Table 1.

Detailed bladder dysfunction and health table addressing functions as well as symptoms and experiences of the bladder in health and disease.

		Bladder Dysfunction	Bladder Health (BH) (PLUS definitions)
		The subjective indicator of a disease or change in condition as perceived by the patient, caregiver, or partner and may lead her tseek help from healthcare professionals. (PLUS modification†)	A complete state of physical, mental and social well-being related tbladder function, and not merely the absence of LUTS. Healthy bladder function does not impact daily activities on a routine basis, is adaptable tshort term physical or environmental stressors, and allows pursuit of optimal well-being (e.g. travel, exercise, social, occupational or other activities)*.
Bladder Function	Elements of Function	LUTS/Subjective Experience(s)	Subjective Experience(s)
Storage	Overall	Bothersome LUTS that occur with filling of the bladder with urine. †	Ability thold urine for a reasonable duration of time and sense bladder fullness without fear of or concern about urgency, discomfort or leakage*
	Capacity/ Frequency – Day/Waking	a. Voiding frequency during waking hours that occurs more frequently than desired and/or impacts daily activities on a routine basis. (PLUS definition) b. Increased daytime urinary frequency: Voiding occurs more frequently during waking hours than previously deemed normal. †	A frequency of voiding during waking hours that does not impact daily activities on a routine basis*.
	Capacity/ Frequency – Night/Sleeping	a. Voiding frequency during sleeping hours that occurs more frequently than desired and impacts sleep quality and/or quantity. (PLUS definition) b. Nocturia: Interruption of sleep one or more times because of the need tvoid. Each void is preceded and followed by sleep. †	A frequency of voiding during sleeping hours, due turge tvoid, that allows for optimal sleep quality and is within physiologic age norms*
	Continence -Day/Waking	a. Urinary incontinence: Involuntary loss of urine. † b. Types of UI† : • Stress UI: urine loss with physical exertion, sneezing, or coughing • Urgency UI: urine loss associated with urgency • Postural UI: urine loss with change in body position • Mixed UI: urine loss with urgency and alswith physical exertion, sneezing, or coughing OR urgency and stress UI • Continuous UI: continuous urine loss • Insensible UI: urine loss without awareness • Coital UI: urine loss with coitus c. Post void dribble (post void leakage): Involuntary passage of urine following the completion of voiding. †	a. The ability thold urine during waking hours for a reasonable duration of time and throughout daily activities without any leakage of urine* b. At completion of voiding there is continence (i.e. nsubsequent leakage or dribbling of urine) *
	Continence -Night/Sleeping	a. Nocturnal enuresis: Involuntary loss of urine that occurs during sleep and is recognized upon awakening. † b. Nocturnal urgency incontinence: Leakage of urine on the way tthe toilet upon waking from sleep due turgency tvoid. (PLUS definition) c. Nocturnal post void dribble (post void leakage): Involuntary passage of urine following the completion of voiding during sleeping hours. †	a. The ability thold urine during sleeping hours, without leakage of urine* b. At completion of voiding during sleeping hours there is continence (i.e. nsubsequent leakage or dribbling of urine) *
	Sensation - Urge	a. Urinary urgency: The sudden, compelling desire tpass urine that is difficult tdefer. The urgency may be associated with fear of urine loss before making it tthe toilet. Despite absence of leakage, this may cause distress or bother, and/or impact daily activities. † b. Absence of urge: The lack of sensation at full capacity. (PLUS definition)	The awareness and sensation of urge and bladder fullness that allows sufficient time tget tthe toilet facilities without fear of leakage*
	Sensation - Comfort	Bladder pain: Suprapubic or retropubic pain, pressure, or discomfort, related tthe bladder, and usually increasing with bladder filling. Sensation may persist or be relieved after voiding. †	The bladder fills and stores urine with increasing degree of sensation*
Bladder Function	Elements of Function	LUTS Subjective Experience(s)	Subjective Experience(s)
Emptying	Overall	a. Voiding symptoms: A departure from normal sensation or function, experienced by the woman during or following the act of voiding. † b. Bothersome LUTS that occur during or immediately following bladder emptying of urine. †	The ability tempty the bladder completely in a timely, efficient, effortless, comfortable manner*
	Voiding Initiation	Hesitancy: A delay in initiating voiding. †	Voiding proceeds when intended and without effort*
	Stream Flow - Speed	Slow stream: The urinary stream is perceived as slower compared tprevious performance or in comparison with others. †	Voiding occurs in an amount of time that does not impact daily activities*
	Stream Flow - Character	Spraying (splitting) of urinary stream: Urine is passed as a spray or split rather than a single discrete stream. †	Voiding occurs in a uniform stream without spraying or splitting*
	Stream Flow - Continuity	Intermittency: Urine flow that stops and starts on one or more occasions during voiding. †	Voiding occurs continuously without interruption*
	Efficacy	Urinary retention: The inability tvoid completely despite persistent effort in the presence of a full bladder. †	The bladder empties completely with minimal effort*
	Sensation – Urge relief	a. Persistent urgency: Sensation of urinary urge or urgency after voiding. (PLUS definition) b. Need timmediately re-void: Sensation that further voiding is necessary soon after passing urine. †	The bladder feels empty without urinary urge or urgency after voiding*
	Sensation - Completeness	a. Feeling of incomplete (bladder) emptying: Sensation that the bladder is not empty after voiding. † b. Non-neurogenic chronic urinary retention: An elevated post-void residual of greater than 300 mL that persists for at least 6 months and is documented on twor more separate occasions.25 c. Post void dribble (post void leakage): Involuntary passage of urine following the completion of voiding. †	The bladder feels empty at the end of voiding*
	Sensation -Comfort	a. Dysuria: Urethral pain, burning, or other discomfort during voiding. †	The bladder empties with decreasing degree of sensation*
Biregulatory	Elements of Function	LUTS Objective Experience(s)	Bladder Health Objective Experience(s)
	Overall	A disruption in the protective barrier of the bladder resulting in LUTS. (PLUS definition)	The bladder barrier protects the individual/host from pathogens, chemicals, and malignancy; is adaptable tshort term physical or environmental stressors and is able tcompletely recover from disruption of the barrier layer, without long term or persistent sequelae.
Barrier Function	Biosis barrier	Dysbiosis and/or infection: Disruption of the symbiotic relationship between host and healthy bladder microbiota. (PLUS definition)	A healthy relationship (symbiosis) between host and bladder microbiota**
	Physical/ Chemical Barrier	A breakdown in the apical layer of urothelium (‘umbrella cells’) due tdisruption of tight-junction complexes and uroplakins (hexagonal plaques) and/or the sulfated polysaccharide glycosaminoglycan (GAG) layer allowing passage of toxic and irritating urinary substances through the urothelium or release of neuroactive chemicals stimulating LUTS. (PLUS definition)	The intact urothelium that lines the bladder (basal/intermediate/umbrella cells) provides a barrier between irritating urinary substances and underlying neuromuscular tissue**
	Neoplastic barrier	Malignancy that forms in tissues of the bladder. Most bladder cancers are transitional cell carcinomas. Other types include squamous cell carcinoma and adenocarcinoma. (PLUS definition)	The intact urothelium that lines the bladder (basal/intermediate/umbrella cells) which sloughs and regenerates in a regulated manner**

Each BH element of function definition for Storage and Emptying is followed with an asterisk (*) that refers tthe qualifying statement: “…and does not impact daily activities on a routine basis, is adaptable tshort term physical or environmental stressors, and allows a woman tpursue her optimal well-being (e.g. travel, exercise, social, occupational or other activities).” For the Bioregulatory BH elements of function definitions, each is followed by double asterisks (**) that refers tthe qualifying statement: “…and is adaptable tshort term physical or environmental stressors and is able tcompletely recover from disruption of the microbiome and barrier layer, without long term or persistent sequelae.” In accordance with the recommendations in the review of terminology by the ICS in 2004, “voiding” was used in place of micturition, passing urine or urination in both existing ICS LUTS terminology and newly proposed BH and LUTS definitions.³ Definitions with this terminology change are included with other “PLUS modifications” marked with a (†) symbol.