of women's bladder health which includes annual surveys and an in-person visit. For the in-person exam, a standardized, replicable approach to conducting a pelvic muscle (PM) assessment was necessary. The process used to develop the training, the products, and group testing results from the education and training are described.METHODS:A comprehensive pelvic muscle assessment (CPMA) program was informed by literature view and expert opinion. Training materials were prepared for use on an electronicLearning (e-Learning) platform. An in-person hands-on simulation and certification session was then designed. It included a performance checklist assessment for use by Clinical Trainers, who in collaboration with a gynecology teaching assistant, provided an audit and feedback process to determine Trainee competency.RESULTS:Five discrete components for CPMA training were developed as e-Learning modules. These were: (1) overview of all the clinical measures and PM anatomy and examination assessments, (2) visual assessment for pronounced pelvic organ prolapse, (3) palpatory assessment of the pubovisceral muscle to estimate muscle integrity, (4) digital vaginal assessment to estimate strength, duration, symmetry during PM contraction, and (5) pressure palpation of both myofascial structures and PMs to assess for self-report of pain. Seventeen Trainees completed the full CPMA training, all successfully meeting the a priori certification required pass rate of 85% on checklist assessment.CONCLUSIONS:The RISE CPMA training program was successfully conducted to assure standardization of the PM assessment across the PLUS multicenter research sites. This approach can be used by researchers and healthcare professionals who desire a standardized approach to assess competency when performing this CPMA in the clinical or research setting.