{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:49:41Z","timestamp":1792410581086,"version":"4.4.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Urogynecol J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and Hypothesis<\/jats:title>\n                    <jats:p>Lower urinary tract symptoms (LUTS) are common in women with multiple sclerosis (MS) and may be influenced by neurological involvement as well as behavioral and knowledge-related factors. This study aimed to compare LUTS, pelvic floor health knowledge, and toileting behaviors between women with MS and demographically matched women without MS, examine their associations, and identify predictors of LUTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional survey included 59 women with MS and 60 demographically matched women without MS. LUTS were assessed using Urogenital Distress Inventory-6 (UDI-6) and Bristol Women\u2019s Lower Urinary Tract Symptoms Questionnaire (BFLUTS). Pelvic floor health knowledge and toileting behaviors were evaluated using Pelvic Floor Health Knowledge Quiz and Toileting Behavior-Women\u2019s Elimination Behaviors Scale, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Women with MS had higher UDI-6 scores, lower pelvic floor health knowledge, and more negative toileting behaviors compared to women without MS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). After adjustment for potential confounders, group differences remained significant for UDI-6, BFLUTS, and premature voiding (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), whereas pelvic floor health knowledge was no longer significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). In both groups, LUTS severity was positively associated mainly with premature voiding and straining voiding (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). The final regression model explained 52.2% of the variance in UDI-6 scores; straining to void, premature voiding, and place preference for voiding were significant predictors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Women with MS had higher LUTS and more negative toileting behaviors, while pelvic floor health knowledge was more closely associated with sociodemographic factors than MS status. These findings underscore the relevance of considering LUTS and toileting behaviors in women with MS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00192-026-06946-4","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:26:52Z","timestamp":1792409212000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pelvic Floor Knowledge, Toileting Behaviors, and Lower Urinary Tract Symptoms in Women with Multiple Sclerosis"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4340-3443","authenticated-orcid":false,"given":"Humeyra","family":"Kiloatar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5772-2376","authenticated-orcid":false,"given":"Aylin Aydogdu","family":"Delibay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1047-1101","authenticated-orcid":false,"given":"Cimen Ol\u00e7ay","family":"Demir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5110-1248","authenticated-orcid":false,"given":"Dursun","family":"Ceylan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1395-5391","authenticated-orcid":false,"given":"Afife","family":"Orucu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"6946_CR1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000037297","volume":"103","author":"M Haki","year":"2024","unstructured":"Haki M, Al-Biati HA, Al-Tameemi ZS, et al. Review of multiple sclerosis: epidemiology, etiology, pathophysiology, and treatment. Medicine (Baltimore). 2024;103:e37297.","journal-title":"Medicine (Baltimore)"},{"key":"6946_CR2","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s44197-025-00353-6","volume":"15","author":"G Khan","year":"2025","unstructured":"Khan G, Hashim MJ. Epidemiology of multiple sclerosis: global, regional, national and sub-national-level estimates and future projections. J Epidemiol Glob Health. 2025;15:21. https:\/\/doi.org\/10.1007\/s44197-025-00353-6","journal-title":"J Epidemiol Glob Health"},{"key":"6946_CR3","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/nau.20798","volume":"29","author":"BT Haylen","year":"2010","unstructured":"Haylen BT, de Ridder D, Freeman RM. International continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4\u201320.","journal-title":"Neurourol Urodyn"},{"key":"6946_CR4","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1177\/1352458506075651","volume":"13","author":"M De S\u00e8ze","year":"2007","unstructured":"De S\u00e8ze M, Ruffion A, Denys P, et al. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler. 2007;13:915\u201328. https:\/\/doi.org\/10.1177\/1352458506075651","journal-title":"Mult Scler"},{"key":"6946_CR5","doi-asserted-by":"publisher","first-page":"91","DOI":"10.7224\/1537-2073.2019-030","volume":"22","author":"HB Al Dandan","year":"2020","unstructured":"Al Dandan HB, Coote S, McClurg D. Prevalence of lower urinary tract symptoms in people with multiple sclerosis. Int J MS Care. 2020;22:91\u20139. https:\/\/doi.org\/10.7224\/1537-2073.2019-030","journal-title":"Int J MS Care"},{"key":"6946_CR6","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1002\/nau.22670","volume":"35","author":"KM Khalaf","year":"2016","unstructured":"Khalaf KM, Coyne KS, Globe DR, et al. The impact of lower urinary tract symptoms on health-related quality of life among patients with multiple sclerosis. Neurourol Urodyn. 2016;35:48\u201354. https:\/\/doi.org\/10.1002\/nau.22670","journal-title":"Neurourol Urodyn"},{"key":"6946_CR7","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1097\/NNR.0b013e3182159cc7","volume":"60","author":"K Wang","year":"2011","unstructured":"Wang K, Palmer MH. Development and validation of an instrument to assess women\u2019s toileting behavior related to urinary elimination: preliminary results. Nurs Res. 2011;60:158\u201364.","journal-title":"Nurs Res"},{"key":"6946_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijnurstu.2016.10.005","volume":"65","author":"X Wan","year":"2017","unstructured":"Wan X, Wu C, Xu D, et al. Toileting behaviours and lower urinary tract symptoms among female nurses: a cross-sectional questionnaire survey. Int J Nurs Stud. 2017;65:1\u20137.","journal-title":"Int J Nurs Stud"},{"key":"6946_CR9","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1007\/s00192-024-05831-2","volume":"35","author":"Y Karaaslan","year":"2024","unstructured":"Karaaslan Y, Korkut Z, Yilmaz H, et al. Lower urinary tract symptoms, toileting behaviors, and pelvic floor health knowledge in younger and older women. Int Urogynecol J. 2024;35:1457\u201368. https:\/\/doi.org\/10.1007\/s00192-024-05831-2","journal-title":"Int Urogynecol J"},{"key":"6946_CR10","doi-asserted-by":"publisher","first-page":"1524","DOI":"10.1589\/jpts.28.1524","volume":"28","author":"H Neels","year":"2016","unstructured":"Neels H, Wyndaele J-J, Tjalma WA, et al. Knowledge of the pelvic floor in nulliparous women. J Phys Ther Sci. 2016;28:1524\u201333.","journal-title":"J Phys Ther Sci"},{"key":"6946_CR11","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1586\/14737175.9.3.331","volume":"9","author":"PA McCombe","year":"2009","unstructured":"McCombe PA, Gordon TP, Jackson MW. Bladder dysfunction in multiple sclerosis. Expert Rev Neurother. 2009;9:331\u201340. https:\/\/doi.org\/10.1586\/14737175.9.3.331","journal-title":"Expert Rev Neurother"},{"key":"6946_CR12","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/BF02294090","volume":"43","author":"TP Hettmansperger","year":"1978","unstructured":"Hettmansperger TP, McKean JW. Statistical inference based on ranks. Psychometrika. 1978;43:69\u201379. https:\/\/doi.org\/10.1007\/BF02294090","journal-title":"Psychometrika"},{"key":"6946_CR13","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1016\/S1474-4422(25)00270-4","volume":"24","author":"X Montalban","year":"2025","unstructured":"Montalban X, Lebrun-Fr\u00e9nay C, Oh J, et al. Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria. Lancet Neurol. 2025;24:850\u201365. https:\/\/doi.org\/10.1016\/S1474-4422(25)00270-4","journal-title":"Lancet Neurol"},{"key":"6946_CR14","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1212\/WNL.33.11.1444","volume":"33","author":"JF Kurtzke","year":"1983","unstructured":"Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33:1444\u20131444. https:\/\/doi.org\/10.1212\/WNL.33.11.1444","journal-title":"Neurology"},{"key":"6946_CR15","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1002\/nau.20292","volume":"26","author":"C Cam","year":"2007","unstructured":"Cam C, Sakalli M, Ay P, et al. Validation of the short forms of the incontinence impact questionnaire (IIQ-7) and the urogenital distress inventory (UDI-6) in a Turkish population. Neurourol Urodyn. 2007;26:129\u201333. https:\/\/doi.org\/10.1002\/nau.20292","journal-title":"Neurourol Urodyn"},{"key":"6946_CR16","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1007\/BF00451721","volume":"3","author":"SA Shumaker","year":"1994","unstructured":"Shumaker SA, Wyman JF, Uebersax JS, et al. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res. 1994;3:291\u2013306. https:\/\/doi.org\/10.1007\/BF00451721","journal-title":"Qual Life Res"},{"key":"6946_CR17","first-page":"415","volume":"3","author":"CS Gokkaya","year":"2012","unstructured":"Gokkaya CS, Oztekin CV, Doluoglu OG, et al. Validation of Turkish version of bristol female lower urinary tract symptom Index. J Clin Anal Med. 2012;3:415\u20138.","journal-title":"J Clin Anal Med"},{"key":"6946_CR18","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1046\/j.1464-410X.1996.00186.x","volume":"77","author":"S Jackson","year":"1996","unstructured":"Jackson S, Donovan J, Brookes S, et al. The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing. Br J Urol. 1996;77:805\u201312. https:\/\/doi.org\/10.1046\/j.1464-410X.1996.00186.x","journal-title":"Br J Urol"},{"key":"6946_CR19","doi-asserted-by":"publisher","first-page":"122","DOI":"10.21653\/tjpr.754949","volume":"32","author":"W Al\u2019deges","year":"2021","unstructured":"Al\u2019deges W, \u00c7elenay \u015eT. Development of pelvic floor health knowledge quiz in Turkish people: validity and reliability. Turk Fizyoter Rehabil Derg. 2021;32:122\u201331.","journal-title":"Turk Fizyoter Rehabil Derg"},{"key":"6946_CR20","doi-asserted-by":"publisher","first-page":"339","DOI":"10.5336\/nurses.2019-70355","volume":"11","author":"ES Ak","year":"2019","unstructured":"Ak ES, Kaydirak MM, Sayilan AA, \u00d6zba\u015f A. Tuvalet Davran\u0131\u015f\u0131-Kad\u0131nlar\u0131n Bo\u015falt\u0131m Davran\u0131\u015flar\u0131 \u00d6l\u00e7e\u011fini T\u00fcrk\u00e7e\u2019ye Uyarlama \u00c7al\u0131\u015fmas\u0131. Turkiye Klinikleri J Nurs Sci. 2019;11:339\u201346. https:\/\/doi.org\/10.5336\/nurses.2019-70355","journal-title":"Turkiye Klinikleri J Nurs Sci"},{"key":"6946_CR21","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1111\/j.1365-2648.2010.05341.x","volume":"66","author":"K Wang","year":"2010","unstructured":"Wang K, Palmer MH. Women\u2019s toileting behaviour related to urinary elimination: concept analysis. J Adv Nurs. 2010;66:1874\u201384. https:\/\/doi.org\/10.1111\/j.1365-2648.2010.05341.x","journal-title":"J Adv Nurs"},{"key":"6946_CR22","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/j.ucl.2010.06.003","volume":"37","author":"JT Stoffel","year":"2010","unstructured":"Stoffel JT. Contemporary management of the neurogenic bladder for multiple sclerosis patients. Urol Clin. 2010;37:547\u201357. https:\/\/doi.org\/10.1016\/j.ucl.2010.06.003","journal-title":"Urol Clin"},{"key":"6946_CR23","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s12875-019-0958-z","volume":"20","author":"CCG Chen","year":"2019","unstructured":"Chen CCG, Cox JT, Yuan C, et al. Knowledge of pelvic floor disorders in women seeking primary care: a cross-sectional study. BMC Fam Pract. 2019;20:70. https:\/\/doi.org\/10.1186\/s12875-019-0958-z","journal-title":"BMC Fam Pract"},{"key":"6946_CR24","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.jphys.2018.02.010","volume":"64","author":"RL de Andrade","year":"2018","unstructured":"de Andrade RL, B\u00f8 K, Antonio FI, et al. An education program about pelvic floor muscles improved women\u2019s knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial. J Physiother. 2018;64:91\u20136.","journal-title":"J Physiother"},{"key":"6946_CR25","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16204000","volume":"16","author":"C Wu","year":"2019","unstructured":"Wu C, Xue K, Palmer MH. Toileting behaviors related to urination in women: a scoping review. Int J Environ Res Public Health. 2019;16:4000.","journal-title":"Int J Environ Res Public Health"},{"key":"6946_CR26","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.juro.2018.07.044","volume":"201","author":"CG Kowalik","year":"2019","unstructured":"Kowalik CG, Daily A, Delpe S, et al. Toileting behaviors of women\u2014what is healthy? J Urol. 2019;201:129\u201334. https:\/\/doi.org\/10.1016\/j.juro.2018.07.044","journal-title":"J Urol"},{"key":"6946_CR27","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.urology.2019.08.038","volume":"134","author":"AM Daily","year":"2019","unstructured":"Daily AM, Kowalik CG, Delpe SD, et al. Women with overactive bladder exhibit more unhealthy toileting behaviors: a cross-sectional study. Urology. 2019;134:97\u2013102.","journal-title":"Urology"},{"key":"6946_CR28","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/s0090-4295(02)02243-4","volume":"61","author":"P Abrams","year":"2003","unstructured":"Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61:37\u201349. https:\/\/doi.org\/10.1016\/s0090-4295(02)02243-4","journal-title":"Urology"},{"key":"6946_CR29","volume-title":"Campbell Walsh Wein handbook of urology-E-book","author":"AW Partin","year":"2021","unstructured":"Partin AW, Kavoussi LR, Peters CA, Dmochowski RR. Campbell Walsh Wein handbook of urology-E-book. Elsevier Health Sciences; 2021."},{"key":"6946_CR30","doi-asserted-by":"publisher","first-page":"91","DOI":"10.7224\/1537-2073.2019-030","volume":"22","author":"HB Al Dandan","year":"2020","unstructured":"Al Dandan HB, Coote S, McClurg D. Prevalence of lower urinary tract symptoms in people with multiple sclerosis: a systematic review and meta-analysis. Int J MS Care. 2020;22:91\u20139.","journal-title":"Int J MS Care"},{"key":"6946_CR31","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1007\/s13760-025-02889-7","volume":"125","author":"H Kiloatar","year":"2025","unstructured":"Kiloatar H, Demir CO, Delibay AA, et al. Fear of falling, gait capacity, and dual task performance in multiple sclerosis patients with and without neurogenic overactive bladder. Acta Neurol Belg. 2025;125:1575\u201383. https:\/\/doi.org\/10.1007\/s13760-025-02889-7","journal-title":"Acta Neurol Belg"},{"key":"6946_CR32","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1016\/S1474-4422(15)00070-8","volume":"14","author":"JN Panicker","year":"2015","unstructured":"Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol. 2015;14:720\u201332.","journal-title":"Lancet Neurol"},{"key":"6946_CR33","doi-asserted-by":"publisher","first-page":"4000","DOI":"10.3390\/ijerph16204000","volume":"16","author":"C Wu","year":"2019","unstructured":"Wu C, Xue K, Palmer MH. Toileting behaviors related to urination in women: a scoping review. Int J Environ Res Public Health. 2019;16:4000. https:\/\/doi.org\/10.3390\/ijerph16204000","journal-title":"Int J Environ Res Public Health"},{"key":"6946_CR34","doi-asserted-by":"publisher","first-page":"100052","DOI":"10.1016\/j.ijnsa.2021.100052","volume":"3","author":"DK Newman","year":"2021","unstructured":"Newman DK, Burgio KL, Cain C, et al. Toileting behaviors and lower urinary tract symptoms: a cross-sectional study of diverse women in the United States. Int J Nurs Stud Adv. 2021;3:100052. https:\/\/doi.org\/10.1016\/j.ijnsa.2021.100052","journal-title":"Int J Nurs Stud Adv"}],"container-title":["International Urogynecology Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-026-06946-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00192-026-06946-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-026-06946-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:26:53Z","timestamp":1792409213000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00192-026-06946-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":34,"alternative-id":["6946"],"URL":"https:\/\/doi.org\/10.1007\/s00192-026-06946-4","relation":{},"ISSN":["0937-3462","1433-3023"],"issn-type":[{"value":"0937-3462","type":"print"},{"value":"1433-3023","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"22 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This research was conducted according to the principles of the Declaration of Helsinki and approved by the Ethics Committee Kutahya Health Sciences University","order":1,"name":"Ethics","label":"Ethical Approval and Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None.","order":2,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}