Female genital cutting (FGC) results in a higher risk for sexual issues in impacted women. This study examined this impact in a sample of 300 women identifying as Somali and living in the United States. FGC is highly prevalent in Somalia, with rates as high as 98%. Bilingual community researchers recruited participants from community and clinic spaces. Participants completed a survey using standardized measures and team-created questionnaires, in addition to a structured interview about their FGC history. Results indicated the most common sexual concern was dyspareunia (22%). Sexual problems were not universal; 18% reported they did not enjoy sex, 17% reported low sexual interest, 15% reported difficulty with orgasm, 12% reported anxiety about sex, and 9% reported arousal problems. Most participants with dyspareunia did not seek out medical or psychological intervention. The majority of participants who were infibulated were deinfibulated during labor and delivery. Deinfibulation before sexual intercourse and never being deinfibulated were associated with a higher risk of dyspareunia than never being infibulated. Deinfibulation was not associated with overall sexual function. Results indicate health care providers and therapists should assess FGC history and sexual concerns among patients born in countries that practice FGC. Patients may need education and guidance in regard to accessing evidence-based interventions for sexual problems.

BACKGROUND AND OBJECTIVES:Urinary incontinence (UI) has not been examined in relation to perceptions of age discrimination (ageism). This study examined whether UI, absorbent product use, and confidence gained from absorbent product use are associated with ageism in later adulthood. RESEARCH DESIGN AND METHODS:Cross-sectional data were collected from 680 community-dwelling female and male participants. Participants were aged 55-73 years; 62% were women. In 2023-2024, UI, absorbent product use, confidence gained from absorbent product use, and ageism were assessed. Ageism variables (frequency across 7 settings, number of settings, perceived stress of discrimination) were regressed on frequency and severity of UI, absorbent product use frequency, and (among those who used absorbent products) confidence gained from product use. Covariates included age, gender, race, and education. RESULTS:A one standard deviation (SD) greater frequency of UI (Beta = 0.25, 95% CI = 0.18, 0.33), severity of UI (Beta = 0.19, 95% CI = 0.12, 0.27), and frequency of absorbent product use (Beta = 0.12, 95% CI = 0.04, 0.20) were each associated with more frequent exposure to age discrimination across settings. A similar pattern was observed for the number of settings in which participants experienced age discrimination. Frequency and severity of UI and absorbent product use frequency were not associated with perceived stress of discrimination. Confidence gained from absorbent product use was not associated with ageism variables. DISCUSSION AND IMPLICATIONS:Longitudinal research is needed to test whether UI-related characteristics are prospectively associated with ageism. Programs and policies are needed to address discriminatory behaviors toward aging individuals in different settings.

OBJECTIVES:Work environments have received little attention as a potential determinant of lower urinary tract symptoms (LUTS). A small literature among women, and an even smaller literature among men, suggests that occupations with manual labor demands are associated with greater likelihood of experiencing LUTS. Job strain, defined as low decision latitude in combination with high psychological demands, was found not to be associated with LUTS in one sample of women. Associations of occupation and job strain with LUTS among men were examined using Coronary Artery Risk Development in Young Adults cohort study data. METHODS:Occupation was assessed 7 times beginning when men were aged 18-30 years (1985-1986 through 2005-2006). Job strain and its components (psychological job demands, decision latitude) were assessed in 1987-1988 and 1995-1996. In 2012-2013, LUTS were assessed. LUTS category (severe or moderate versus mild or none) was regressed on job strain and occupation variables in separate analyses, adjusting for age, race, and self-reported benign prostatic hyperplasia (BPH) (n = 858). RESULTS:Differences in LUTS and job characteristics were observed between Black and White men. Neither job strain nor occupation were associated with men's LUTS, both before and after adjustment for BPH. CONCLUSIONS:Among this population-based sample of United States men, assessed aspects of occupations across early and midlife adulthood were not associated with men's LUTS at midlife. This is in contrast to some population-based research on occupations among Chinese and Korean men. Additional research is needed to understand whether specific occupations and work characteristics are associated with men's LUTS.

Objective Barriers to toilet access and suboptimal toilet environments in workplaces and schools may contribute to unhealthy toileting behaviors and poorer bladder health in women, but quantitative evidence is limited. We examine associations between workplace toilet access, autonomy, and environment with women’s toileting behaviors and test whether these behaviors mediate relationships with bladder function. Methods Data from 1,772 women (mean age 51 years) in the RISE FOR HEALTH study were analyzed. Participants completed Toilet Environment and Access Scales (TEAS), Toileting Behaviors–Women’s Elimination Behaviors (TB-WEB), and the Bladder Function Index (BFI). Regression and structural equation modeling tested associations among TEAS domains (access/autonomy and toilet environment), TB-WEB subscales, and BFI. Results Mean TEAS scores indicated high access and favorable environments (4.1 and 4.4 on a 0–5 scale). Greater access/autonomy and more favorable environments were associated with less delayed voiding (b=–0.26, –0.15), straining (b=–0.17, –0.15), and premature voiding (b=–0.13, –0.08). All unhealthy behaviors were associated with lower BFI scores, with delayed voiding showing the strongest association (b=–8.0). Higher TEAS scores were associated with higher BFI (b=3.3–3.8 per unit). Mediation analyses indicated that toileting behaviors, particularly delayed voiding, partially mediated associations between TEAS domains and BFI. Conclusions Favorable toilet environments and greater toilet access and autonomy were associated with healthier toileting behaviors and better bladder function. Policies and practices that support toilet access and autonomy in workplaces and schools may promote bladder health by reducing unhealthy toileting behaviors.

IMPORTANCE:An improved understanding of associations of bladder-related knowledge and agentic beliefs with bladder health can be informative for developing strategies to prevent lower urinary tract symptoms (LUTS). OBJECTIVES:The objectives of this study were to evaluate associations of bladder knowledge and agentic beliefs with bladder health status. STUDY DESIGN:We assessed bladder-related knowledge and beliefs in RISE FOR HEALTH participants using the Bladder Health Knowledge, Attitudes and Beliefs instrument (BH-KAB, range 0-100) in a cross-sectional analysis. Bladder health was assessed using the Global scale of the Bladder Health Scales (BHS, 0-100), the Total Bladder Function Index (BFI, 0-100), and the Lower Urinary Tract Dysfunction Research Network Symptom Index-10 (LURN SI-10, 0-38). Associations of bladder-related knowledge and agentic beliefs with each bladder health outcome were assessed using linear regression. RESULTS:The mean age of participants was 49.2 years (range=18-101 years). The mean knowledge score was 67.5 and the mean agency score was 56.5. The associations of the knowledge score with Global BHS and BFI were weak (-0.9 and -1.1), while associations of the agency score with Global BHS and BFI were stronger, with a 2.4 and 1.4 higher score (better health), respectively, for every 10-point increase in agency. Increased agency was also associated with fewer LUTS; for every 10-point increase in agency score, there was a 0.5 decrease in the LURN SI-10 score. CONCLUSIONS:Bladder-related knowledge was weakly associated and agentic beliefs were more strongly associated with bladder health and function. Longitudinal prevention intervention studies can help determine whether increases in agentic beliefs promote bladder health and prevent the development and worsening of LUTS.

Background: To advance existing knowledge, this study examined mechanisms that may link retrospectively reported adverse childhood family environment (ACFE) to lower urinary tract symptoms and their impact (LUTS/impact), a composite variable with four levels (bladder health and mild, moderate, or severe LUTS/impact), among women (n = 1,026) in the Coronary Artery Risk Development in Young Adults cohort study. A prior study demonstrated that ACFE was associated with greater LUTS/impact. Materials and Methods: In 2000-01, the frequency of ACFE events was retrospectively assessed. In 2012-13, data on LUTS/impact were collected. Between 1985-86 and 2010-11, data on proposed mediators were collected at varying time points and averaged to form composite variables. A series of proportional odds ordinal logistic regression analyses were conducted. LUTS/impact was regressed on ACFE, adjusting for age, race, education, and parity. A single proposed mediator was added to the model at one time to determine whether the strength of the association between ACFE and LUTS/impact was attenuated. Results: When entered into regression models individually, life stressors, low levels of emotional support, and depressive symptoms each significantly attenuated the association between ACFE and LUTS/impact, with the association becoming nonsignificant when depressive symptoms were entered. Remaining proposed mediators (social network extensiveness, health behaviors, physiological health, cognitive function) did not mediate the association. Conclusions: ACFE may place women at risk for repeated or chronic episodes of experiencing life stressors, low support, and depressive symptoms during early and midlife adulthood, which in turn may place women at risk for more LUTS and impact during midlife adulthood.

Purpose: Qualitative studies exploring bladder health are rare compared to research focusing on lower urinary tract symptoms (LUTS). Our aim was to explore adolescent and adult women's perceptions about what constitutes a healthy bladder. Methods: We conducted a 7-site focus group study of bladder health with adolescent and adult women across six age categories (11-14 to 65+ years). Transcripts were analyzed using transdisciplinary, directed content analysis and an iterative interpretive consensus building approach to identify key constructs, focusing on "healthy bladder"and "unhealthy bladder"codes. Results: Forty-four focus groups with 360 participants were completed. Three thematic categories were identified: (1) concept of a healthy bladder (conceptual abstraction); (2) experience of a healthy bladder (subjective experience); and (3) lifestyle and life course considerations (bladder health in context). Participants struggled to define the unfamiliar concept of healthy bladder and relied on contextualized experiences and behaviors for characterizing bladder health. They described the concept of a healthy bladder as something that you did not need to think about but did require attention to healthy habits to maintain. Other features of a healthy bladder discussed include having bladder control despite urgency and environmental constraints on voiding, normal voiding frequency, and qualities of urine and urination. Participants struggled with lack of information about healthy bladder habits and noted absence of routine bladder health screening. Discussion: Findings identify need to promote public education and information sharing in health care visits about bladder health. Further they can inform bladder health promotion and clinical research on LUTS prevention.

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.

STUDY OBJECTIVE:Lower urinary tract symptoms (LUTS) can have a pronounced impact on adolescent women's overall health and quality of life, both during adolescence and across the life course. Little research has examined adolescent women's knowledge, attitudes, and beliefs (KAB) about bladder health and preventing LUTS. METHODS:This study combines data from two large multi-site focus group studies of individuals born female, who identified as women, conducted by the Prevention of Lower Urinary Tract Symptoms Research Consortium. The first study included data from 8 focus groups conducted in 2018 with 44 adolescents aged 11 through 17 years. The second consisted of data from 20 focus groups conducted in 2020 with 123 adolescents aged 13 through 17 years. We used directed content analysis, including deductive and inductive approaches, to explore textual data and identify emergent insights. We present themes that emerged from analyzing coded data related to KAB. RESULTS:Themes included: (1) lack of information about bladder function, leading to limited knowledge, (2) hydration as a healthy behavior, (3) distinguishing healthy versus unhealthy voiding, (4) social and environmental barriers to voiding, and (5) shame and stigma of bladder related behaviors. CONCLUSION:Our data suggests that adolescent women are aware of healthy and unhealthy behaviors related to bladder health, despite little exposure to formal education about the bladder. Social and environmental factors, including stigma, appear to be primary drivers of adolescents' behaviors around bladder health, suggesting that multi-level socio-ecological prevention interventions are needed to prevent LUTS in this population.

OBJECTIVE:To examine whether subjective social standing is associated with lower urinary tract symptoms (LUTS) among women and men in the Coronary Artery Risk Development in Young Adults study, and whether racial identity modifies this association. METHOD:The MacArthur Scale of Subjective Social Status was administered in 2000-2001 and 2005-2006; scores were averaged. LUTS were assessed in 2012-2013. Separately for women and men, LUTS were regressed on perceived standing relative to others in one's community and relative to others in the United States. Analyses were adjusted for race, age, parity (for women), benign prostatic hyperplasia (for men), objective indices of social standing, alcohol consumption, smoking, body mass index, and diabetes. The analytic sample consisted of 1,214 women and 874 men, aged 42-59 years. RESULTS:Both higher subjective social standing in one's community and relative to the United States were associated with a lower likelihood of experiencing more severe LUTS when the variables were entered individually into regression models with adjustment variables. When entered simultaneously, only higher perceived standing relative to others in the United States was associated with less severe LUTS among women, and only higher perceived standing relative to others in one's community was associated with less severe LUTS among men. Racial identity did not modify associations. CONCLUSIONS:Consistent with literature on other health outcomes, lower social standing relative to others in one's community or the United States was associated with LUTS. Research is needed to understand the mechanisms by which perceptions of lower social standing may influence the development, maintenance, or worsening of LUTS. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This study is a secondary analysis of Coronary Artery Risk Development in Young Adults data examining whether men's experience of psychosocial factors from baseline (1985-1986), when men were aged 18-30 years, through 25 years of follow-up (2010-2011) are associated with lower urinary tract symptoms (LUTS) in 2012-2013. Consistent with previous literature, adverse childhood family environment (OR = 1.24, 95% CI 1.07, 1.43) and depressive symptoms across early and midlife adulthood (OR = 1.60, 95% CI 1.38, 1.87) were associated with higher numbers of and more severe LUTS, a composite measure. Novel findings demonstrated that interpersonal stressors (OR = 1.24, 95% CI 1.07, 1.44) and other life stressors (OR = 1.33, 95% CI 1.15, 1.53) in early and midlife adulthood were associated with worse LUTS among men, while emotional support was protective (OR = 0.69, 95% CI 0.60, 0.81). Findings suggest that a variety of psychosocial experiences may influence LUTS. Additional research is needed to confirm novel findings and identify mechanisms by which life course psychosocial factors may influence the development, maintenance, or worsening of LUTS.

Introduction: Toileting behaviors are recognized as potential contributors to lower urinary tract symptoms (LUTS) in women. This study examines the association between toileting behaviors and LUTS among community-dwelling women and whether age modifies these associations. Methods: Cross-sectional analyses were conducted using baseline data from a population-based cohort study, RISE FOR HEALTH (RISE). Women completed validated questionnaires assessing toileting behaviors (Toileting Behaviors-Women's Elimination Behaviors scale) and LUTS (10-item Lower Urinary Tract Dysfunction Research Network-Symptom Index [LURN SI-10]). Toileting behaviors included place preference for voiding, premature voiding, delayed voiding, straining to void, and toileting position. LUTS items included urine storage, emptying, and postmicturition symptoms. Associations were analyzed by proportional odds logistic regression. Analyses were stratified by seven age groupings. Results: Data from 2,327 women (mean age 51.1 years, standard deviation = 18.2) were analyzed. Delayed voiding was most strongly associated with the LURN SI-10 composite score (odds ratio [OR] 1.89; 95% confidence interval [CI]: 1.72, 2.09) and urgency incontinence (OR 1.87; 95% CI: 1.66, 2.10). Premature voiding showed the strongest association with urgency (OR 1.82; 95% CI: 1.68, 2.04). Straining was strongly associated with emptying symptoms, including delay before urine starts (OR 2.28; 95% CI: 2.05, 2.54) and slow stream (OR 2.28; 95% CI: 2.05, 2.53). Age modified associations between delayed voiding and LUTS, with strongest associations among 18- to 25 year-old women. Conclusions: Premature voiding, delayed voiding, and straining showed the strongest associations with LUTS in this cross-sectional analysis. Longitudinal studies are needed to clarify the directionality of these associations. Educating young women on healthy toileting habits may mitigate potential effects of unhealthy toileting behaviors on bladder health.

This research utilizes Coronary Artery Risk Development in Young Adults (CARDIA) cohort study data to examine whether financial strain is associated with subsequent lower urinary tract symptoms among men and whether healthcare barriers, health risk behaviors, and comorbid conditions explain this association. CARDIA recruited Black and White participants aged 18 to 30 years at baseline (1985-1986) from four United States cities. The analytic sample was comprised of men with complete data for analyses involving financial strain trajectories across 7 assessments (n = 602) and mediation tests of data collected at 4 assessments (n = 634). The outcome variable, assessed when the mean age of men was 50 years, was the American Urologic Association Symptom Index score, recoded into four symptom categories: none (6.3%); mild (62.6%), moderate (28.5%), and severe (2.6%). Symptom category was regressed on financial strain variables, adjusting for age, race, education, and self-reported benign prostatic hyperplasia. Regression analyses and structural equation modeling tested potential mediators. Compared to not being financially strained across early and midlife adulthood, experiencing more than one shift in financial strain was associated with 84% greater odds (95% confidence interval [1.24, 2.75]) of being categorized into a worse symptom category. Structural equation modeling showed that both difficulty receiving healthcare and depressive symptoms explained an association between difficulty paying for medical care and worse symptoms. Additional research is needed to confirm findings and examine other mechanisms that may further explain associations between financial strain and symptoms, such as stress responses. Accumulated evidence may inform future prevention interventions, including integrated healthcare approaches.

To inform policies and programs designed to prevent lower urinary tract symptoms (LUTS) and promote bladder health among different social groups, this research utilized RISE FOR HEALTH data to examine potential health inequities in LUTS and bladder health by different indices of socioeconomic position, as well as ethnic and racial social identity. Data were collected in 2022-2023 from 3322 adult women from nine regions of the United States. Higher socioeconomic position-regardless of whether it was measured as education, percent federal poverty level, or health insurance coverage and type-was associated with fewer, less frequent LUTS and better bladder health independent of ethnic and racial identity. These findings are consistent with the broader literature on LUTS, while also extending this literature to encompass different facets of bladder health, including perceived impact of bladder health status on social and occupational activities, physical activity, travel, and emotions. Poorer bladder health among women of Hispanic ethnic identity relative to Non-Hispanic White women appeared to be largely driven by socioeconomic disadvantage. Independent of socioeconomic position, women who identified as Non-Hispanic Black or Non-Hispanic Asian reported better bladder health relative to Non-Hispanic White women. Future qualitative research may be useful in identifying health promoting attitudes, behavioral habits, and intergenerational messages about caring for the bladder that can be incorporated into health promotion programs tailored to women's ethnic and racial identity, as well as universal programs. Consistent with the World Health Organization's Conceptual Framework for Action on Social Determinants of Health (Solar and Irwin, 2010), findings highlight the importance of policies that ensure equitable access to health promoting resources, including education, poverty-alleviating assistance, and high-quality health care. Reference: Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice).https://www.who.int/publications-detail-redirect/9789241500852.

BACKGROUND:Bladder health encompasses total bladder well-being and not merely the absence of urinary symptoms. While much is known about the prevalence of urinary symptoms in women, little is known about the distribution of bladder health (eg, optimal to poor). OBJECTIVE:We report the distributions of multiple dimensions of bladder health and function in a population-based sample of community-dwelling women, overall and separately in women without urinary symptoms to begin to explore bladder health dimensions that may precede the onset of symptoms. STUDY DESIGN:RISE FOR HEALTH is a regionally-representative cohort study of US women aged 18 and older. Baseline surveys included the validated Bladder Health Scales/Bladder Function Indices, the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index, and additional study items. Bladder well-being was assessed across 10 scales and bladder function across 6 indices. Bladder Health Scale scores were adjusted for adaptive/coping behaviors (eg, using/carrying pads, staying close to a toilet) to account for the perceived impact of urinary symptoms on well-being. Scores for scales and indices ranged from 0 (poor well-being/function) to 100 (optimal well-being/function). We calculated summary statistics for each scale (with and without adaptive behavior adjustment) and each index in the full study population and subset of women without urinary symptoms. RESULTS:The mean age of 3027 eligible participants was 49.8 years (standard deviation 17.9). The median global Bladder Health Scale score was 72 (interquartile range: 56, 84) before adjustment for adaptive/coping behaviors and 55 (interquartile range: 34, 78) after adjustment. Median scores for the other scales ranged from 75 to 100 before and 61 to 72 after adjustment. Sixty-nine percent of participants reported using adaptive/coping behaviors, including using pads (40%), toilet mapping (58%), and staying close to a toilet (3%). The median overall Bladder Function Index score was 77 (interquartile range: 63, 89); individual median scores ranged from 63 to 68 for frequency, sensation, continence, and emptying indices to 100 for biosis/urinary tract infection and comfort indices. Among participants without reported urinary symptoms (n=700), scores were higher across all scales (unadjusted medians=88-100 and adjusted medians=82-100) and indices (medians=93-100), indicating better, but not optimal health; however, 38% of asymptomatic women reported using adaptive/coping behaviors: 11% using pads, 30% toilet mapping, and 2% staying close to a toilet. CONCLUSION:We observed a wide range of bladder well-being and function in RISE participants and high utilization of adaptive/coping behaviors. Bladder health variability and utilization of adaptive/coping behaviors was also observed in women without urinary symptoms, highlighting bladder health dimensions not captured by traditional urinary symptom tools and potentially identifying a group of women with "subclinical" symptoms who may be at greater risk of developing urinary symptoms. Future prospective analyses should investigate this novel group of women further.

PURPOSE:We examined whether occupation, repeatedly assessed across 20 years, is associated with women's lower urinary tract symptoms (LUTS) and their impact in midlife adulthood. MATERIALS AND METHODS:Coronary Artery Risk Development in Young Adults cohort study data among women were examined. Occupation was assessed 7 times beginning when women were aged 18 to 30 years (1985-1986 through 2005-2006). The number of assessments that participants reported working in each of 9 job categories was counted (9 variables). In 2012-2013, when women were aged 44 to 61 years, LUTS and their impact (a 4-level composite variable) were assessed. In proportional odds ordinal logistic regression analyses, symptoms/impact were regressed on a single occupation variable, adjusting for age, race, and parity (n = 858). RESULTS:For each additional assessment that women reported employment in a managerial or professional job, they had 9% lower odds of subsequently experiencing greater symptoms and impact (odds ratio = 0.91; 95% CI = 0.86, 0.96). For each additional assessment that women reported employment in a service job, they had 25% greater odds of subsequently experiencing greater symptoms and impact (odds ratio = 1.25; 95% CI = 1.14, 1.36). Associations remained significant after additional adjustment for education, financial hardship, health behaviors, and health conditions. CONCLUSIONS:Employment in managerial and professional positions across early and midlife adulthood is associated with lower risk for more burdensome LUTS at midlife, while employment in service positions is associated with higher risk. Research is needed to investigate mechanisms by which occupation may influence later symptoms, such as timely access to workplace toilets.

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.

ObjectiveMechanistic studies are needed to understand why depressive symptoms are associated with poorer physical health. The objective of this study was to examine whether behavioural, cognitive and physiological factors mediated an association between depressive symptoms, measured in early adulthood, and lower urinary tract symptoms (LUTS) and their impact, a composite variable measured in mid-life adulthood, among women in the Coronary Artery Risk Development in Young Adults study, conducted in four regions of the United States.DesignProspective cohort study.MethodsData were examined for 871 women. Depressive symptoms were measured and averaged across Years 5, 10 and 15. Year 20 health behaviour combined information about smoking, physical activity and diet. Year 25 cognitive function combined performance on different cognitive tests. Year 25 metabolic syndrome combined standard risk criteria for waist circumference, triglycerides, high-density lipoprotein, blood pressure and glucose. A cluster analysis of urinary incontinence, other LUTS and impact data-collected two years after Year 25-was used to group women into one of four categories: no or very mild symptoms with no impact (bladder health) versus mild, moderate or severe symptoms/impact.ResultsStructural equation modelling showed a statistically significant direct path between depressive symptoms and LUTS/impact. Tests of indirect paths showed that health behaviours, cognitive function and metabolic syndrome did not mediate the association between depressive symptoms and LUTS/impact.ConclusionsDepressive symptoms in early adulthood appear to be associated with LUTS and their impact in mid-life adulthood over and above health behaviours, cognitive function and metabolic syndrome.

Background: Associations between different forms of emotional distress (depression, anxiety, posttraumatic stress) and lower urinary tract symptoms (LUTS) among general populations of women are well established. Objective: To contribute to culturally informed clinical practice, this study examines the association between emotional distress and LUTS among Somali migrant women who have experienced female genital cutting (FGC). Methods: Data was analyzed from the Our body, Our health study of Somali women (n = 300; mean age, 36 years). Data were collected via audio computer-assisted self-survey between September 2021 and April 2023. The Refugee Health Screener was used to assess emotional distress (symptoms of depression, anxiety, and posttraumatic stress). LUTS items were adapted from the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms. Results: In logistic regression analyses adjusting for covariates (age, education, vaginal childbirth, episiotomy, FGC type), total emotional distress was associated with greater odds of experiencing all assessed LUTS (urgency, frequency, nocturia, urgency and stress urinary incontinence, straining, bladder pain). For example, for each 1-unit increment in total emotional distress, participants' odds of urgency increased by 10% (OR = 1.10, 95% CI = 1.05, 1.16), urgency urinary incontinence by 9% (OR = 1.09, 95% CI = 1.04, 1.14), and stress urinary incontinence by 12% (OR = 1.12, 95% CI = 1.07, 1.18). Conclusions: In this cross-sectional study of Somali migrant women who had experienced FGC, consistent associations were observed between emotional distress in the past month and an array of LUTS. Women who present with LUTS should be screened for emotional distress and referred for mental health services as indicated.