<b>Association of Urinary Incontinence and Overactive Bladder with Public Washroom Avoidance and Delayed Urination Among Women</b>

Background: Urinary incontinence and overactive bladder are common lower urinary tract problems in women and may be influenced by unhealthy toileting behaviors such as public washroom avoidance and delayed urination. These behaviors can disrupt daily life and may aggravate bladder-related symptoms. Objective: To determine the association of urinary incontinence and overactive bladder with public washroom avoidance and delayed urination among women. Methods: This analytical cross-sectional study was conducted among 153 community-dwelling women aged 18–70 years in Karachi using convenience sampling. Data were collected with a structured questionnaire incorporating the Incontinence Severity Index, Overactive Bladder Questionnaire Short Form, and Shy Bladder and Bowel Scale. Descriptive statistics were used to summarize participant characteristics and symptom burden, and chi-square testing was applied to assess associations between urinary symptom categories and toileting behaviors. Results: Public washroom avoidance was reported by 137 participants (89.5%), while 100 (65.4%) reported frequent or persistent delayed urination. Most women had no urinary incontinence (122, 79.7%), and mild overactive bladder symptom bother was the most common category (98, 64.1%). Moderate-to-severe shy bladder-bowel symptoms were observed in 113 participants (73.9%). Urinary incontinence was significantly associated with public washroom avoidance (χ²=45.672, p<0.001) and delayed urination (χ²=32.145, p=0.002). Overactive bladder was also significantly associated with public washroom avoidance (χ²=34.230, p=0.004) and delayed urination (χ²=51.334, p<0.001). Conclusion: Adverse toileting behaviors were highly prevalent and were significantly associated with urinary symptom burden in women. Early behavioral screening, patient education, and improved public restroom environments may help reduce bladder health burden.