Researchers at the University of Michigan are working alongside the University of Minnesota’s Prevention of Lower Urinary Tract Symptoms Research Consortium to study the various perceptions of bladder health among women. The consortium produced a qualitative study examining 360 women’s views about what constitutes a “healthy” versus “unhealthy” bladder. The researchers found participants often lacked sufficient information about general bladder health, showing room for growth in education regarding women’s bladder health and prevention of lower urinary tract symptoms.
Initially, the researchers sought to understand bladder health from patients’ perspectives. To achieve this, they created 44 focus groups of women based on shared social context and similar life experiences,each moderated by women trained in qualitative research. They then analyzed how the participants viewed healthy bladders.
In an interview with The Daily, Lisa Kane Low, nursing professor at the University and lead author of the study, highlighted the importance of including people of diverse backgrounds in women’s health research.
“We asked people from the ages of 11 to 93 using focus groups what they thought bladder health was and what it would mean to them and learned a lot about new ways of thinking about it,” Low said. “Some of the big things that we identified is that a lot of people experience challenges, particularly in the workplace, with having the autonomy to go to the bathroom when they needed to.”
The researchers identified the role of gatekeepers, people in positions of power who limit workers’ access to restrooms. Low said the study found participants who worked in such inflexible jobs or experienced a language barrier sometimes had difficulty accessing a bathroom.
“If you’re working in a staffing position, you often weren’t given the flexibility to go when you needed to, or potentially questioned related to the frequency of going and things like that,” Low said. “Depending upon where you lived, people found challenges asking for access to the bathroom. Particularly in some of our Spanish-speaking populations, asking to use a restroom at a business was more challenging or complicated for them.”
The researchers used a socio-ecological model to inform this study. By observing differences and similarities between different focus groups based on location, age, English proficiency or income, this research sought to account for disparities surrounding bladder health. Low said this approach was crucial for understanding how environmental factors shape women’s perceptions about bladder health.
“You would think something like a (biological) need to go to the bathroom, you should be able to go,” Low said. “And yet, in so many scenarios, you either can’t go or the bathroom environment is not one that you’re comfortable in. Then you start having to completely change your habits, and that’s what then could lead to some of the negative symptoms.”
The findings also showed that participants had varying understandings of bladder health, often defining “healthy” as the absence of discomfort or abnormal coloring, rather than an active state of well-being. Low said the study also revealed that misconceptions about bladder health were widespread.
“There was a lot of shared experience and some confusion,” Low said. “Some people thought you had to drink a lot of water. Other people didn’t want you to drink too much. Some people felt like you got stronger by holding, and yet that actually makes it weaker over time.”
With many participants only considering their bladder’s function when symptoms arose, Low said bladder health should be more intentionally integrated into public health messaging and school curriculums.
“We learn about different things about our bodies and health, and for some reason, the bladder and peeing is just not talked about very much,” Low said. “And that needs to change in order for people to better understand what is normal, what’s not normal.”
Low also said even in health care settings, discussing bladder health should be normalized to encourage patients to be more open with their providers.
“We found that people were afraid to say that they had what they would often refer to as ‘having an accident or leaking,’ and they were not comfortable talking to their health care provider, because they felt that it was something to be shameful about because their health care provider didn’t ask and they didn’t feel comfortable bringing it up,” Low said.
In an email to The Michigan Daily, Kathryn Burgio, professor at the University of Alabama School of Medicine and study contributor, wrote that a main goal of the PLUS Research Consortium is to expand public health education regarding bladder health.
“We hope this information will help us to understand our audiences of adolescents and adult women and guide us in designing public health messaging and other educational interventions that will be of interest to them, address their expressed desire for trustworthy information in this area, correct misconceptions, reinforce accurate guidance and help them adopt healthy bladder habits at all ages,” Burgio wrote.
In an interview with The Daily, LSA sophomore Saiya Zeng, member of M-HEAL’s Project Mia, a project team centered around period health and education, compared bladder health education with the progress made in normalizing conversations about menstruation.
“Periods used to be so stigmatized, but now I’m in a group where people talk about it to our community partners openly,” Zeng said. “Normalizing it, people talking about it more, just like everything else, is important in understanding women’s health.”
Daily Staff Reporter Alaine Hanson can be contacted at alaineh@umich.edu.
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