A mixed-methods scoping review on bladder self-care practices in women with and without lower urinary tract symptoms.

A total of 2419 records were identified after removing duplicates, including 2391 from database searches and 28 from reference lists. Following title, abstract, and full-text screening, 104 reports met eligibility criteria ( Fig. 1 ). Six secondary analyses [ 5 , 20 , 21 , 22 , 23 , 24 ] were consolidated under their parent studies [ 4 , 25 , 26 , 27 ], resulting in 97 unique studies included in the review. Table 1 summarizes the characteristics of the 97 included studies. Most employed (n = 69, 71.1 %) quantitative designs, followed by qualitative (n = 24, 24.7 %) and mixed methods (n = 4, 4.1 %). Among qualitative and mixed-methods studies, content analysis (n = 10, 35.7 %) and interpretivist or phenomenology approaches (n = 6, 21.4 %) were most common. Most quantitative and mixed-methods studies were cross-sectional and used non-random samples (n = 50, 68.5 %), while only 13 (17.8 %) employed random or age-stratified sampling. Nearly all studies (n = 86, 89.7 %) collected data through interviews and/or questionnaires; nine (32.1 %) qualitative and mixed-methods studies used focus groups, and one analyzed social media content. Studies were conducted in 19 countries and one special administrative territory, primarily in English-speaking nations (n = 60, 62.5 %). A total of 66,196 women aged 17–99 years participated, with a weighted mean age of 42.6 years. Most studies (n = 81, 84.4 %) recruited participants with a history of UI, OAB, or LUTS, with UI being the most common condition. Fifteen studies (15.5 %) recruited women from a general, employed, or college population without requiring LUTS for eligibility. Most studies examined self-care practices for managing incontinence, OAB, or LUTS (23 qualitative, 95.8 %; 56 quantitative, 76.7 %.), while only one qualitative study explored practices promoting bladder health [ 11 ]. Quantitative and mixed-methods studies assessed a relatively limited set of self-care behaviors using questionnaires, typically employing Likert-like frequency scales (e.g., “never,” “rarely,” “sometimes,” “often,” and “always”). Commonly assessed behaviors included preemptive voiding (e.g., voiding “just-in case” before leaving home, work, or school), pad use, fluid intake, pelvic muscle exercises, physical activity modifications, and use of anti-incontinence medications. Eleven studies (15.9 %) focused on toileting behaviors such as preemptive, delayed, or strained voiding, as well as place and position preference for toileting [ 6 , 48 , 50 , 51 , 64 , 72 , 81 , 99 – 101 , 104 ]. More than three-quarters of studies (n = 58, 79.5 %) used investigator-designed instruments, most of which had limited (n = 28, 38.4 %) or no (n = 30, 41.1 %) evidence of validation ( Table 2 ). Twenty questionnaires (35.5 %) were pilot-tested, and five (8.6 %) underwent reliability testing. Instruments that had undergone psychometric evaluation and demonstrated reliability as well as construct and/or criterion-related validity were used in 22 studies (30.1 %). These include the Toileting Behaviors-Women’s Elimination Behavior Scale (TB-WEB) [ 4 , 6 , 48 , 50 , 64 , 72 , 81 , 99 , 100 , 23 ], which measured 18 toileting behaviors and the Taiwan Nurse Bladder Survey (TBNS) [ 65 ] which assessed four bladder-related habits. Three studies incorporated validated items or subscales from other instruments, such as the Bristol Female Lower Urinary Tract Symptoms Questionnaire (BFLUTS; now known as ICIQ-FLUTS) [ 102 ] and the Questionnaire-Based Voiding Diary [ 103 ], to evaluate fluid restriction and avoidance of places and situations without nearby restroom. One study used items from the Bladder Questionnaire—Quality of Life (OAB-qol) subscale [ 69 , 102 ] to evaluate five coping behaviors related to restroom use and physical activity limitations. Only one study [ 14 ] used a tool specifically designed to assess bladder-related coping behaviors–the 4-item scale Adaptive Behavior Index (ABI) [ 108 ]. Across all studies, 107 distinct bladder self-care practices were identified and organized into four domains: Toileting and Bladder Management, Personal Care and Hygiene Practices, Lifestyle and Behavioral Strategies, and Therapeutic Interventions. These were further classified into 13 subdomains representing categories of self-care behaviors ( Fig. 2 ; Table 3 ). Qualitative studies identified slightly more unique behaviors than quantitative studies (84 vs 79, respectively). Sixty studies (61.9 %) reported 29 Toileting and Bladder Management practices. The most frequent subdomain was Timing When to Void (55.1 %), including delayed voiding (17.5 %), frequent (16.5 %), preemptive (13.4 %), and planned voiding (13.4 %). Practices related to Managing Toileting Environments Outside the Home appeared in 26 % of the studies, including toilet mapping (25.8 %; e.g., identifying accessible restroom locations, planning routes and activities based on restroom availability), and avoiding or limiting use of public toilets or in other settings (13.4 %). Fewer studies described bladder emptying behaviors (16.5 %) or self-monitoring (1 %). Seventy studies (72.2 %) described 31 Personal Care and Hygiene Practices. The most frequent subdomain reported was Absorbent Product Use (76.3 %), including commercial products (56.7 %; e.g., pads, pantiliners, absorbent briefs) and homemade alternatives, (13.4 %, e.g., toilet tissue, washcloth, towel, handkerchief). Less commonly reported Personal and Urogenital Hygiene practices included frequent showering or bathing (6.2 %); use of vaginal hygiene products (6.2 %; e.g., deodorant, spray, dusting powder); wiping technique (2.1 %); and type of bath product (1 %; soap or bodywash, scented or unscented). Within the Clothing Habits subdomain, less frequently reported behaviors included wearing concealing clothing (20.6 %, e.g., dark-colored, loose-fitting, or long garments), carrying spare clothes or underwear (10.0 %), changing pads or underwear frequently (9.2 %), and uchosing specific types of underwear (1 %). Sixty studies (61.9 %) identified 29 Lifestyle and Behavioral Strategies. The most common behaviors were restricting fluid intake (41.2 %) and limiting physical activity (21.7 %). Other reported practices included avoiding caffeine (10.0 %); avoiding or limiting strenuous or high impact exercise (10.0 %); modifying exercise (8.2 %); and context-specific fluid restriction, e.g., before bedtime (6.2 %); during work, travel, or being away from home (9.3 %); or exercise (2.1 %). Additional behaviors included weight management (5.2 %) and psychological strategies (6.2 %), increased or maintained fluid intake for bladder health (4.1 %), or use of probiotics, vitamins, and cranberry products (4.1 %). Forty-one studies (42.3 %) described 18 Therapeutic Interventions. Pelvic muscle exercises were commonly reported in 34 studies (35.1 %). Fewer studies reported use of vaginal devices (7.2 %; e.g., cones, balls, pessaries) or physical maneuvers to prevent leakage (1 %). Medication use appeared in 20.6 % of studies, including prescription medications for UI or OAB (16.5 %) and adjustments to dosing or timing of anti-incontinence or diuretic medications (4.1 %). Non-prescription medication use (2.1 %) was rare. Distinct Complementary and Integrative Health practices were reported in 11.3 % of studies (e.g., acupuncture, herbal supplements, perineal pressure or heat, energy-based therapies, mind-body approaches, and whole-system medicine). One qualitative study described cannabidiol use to reduce nocturia.

Bladder self-care encompasses behaviors that maintain bladder and pelvic floor health, prevent related conditions such as UTIs, UI, overactive bladder (OAB), and interstitial cystitis/bladder pain syndrome (IC/BPS), and manage LUTS with or without health care support [ 11 ]. These behaviors include toileting and voiding practices, hygiene practices, clothing choices, absorbent product use, diet and fluid intake, supplement use, physical activity, pelvic muscle exercises and devices, medication use, and complementary and integrative health practices. This review followed the Joanna Briggs Institute’s scoping review guidelines [ 18 ] and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist [ 19 ]. The protocol was registered in the Open Science Framework (osf.io/nt8a4). Eligible studies included community-dwelling women aged 18 years and older, with and without UI, LUTS, or OAB, residing in high- or upper-middle-income countries as defined by the World Bank at the time of the search. Studies used qualitative, quantitative, or mixed-methods designs and reported current self-care behaviors that could influence bladder health. Quantitative and mixed-methods studies were required to report frequencies of individual self-care behaviors. Only full-text, English-language, peer-reviewed articles were included. Studies were excluded if they involved pregnant or postpartum women; men; elite athletes; active-duty military personnel; and individuals with cognitive or developmental disabilities, spinal cord injuries, or progressive neurological conditions (e.g., dementia, multiple sclerosis, Parkinson’s disease). Institutionalized women (e.g., prisons, acute care hospitals, long-term care facilities) and those receiving home care services were also excluded. We further excluded women with sexually transmitted infections, endometriosis, gynecologic or bladder cancer, prior bladder or pelvic surgery, terminal illness, or use of intermittent or indwelling catheters. Finally, studies focused on women with UTIs, IC/PBS, or congenital urinary tract abnormalities were excluded, as these populations may engage in distinct self-care behaviors to manage urinary symptoms. Studies conducted in low- and lower-middle-income countries were excluded due to contextual differences in hygiene (e.g., limited access to private or clean toilets, particularly in rural areas); water sources and quality (e.g., inconsistent or unsafe water supply for washing, bathing, and cleaning reusable absorbent products); sanitation infrastructure (e. g., poorly maintained or distant toilets); and limited availability and access to appropriate health care. These factors can substantially influence self-care practices and bladder health. Observational studies providing only population estimates of food and fluid intake, urinary frequencies and symptoms, physical activity, absorbent product use, or adherence to behavioral treatments were also excluded. Studies involving both sexes were eligible if women’s data were reported separately or if men represented ≤1 % of the sample. Abstracts, case studies, guidelines, editorials, commentaries, opinion pieces, letters, news articles, systematic reviews, and protocol papers were excluded. In collaboration with a medical librarian, search strategies were developed using controlled vocabulary (e.g., MeSH) and free-text words related to self-care and LUTS. Searches were limited to English language studies. Five electronic databases were searched from inception to April 1, 2025: Ovid MEDLINE ® All (1946-present), APA PsycInfo (via Ovid), CINAHL Ultimate (via EBSCOHost), and Scopus (Elsevier). Reference lists of relevant reviews and included articles were also manually screened. Search results were managed in Covidence (Veritas Health Innovation, Melbourne, Australia), with duplicates automatically removed. The search strategy for each database is provided in Supplemental Table A–1 . Two independent reviewers screened titles and abstracts, followed by full-text review with documented reasons for exclusion. Discrepancies were resolved through discussion or adjudication by a third reviewer. Data were extracted using a customized Covidence template to ensure consistency. Extracted variables included study type, country, setting, target population, sample size, participant characteristics, data collection methods, and self-care outcomes. Open-ended text fields captured participant characteristics and practices not pre-listed. Descriptions of each self-care behavior were extracted verbatim from authors’ published descriptions. Two reviewers piloted and refined the template; three reviewers completed extraction, with one reviewer verifying all entries. Consistent with JBI guidance for scoping reviews [ 19 ], quality appraisals were not conducted. Self-care practices were initially coded into preliminary categories using an inductive approach. After team review and synthesis, they were organized into 13 subdomains: a) timing when to void; b) bladder toileting and emptying strategies; c) toilet environments away from home; d) bladder self-monitoring; e) personal and urogenital hygiene; f) clothing habits; g) absorbent product use; h) diet, fluid intake, and supplements; i) physical activity modifications; j) psychological strategies; k) pelvic muscle exercises, maneuvers, and devices; l) medication use; and m) complementary and integrative health practices. These subdomains were grouped into four overarching domains for interpretation: Toileting and Bladder Management, Personal Care and Hygiene Practices, Lifestyle and Behavioral Strategies, and Therapeutic Interventions. Within each subdomain, discrete behaviors were identified and classified as self-care practices. Supplemental Table A2 provides domain and subdomain definitions and descriptions. Descriptive statistics were used to summarize study methods, participant characteristics, and self-care practices within research designs. When data were available, a weighted mean age was calculated.

This scoping review is the first to synthesize research on women’s bladder self-care practices and the questionnaires used to assess them. The large number of studies and diversity of behaviors identified highlight the breadth and complexity of applying the concept of self-care to bladder health. Findings reveal a wide spectrum of practices that may act as risk or protective factors, yet most research has focused on symptom management among women with UI, OAB, or LUTS. Few studies have examined behaviors aimed at maintaining bladder health in asymptomatic populations. Bladder self-care extends beyond toileting habits, bladder emptying techniques, and absorbent product use. It includes practices such as monitoring for dehydration or UTIs; personal and urogenital hygiene; clothing habits; dietary modifications; constipation prevention; weight management; supplement use; physical activity modifications; psychological strategies; and therapeutic interventions (e.g., pelvic muscle exercises, vaginal support devices, medication use, and complementary and integrative health approaches). Despite this broad range of behaviors, only one quantitative study specifically evaluated maintaining adequate fluid intake (6–8 glasses per day) [ 67 ]. This gap indicates the need for research on intentional, routine practices, particularly fluid management behaviors, that support bladder health rather than focusing solely on symptom prevention or management through fluid restriction or increased intake. Some practices may be underrepresented not because they are unimportant, but because they have not been systematically conceptualized, measured, or incorporated into existing instruments. Current understanding of women’s bladder self-care practices is shaped by methodological heterogeneity across studies, including differences in aims, design, sampling, and measurement. Most research has focused on women with UI, OAB, or LUTS, with relatively few studies including asymptomatic or population-based samples. Qualitative studies primarily explored women’s experiences of living with or managing bladder problems, whereas, quantitative studies tended to assess a narrow set of coping behaviors, rarely as a primary focus. Such methodological limitations hinder efforts to characterize the full spectrum of self-care behaviors and to identify which may serve as risk or protective factors for bladder health. A key limitation across literature is the absence of a comprehensive, validated questionnaire to assess the full range of women’s bladder self-care practices. Approximately 80 % of identified instruments had limited or no evidence of validity. Only three well-validated questionnaires–the Toileting Behaviors-Women’s Elimination Behavior Scale [ 36 ], the Taiwanese Nurse Bladder Survey [ 66 ], and the Adaptive Behavior Index (ABI) [ 108 ] captured specific aspects of bladder self-care, toileting behaviors, and coping strategies for UI, respectively. A recently validated questionnaire assessing 16 non-medication coping strategies for UI in older adults included a broader range of behaviors, some relevant to bladder self-care. However, several items focused on quality-of-life adaptations rather than practices that directly influenced bladder function [ 115 ]. The lack of a multidimensional, validated questionnaire limits the systematic assessment of self-care behaviors and constrains the development of evidence-based prevention and intervention strategies. Future research should therefore prioritize the development and psychometric validation of comprehensive instruments applicable across populations and life stages to identify modifiable behaviors and inform clinical care and public health efforts that promote bladder health. Together, these findings highlight the diversity and undermeasurement of women’s bladder self-care practices. Advancing the field will require conceptual frameworks and validated instruments that capture the full range of behaviors influencing bladder health. Future work should integrate these insights to strengthen theoretical foundations and measurement approaches that inform prevention, education, and health promotion efforts. Strengths of this review include a systematic, comprehensive search strategy encompassing qualitative, quantitative, and mixed-methods studies. Despite these strengths, several limitations should be noted. Excluding studies involving women with UTIs, IC/BPS, and prolapse and those conducted in low- and lower-middle-income may limit generalizability to populations with different symptom etiologies or environmental and health care contexts influencing self-care. Help-seeking practices were not included as this topic has been reviewed previously [ 116 ]. Although sexual activity and contraceptive practices can affect bladder health, particularly UTIs, they were excluded because they represent reproductive rather than bladder-specific self-care. Expanding to include these populations and behaviors could have broadened the scope but reduced feasibility and focus. Finally, only English-language articles were included. Findings highlights the need to develop and validate multidimensional instruments that comprehensively assess women’s bladder self-care practices. Such tools are essential for population-based research to identify behaviors that function as risk or protective factors and to inform prevention and intervention efforts. The broad range of practices identified suggests that women often manage bladder health independently. Although this review did not evaluate the availability of self-care guidance, the diversity of reported behaviors underscores the importance of understanding women’s knowledge, information sources, and access to bladder self-care education. Public health initiatives should prioritize developing accessible, evidence-informed messaging and educational resources that promote preventive self-care. Future research should examine variations in bladder self-care across demographic characteristics (age, race, and ethnicity), geographical settings (urban vs rural), and urological conditions. Evidence from such work will be critical to refine and test the conceptual model of bladder self-care and to guide targeted interventions and prevention strategies that promote bladder health and reduce urinary dysfunction across the life course.

This scoping review provides the first comprehensive synthesis of women’s bladder self-care practices and related assessment tools. By organizing 107 distinct practices across 13 subdomains within four domains, it establishes a conceptual foundation for advancing research on bladder self-care. Results reveal the multidimensional nature of these behaviors and major gaps in their measurement. Strengthening evidence through validated instruments and population-based studies will be essential to inform prevention, education, and health promotion efforts that support women’s bladder health across the life course.

Self-care, as defined by the World Health Organization, is the ability of individuals to promote and maintain their health, prevent disease, and cope with illness and disability, with or without the support of a health care provider [ 1 ]. In bladder health, self-care is central to maintaining bladder function, preventing urinary tract infections (UTIs), and managing lower urinary tract symptoms (LUTS). While lifestyle-related behaviors are well characterized in cardiovascular and metabolic health [ 2 , 3 ], bladder-specific self-care remains underexplored, particularly among women who are at greater risk due to anatomical, biological, and lifestyle factors. Daily behaviors related to toileting, hygiene, diet, clothing, physical activity, and medication may influence bladder health. Toileting behaviors such as delaying voiding, straining to void, preemptive voiding, or hovering over the toilet have been associated with increased LUTS [ 4 – 6 ], whereas weight management and pelvic floor muscle exercises may reduce risk [ 7 , 8 ]. Women also adopt self-directed strategies such as modifying fluid intake or using supplements (e.g., cranberry or herbal products) to manage urinary symptoms [ 7 , 9 – 11 ]. Current knowledge of bladder self-care remains limited, especially regarding practices beyond symptom management. Most studies focus on toileting behaviors, fluid intake, and absorbent product use among women with LUTS [ 12 – 15 ], leaving many other behaviors that may influence bladder health understudied. Two prior reviews have addressed selected aspects of self-care: one qualitative systematic review examined women’s experiences with urinary incontinence (UI) and their coping mechanisms [ 14 ; 16 ], while another scoping review focused solely on toileting behaviors [ 13 ]. Advancing bladder self-care research requires comprehensive evaluation of the full spectrum of women’s behaviors, with greater rigor and consistency in how these practices are defined, measured, and reported. To address these gaps, this scoping review synthesizes evidence from qualitative, quantitative, and mixed-methods studies involving women with and without urinary symptoms. It integrates findings across study designs to describe women’s bladder self-care behaviors and proposes a conceptual framework to guide future measurement, research, and intervention efforts. The objectives of this review are to: 1) describe study characteristics, including methodological approaches used to examine women’s bladder self-care; 2) identify questionnaires used to assess these behaviors; and 3) catalog practices relevant to bladder function. Findings informed the development of items to evaluate bladder self-care in the RISE FOR HEALTH study, a population-based survey of U.S. women designed to identify risk and protective factors for bladder health [ 17 ].