An increasing percentage of the population participates in the “gig economy.” The following data was derived from a study conducted by Neurology UroDynamics, showing that drivers in the transportation industry often lack reliable restroom access, which can affect toileting behaviors and bladder health. Adult gig workers were electronically recruited using ResearchMatch. Participants completed validated questionnaires assessing bladder health, lower urinary tract symptoms (LUTS), toileting behaviors, and information about gig economy work. Toileting behaviors, coping strategies, and aspects of their work were compared between those with and without difficulty finding restrooms while at work.
Of 527 gig workers who participated, 80 (15%) reported difficulty finding restrooms while working. Participants were excluded if they were currently pregnant, younger than 18 years old, they reported using a catheter to manage their bladder, had a history of neurogenic bladder dysfunction or didn’t fully complete the questionnaire.
Gig workers with difficulty finding restrooms reported higher rates of unhealthy toileting behaviors and coping strategies, such as fluid restricting and delayed voiding. While at work, those with difficulty finding restrooms experienced more severe LUTS. While difficulty finding restrooms was not associated with any psychosocial or demographic factors, it was associated with worsening of urinary symptoms since starting gig work.
New York City taxi drivers, who often delay voiding while at work, report increased rates of urinary incontinence and overactive bladder (i.e. “taxicab syndrome”), where infrequent voiding among professional taxicab drivers is associated with increased incidence of voiding dysfunction. Infrequent voiding is often related to limitations in restroom access, due to lack of available restrooms or job-related burdens impeding restroom use. Some participants frequently employed coping strategies, such as bringing a change of clothes in case of UI, restricting fluid intake, delaying voiding when busy and waiting to use the restroom until at home or until unable to wait any longer.
Subjects reported whether they had recurrent urinary tract infections (UTIs) (defined as 3 or more UTIs in the past year), prior kidney stones or a diagnosis of interstitial cystitis/bladder pain syndrome. To assess how LUTS may have changed during their gig work, a modified version of the Patient Global Impression of Improvement (PGI-I) compared symptoms before participants started doing gig work by describing how their bladder symptoms are now” with 7-point Likert responses, ranging from “very much worse” to “very much better.”
“Do you purposefully limit your use of the restroom while you are working?” (not at all, occasionally, sometimes, most of the time, all of the time). Those responding at least occasionally were also asked to select reasons why (“quality of the restroom is poor”, “limited availability of a bathroom”, “being busy”, “embarrassment or privacy”, “no need”, “lack of gender options”, “other reason”).
Overall, gig workers most often used restrooms at restaurants, stores, cafés, and rest stops while at work, when not using the restroom at their own home. Those with difficulty finding restrooms were also significantly more worried about public restroom cleanliness (74% vs 54%, p = 0.001) and more frequently avoided public restrooms (44% vs 31%, p = 0.02). Gig workers with difficulty finding restrooms at work most commonly reported a perception of limited access as the reason for having difficulty finding restrooms (64% vs 28%, p < 0.001). On the other hand, reasons such as restroom quality (53% vs. 41%, p = 0.07), being busy (68% vs. 69%, p = 0.9), embarrassment or privacy (22% vs 15%, p = 0.1), and lack of gender options (3% vs. 2%, p = 0.6) were not significantly different from those who did not have difficulty finding restrooms.
Overall, gig workers reported high rates of urinary symptoms and conditions and a high prevalence of LUTS and unhealthy toileting habits. Those with difficulty finding restrooms reported more frequent and severe LUTS than those with no difficulty, and more often reported a perception of their bladder condition causing them at least minor problems (52% vs. 31%, p < 0.001). While there were no differences between the groups in recurrent UTI, kidney stones, interstitial cystitis/bladder pain syndrome or mixed UI, significantly more gig workers with difficulty finding a restroom reported OAB, urgency UI, and stress UI, as well as worse symptom severity, measured by the ICIQ-LUTS questionnaire. More gig workers with difficulty finding restrooms felt their LUTS worsened since starting their gig job (50% vs. 22% p < 0.001).
In addition to challenges regarding time and physical access to restroom spaces, a large portion of gig workers reported avoiding public restrooms when available due to concerns regarding cleanliness. Sanitation has been previously recorded as a major factor leading adults to avoid or delay restroom use.
A previous study of taxi drivers showed 10% of drivers reported OAB and 29% reported moderate to severe LUTS, which is similar to the rates found in this study.
Source: Neurology UroDynamics
