Examining Lower Urinary Tract Symptoms and Bathroom Access in Unhoused Women

Objectives: This research initiative examines the uro-gynecological challenges encountered by women experiencing homelessness (WEH), aiming to provide insights into a demographic that remains underrepresented within the domain of urological research.

Methods: WEH were encountered during a free student-led weekly clinic. Participants, aged 18 or older, were consented on the streets and given a IRB-approved, confidential survey about their urological conditions and lower urinary tract symptoms (LUTS). The LUTS survey was based on the Urogenital Distress Inventory short form (UDI-6) questionnaire and severe symptoms were defined as a score > 33.33. Overactive bladder (OAB) was defined as a UDI-6 urgency question score of 5-6 and stress urinary incontinence (SUI) as a UDI-6 stress question score of 2-6. Clinical information of patients seen between December 2023 and March 2024 was stored in a HIPAA compliant electronic database, REDCap, and de-identified prior to downloading for statistical analysis in SPSS. Data analysis was conducted using descriptive statistics to examine trends and patterns in participants' responses.

Results: There were 8 women in total who participated in the survey, 1 was missing UDI-6 score and thus excluded from the analysis. Out of the 7 with UDI-6 scores, 1 did not report whether they had a known diagnosis of LUTS or not and from this group of 7, 85.7% (n=6) had severe urinary symptoms. Out of those who did report an answer, only 1 reported having a known diagnosis of LUTS and she had a severe UDI-6 score of 79. Of the 6 women with no known diagnosis of LUTS, about 83.3% (n=5) had severe LUTS.

Of the 5 women with severe urinary UDI-6 scores who reported bathroom habits, 3 used the bathroom only during 7am-7pm and 2 had access 24 hrs/day. Regarding where they used the bathroom, 2 used public bathrooms, 2 used overnight shelter and 1 used a day shelter. Out of the total participants with completed surveys, 50% of women experienced OAB symptoms and 50% of women experienced SUI symptoms.

Conclusions: Urinary distress symptoms are prevalent in women experiencing homelessness and are significantly impacting their quality of life. This may be exacerbated by a lack of access to primary or specialty uro-gynecological care. At this stage, the impacts of access to bathrooms, whether the timing or place, with regards to LUTS are inconclusive. The current statistics are preliminary as we continue to collect data. Future directions include implementing interventions to address barriers faced by WEH and increase their access to uro-gynecological care. Future research is needed to explore the efficacy and feasibility of implementing urological treatment interventions tailored to the unique circumstances and challenges faced by WEH.