World Journal of Urology

, Volume 31, Issue 5, pp 1081–1085 | Cite as

Gender differences in bladder control: from babies to elderly

Topic Paper


In both sexes, there are anatomical and behavioral differences in dealing with bladder control, as well as voiding and incontinence. Despite intensive research within the last decades, the differences in physiology and pathophysiology as well as gender differences of bladder control and continence are still poorly understood and further research is highly needed. In babies, gender difference seems to be most likely caused by a difference in maturity rate of the bladder. After gaining bladder control, behavior starts to be influenced by socialization. During preschool and school, children experience a negative perception of school toilets. Especially girls crouch over the toilet seat and train to empty the bladder without relaxation of the pelvic floor. This posture may lead to bladder dysfunction. Often adult women continue this bad habit and bladder dysfunction may consolidate. From the fourth decade in both sexes lower urinary tract symptoms start to develop. However, men and women handle the problem variedly showing gender differences in coping strategies with better coping mechanisms in women. In general, gender difference in help seeking and receiving treatment increases with younger age. In elderly, urinary incontinence is only associated with a higher mortality in men, and elderly men seek more often professional help. Aim of the review is to provide an insight into gender differences of bladder control and bladder dysfunction.


Gender Bladder control Incontinence Female Male Behavior 


  1. 1.
    Thuroff JW, Abrams P, Andersson KE, Artibani W, Chapple CR, Drake MJ et al (2011) EAU guidelines on urinary incontinence. Eur Urol 59:387–400PubMedCrossRefGoogle Scholar
  2. 2.
    Stothers L (2004) Reliability, validity, and gender differences in the quality of life index of the SEAPI-QMM incontinence classification system. Neurourol Urodyn 23:223–228PubMedCrossRefGoogle Scholar
  3. 3.
    Largo RH, Molinari L, von Siebenthal K, Wolfensberger U (1999) Development of bladder and bowel control: significance of prematurity, perinatal risk factors, psychomotor development and gender. Eur J Pediatr 158:115–122PubMedCrossRefGoogle Scholar
  4. 4.
    Shreeram S, He JP, Kalaydjian A, Brothers S, Merikangas KR (2009) Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among US children: results from a nationally representative study. J Am Acad Child Adolesc Psychiatry 48:35–41PubMedCrossRefGoogle Scholar
  5. 5.
    Lundblad B, Hellstrom AL (2005) Perceptions of school toilets as a cause for irregular toilet habits among schoolchildren aged 6 to 16 years. J Sch Health 75:125–128PubMedGoogle Scholar
  6. 6.
    Moore KH, Richmond DH, Sutherst JR, Imrie AH, Hutton JL (1991) Crouching over the toilet seat: prevalence among British gynaecological outpatients and its effect upon micturition. Br J Obstet Gynaecol 98:569–572PubMedCrossRefGoogle Scholar
  7. 7.
    Yang KN, Chen SC, Chen SY, Chang CH, Wu HC, Chou EC (2010) Female voiding postures and their effects on micturition. Int Urogynecol J 21:1371–1376PubMedCrossRefGoogle Scholar
  8. 8.
    Madersbacher S, Pycha A, Schatzl G, Mian C, Klingler CH, Marberger M (1998) The aging lower urinary tract: a comparative urodynamic study of men and women. Urology 51:206–212PubMedCrossRefGoogle Scholar
  9. 9.
    Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S et al (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50:1306–1314 discussion 14–5PubMedCrossRefGoogle Scholar
  10. 10.
    Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS et al (2009) The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int 103(Suppl 3):4–11PubMedCrossRefGoogle Scholar
  11. 11.
    Coyne KS, Sexton CC, Thompson CL, Clemens JQ, Chen CI, Bavendam T et al (2012) Impact of overactive bladder on work productivity. Urology 80:97–103PubMedCrossRefGoogle Scholar
  12. 12.
    Wein AJ, Coyne KS, Tubaro A, Sexton CC, Kopp ZS, Aiyer LP (2009) The impact of lower urinary tract symptoms on male sexual health: EpiLUTS. BJU Int 103(Suppl 3):33–41PubMedCrossRefGoogle Scholar
  13. 13.
    Uzun H, Yilmaz A, Kemik A, Zorba OU, Kalkan M (2012) Association of insulin resistance with overactive bladder in female patients. Int Neurourol J 16:181–186PubMedCrossRefGoogle Scholar
  14. 14.
    Findik RB, Unluer AN, Sahin E, Bozkurt OF, Karakaya J, Unsal A (2012) Urinary incontinence in women and its relation with pregnancy, mode of delivery, connective tissue disease and other factors. Adv Clin Exp Med Off Organ Wroclaw Med Univ 21:207–213Google Scholar
  15. 15.
    Stothers L, Friedman B (2011) Risk factors for the development of stress urinary incontinence in women. Curr Urol Rep 12:363–369PubMedCrossRefGoogle Scholar
  16. 16.
    Campeau L, Gorbachinsky I, Badlani GH, Andersson KE (2011) Pelvic floor disorders: linking genetic risk factors to biochemical changes. BJU Int 108:1240–1247PubMedCrossRefGoogle Scholar
  17. 17.
    Nguyen A, Aschkenazi SO, Sand PK, Du H, Botros SM, Gamble TL et al (2011) Nongenetic factors associated with stress urinary incontinence. Obstet Gynecol 117:251–255PubMedCrossRefGoogle Scholar
  18. 18.
    Walters MD, Taylor S, Schoenfeld LS (1990) Psychosexual study of women with detrusor instability. Obstet Gynecol 75:22–26PubMedGoogle Scholar
  19. 19.
    Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Milsom I (2008) The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int 101:1388–1395PubMedCrossRefGoogle Scholar
  20. 20.
    Irwin DE, Milsom I, Kopp Z, Abrams P, Cardozo L (2006) Impact of overactive bladder symptoms on employment, social interactions and emotional well-being in six European countries. BJU Int 97:96–100PubMedCrossRefGoogle Scholar
  21. 21.
    Roberts RO, Jacobsen SJ, Rhodes T, Reilly WT, Girman CJ, Talley NJ et al (1998) Urinary incontinence in a community-based cohort: prevalence and healthcare-seeking. J Am Geriatr Soc 46:467–472PubMedGoogle Scholar
  22. 22.
    Li Y, Cai X, Glance LG, Mukamel DB (2007) Gender differences in healthcare-seeking behavior for urinary incontinence and the impact of socioeconomic status: a study of the Medicare managed care population. Med Care 45:1116–1122PubMedCrossRefGoogle Scholar
  23. 23.
    Diokno AC (2001) Epidemiology of urinary incontinence. J Gerontol Ser A Biol Sci Med Sci 56:M3–M4CrossRefGoogle Scholar
  24. 24.
    Nuotio M, Tammela TL, Luukkaala T, Jylha M (2003) Predictors of institutionalization in an older population during a 13-year period: the effect of urge incontinence. J Gerontol Ser A Biol Sci Med Sci 58:756–762CrossRefGoogle Scholar
  25. 25.
    Talbot LA, Cox M (1995) Differences in coping strategies among community-residing older adults with functional urinary continence, dysfunctional urinary continence and actual urinary incontinence. Ostomy Wound Manag 41:30–32, 4–7Google Scholar
  26. 26.
    Maggi S, Minicuci N, Langlois J, Pavan M, Enzi G, Crepaldi G (2001) Prevalence rate of urinary incontinence in community-dwelling elderly individuals: the Veneto study. J Gerontol Ser A Biol Sci Med Sci 56:M14–M18CrossRefGoogle Scholar
  27. 27.
    Wilson MM (2003) Urinary incontinence: bridging the gender gap. J Gerontol Ser A Biol Sci Med Sci 58:752–755CrossRefGoogle Scholar
  28. 28.
    Klausner AP, Vapnek JM (2003) Urinary incontinence in the geriatric population. Mt Sinai J Med N Y 70:54–61Google Scholar
  29. 29.
    Herzog AR, Diokno AC, Brown MB, Fultz NH, Goldstein NE (1994) Urinary incontinence as a risk factor for mortality. J Am Geriatr Soc 42:264–268PubMedGoogle Scholar
  30. 30.
    Temml C, Haidinger G, Schmidbauer J, Schatzl G, Madersbacher S (2000) Urinary incontinence in both sexes: prevalence rates and impact on quality of life and sexual life. Neurourol Urodyn 19:259–271PubMedCrossRefGoogle Scholar
  31. 31.
    Teunissen D, Lagro-Janssen T (2004) Urinary incontinence in community dwelling elderly: are there sex differences in help-seeking behaviour? Scand J Prim Health Care 22:209–216PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Urology, University Hospital GrosshadernLudwig-Maximilians-UniversityMunichGermany
  2. 2.Department of UrologyClinic KorneuburgKorneuburgAustria

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