Most of us do not give much thought to how we use the bathroom. However, habits such as holding urine for long periods, urinating “just in case,” pushing to empty the bladder, or hovering over a public toilet may be connected with urinary symptoms.

A study of adult women across the United States examined whether these common toileting behaviors were associated with lower urinary tract symptoms, often called LUTS.

What Are Lower Urinary Tract Symptoms?

Lower urinary tract symptoms can include:

• A sudden or frequent need to urinate
• Urine leakage
• Difficulty starting urination
• A slow or weak urine stream
• Feeling that the bladder did not empty completely
• Dribbling after urination
• Bladder pain or discomfort

The study included 316 women between the ages of 18 and 93. Participants answered questions about their bladder symptoms and bathroom habits at home and in public restrooms.

Which Bathroom Habits Were Studied?

Researchers looked at four common behaviors:

Holding urine: Waiting to use the bathroom even when you feel the urge.

“Just in case” urination: Emptying your bladder before you feel a natural urge, such as before leaving home.

Straining: Pushing with the abdominal muscles to start or speed up urination.

Hovering or squatting: Avoiding sitting on a toilet seat, particularly when using a restroom away from home.

What Did the Study Find?

Younger women were much more likely to report holding their urine. About 77% of women ages 18 to 25 said they often or always delayed urination, compared with about 22% of women ages 75 and older.

Older women were more likely to urinate “just in case.” This may be a way of trying to manage urgency or prevent leakage, although the study could not determine whether the behavior began before or after urinary symptoms developed.

Several toileting behaviors were associated with bothersome urinary symptoms:

• Urinating “just in case” was associated with urgency, frequency, leakage and other bladder-storage symptoms.
• Frequently holding urine was associated with difficulty emptying the bladder.
• Straining to urinate was associated with both storage and emptying symptoms.
• Hovering, crouching or standing over a toilet away from home was associated with bothersome emptying symptoms.

These findings show an association, meaning the behaviors and symptoms were reported together. They do not prove that the bathroom habits caused the symptoms.

Why Might Hovering Make Urination More Difficult?

Many women hover over public toilets because they are concerned about cleanliness. However, hovering may make it more difficult for the pelvic floor muscles and urinary sphincter to relax completely.

When these muscles do not relax, the bladder may not empty as easily. More research is needed to understand the long-term effects of different toileting positions.

The researchers also noted that access to clean, private and safe restrooms may influence bathroom habits. Black and Hispanic women in the study were more likely than White women to report avoiding sitting when using toilets away from home. These differences may reflect unequal access to suitable restroom facilities rather than personal preference alone.

Bladder-Friendly Bathroom Habits

Although this study was not designed to create treatment recommendations, its findings suggest several habits worth considering.

Try to respond to your bladder’s natural signals rather than routinely holding urine for extended periods or urinating without an urge. When possible, sit comfortably and allow the pelvic floor and abdominal muscles to relax. Urination should not normally require forceful pushing or straining.

Occasionally holding urine or using the bathroom before a long trip does not necessarily mean you will develop a bladder problem. The concern is more about habits that happen frequently and are accompanied by symptoms.

When Should You Speak With a Healthcare Professional?

Talk with a healthcare professional if you regularly experience leakage, urgency, frequent urination, difficulty starting, a weak stream, straining, pain or a feeling that your bladder does not empty completely.

Urinary symptoms are common, but they should not automatically be accepted as a normal part of aging. An evaluation can help identify the cause and determine whether bladder training, pelvic floor therapy, medication or another treatment may help.

What Are the Study’s Limitations?

This was a cross-sectional study, meaning the researchers collected information at one point in time. It could not determine whether bathroom habits caused urinary symptoms or whether women adopted these habits to manage symptoms they already had.

The participants were volunteers and may not represent all women. The study also included only adult women, so the findings should not automatically be applied to men or every patient population. More long-term research is needed.

The main message: How and when you use the bathroom may be connected with bladder symptoms. Paying attention to your body, avoiding frequent straining and using a relaxed toileting position may help support healthy bladder function.

Source: Newman DK and colleagues. “Toileting behaviors and lower urinary tract symptoms: A cross-sectional study of diverse women in the United States.” International Journal of Nursing Studies Advances, 2021.

This article is for educational purposes and is not a substitute for individualized medical advice.