Dr. Sebesta on future research on interventions for toilet and sanitation insecurity

In this video, Elisabeth M. Sebesta, MD, discusses potential mechanisms linking insecurity and both urinary symptoms and psychosocial factors. She is an author of the Urology study “Household Toilet and Sanitation Insecurity is Associated with Urinary Symptoms, Psychosocial Burden, and Compensatory Bladder Behaviors.” Sebesta is an assistant professor of urology at Vanderbilt University Medical Center in Nashville, Tennessee.

Transcription:

The study identifies a concerning link between insecurity and unhealthy compensatory bladder behaviors. Do you see potential for future research to explore interventions that could address both the insecurity and the negative coping mechanisms?

This is kind of the last part of this cycle that I'm talking about, connecting toilet and sanitation insecurity to urinary symptoms. We all have coping strategies that we use to deal with unpleasant emotions or situations. And in urology, there are certain toileting behaviors that people utilize to help cope with urinary symptoms or compensate for their disease state like overactive bladder. There are different types of coping, so there are primary strategies, which are focused on problem solving. In urology, this might be like planning an activity or restroom mapping. This is like what you would you would tell someone to do if you want to help them develop healthy bladder coping behaviors, but there are also disengaged strategies, which are more maladaptive. This results when you are managing a stressful situation with avoidance, so avoiding certain activities, avoiding socialization, staying home, that kind of stuff. We've found that people with toilet and sanitation insecurity are more likely to adopt any compensatory bladder behavior, but specifically some of those really maladaptive behaviors. And so this, like I said, is kind of the thing that helps connect this whole picture, like those people without reliable access to toilets and plumbing in their home have worse urinary symptoms, they have stress about this situation, anxiety about this situation. And then to cope with it, they develop maladaptive compensatory bladder behaviors, and this then becomes something that just continues to propagate forward. And so the lack of toilets just becomes the driver of this whole cycle. And so in terms of future knowledge about this, yes, absolutely. I think that coping is a key way that we can help intervene here, acutely if you're talking to someone or a patient who's experiencing some of these situations at home, teaching somebody primary control coping strategies over the avoiding maladaptive strategies is a great way to help them manage their stress and even manage their overall urinary symptoms. Enhancing coping strategies is a really practical thing that can be implemented in a clinical setting, and if coping continues to become a particular struggle for a patient, of course, they should be referred to someone with more specialization and coping like behavioral medicine to help. But yes, this is certainly something that would be interesting to consider for the future. Like, can you help toilet-insecure people manage their stress and anxiety and lower urinary tract symptoms by teaching them to improve their coping behaviors or on toileting?

This transcription was edited for clarity.