Unless there are some truly radical advances in catheter technology, having to pee and not being able to will remain a universal predicament, albeit one more acute for some (Amazon warehouse workers, for instance) than for others. Certainly it can feel, in the moment, like you’re doing real, irreversible damage to yourself, but that feeling often fades the moment you make it to a bathroom. But do the effects of not peeing linger beyond temporary discomfort? What are you really doing to yourself, when—via not wanting to shoulder your way out of a crowded movie theater aisle, or displease your sadistic boss, or because of some kind of medical condition—you put off what badly needs doing?
To find out, for this week’s Giz Asks we reached out to a handful of urologists; if you’re interested in the science of not peeing, I suggest you read on (and also—if you feel the urge, and are physically capable—that you pee, as soon as you possibly can).
Assistant Professor, Urology, Keck School of Medicine of the University of Southern California
Holding in your pee might seem harmless but if you make a habit out of it, you may end up damaging your urinary system. Everyone has done it and the reasons range from the practical to the impractical. Long road trips, truck drivers, pilots, aversions to public restroom… whatever the reason may be, doing it rarely is probably fine but if you make a habit out of it, you begin to change the cellular architecture of the bladder. The bladder has two roles: to store urine and to expel urine when the bladder is full. People who chronically hold on to their urine cause the bladder to slowly stretch out in order to accommodate a bigger capacity. Unfortunately, there is a critical volume in which the muscle loses its ability to eliminate urine efficiently, and as a result, the bladder begins to retain urine. Why is this bad? Well, if you pee but fail to empty your bladder you simply hold on to stagnant urine which makes you prone to urinary tract infections, bladder stones, severe infections of the prostate, and blood in the urine.
It does not stop there. The stretching of the bladder and loss of muscle tone continues and eventually, in some patients, the bladder loses all of its muscular function in a condition called detrusor areflexia. At this point, the bladder is unable to contract with any force to expel urine and patients then are incontinent because they are overflow of urine or are completely unable to pee and require a catheter to be placed. I see this in patients whose professions require long hours with limited access to restrooms.
Other people have less of a choice and hold on to urine because of their anatomy. Older men, in particular are at risk, if they develop an enlarged prostate. In some men, their prostate is so obstructive that it prevents urine from coming out. If left untreated, patients can progress to renal failure. Fortunately, medications and surgeries have been developed to treat an enlarged prostate before it ever progresses to severe kidney dysfunction.
Another bad thing: if you get into a car accident and your bladder is very full, you are more prone to bladder rupture which may require emergent surgery. Lastly, holding onto your pee also makes men susceptible to a condition called prostatitis, which is inflammation of the prostate, which is one of the most common and most annoying conditions that affect men.
J. Quentin Clemens
Professor and Associate Chair for Research, Urology, Michigan Medicine
In descending order of severity:
Your bladder could burst, causing urine to get into your abdomen, causing you to die from peritonitis, causing you to go to hell and be tortured forever by eternal flames. I suppose that would be the ‘worst thing’ that could happen to you. Bladder rupture is very rare and usually occurs with trauma, but I have seen it happen from just bumping into a kitchen counter in a patient who had a chronically overdistended bladder.
Some patients chronically retain urine and this can worsen over time so that the urine backs up into the kidneys and causes kidney damage. This is usually reversible once the bladder is drained, but not always. I have seen some patients require permanent dialysis caused by unrecognized severe urinary retention, but this is rare.
If the bladder is chronically overdistended, it can weaken over time and retain progressively more urine. Eventually the bladder can be stretched and weakened to the point where it cannot empty, and this can require that a catheter be used permanently to empty the bladder. This is typically accomplished by passing a catheter through the urethra and into the bladder multiple times each day.
Bladder emptying is one of the primary factors that can prevent bladder infections (urinary tract infections). It is common for some bacteria to enter the bladder, and these are then washed out when the bladder empties. Holding the urine for a long time can increase the risk of getting bladder infections. This seems especially common in certain occupations (such as schoolteachers) where little time is provided for bathroom breaks.
Holding the urine will eventually lead to pain or urinary urgency and can worsen urinary incontinence. In patients with urinary incontinence, we often suggest that they urinate every 2-3 hours during the day in order to help reduce this problem.
Michael L. Eisenberg
Director of Male Reproductive Medicine and Surgery, and Associate Professor of Urology, at Stanford University School of Medicine
There have certainly been reported incidents of bladders rupturing from holding in urine for too long. There will usually be a release well before that, but in rare circumstances that can happen. Also, if you build up pressure in your bladder, it can affect kidney function, and in some cases lead to some degree of kidney failure.
In occupations where men or women don’t have ready access to a bathroom, or where there’s a schedule that doesn’t allow for regular trips to the bathroom—a bus driver, for instance—people end up retaining urine in the bladder. They kind of train their bladder to hold a lot, and it leads to a lack of movement, and sometimes those patients can develop stones in their bladder, or get infections.
Most people probably empty their bladder every four to six hours, so that’s generally what we tell people to do—some a little bit more, some a little bit less.
Director of Urologic Oncology at Sibley Memorial Hospital and Assistant Professor of Urology at Johns Hopkins University and George Washington University
It’s not possible to hold pee voluntarily for too long, because the body will eventually override your will, and the reflexes will make the bladder wall contract forcefully, expelling the pee. There are some involuntary instances when the bladder is unable to empty, such as anatomical structures blocking the outlet of the bladder, or damage to nerves to the bladder or to muscles regulating the outlet of the bladder, or sometimes medications interfering with the proper function of the bladder. In these instances, if you hold your pee too long, a few things can happen. The urine can flow up into the kidneys, which will cause temporary or permanent damage to the kidneys. The stagnant urine can develop infection. You could form bladder stones. The muscle of the bladder can either become overactive or floppy causing permanent damage to the function of the bladder.
Jeffrey A. Jones
Professor, Urology, Baylor College of Medicine
The first order of damage when you hold in your urine—voluntarily or involuntarily—is to the bladder, which can over-distend and cause injury to the bladder wall. If that goes on long enough, the pressure inside the bladder can build, and that pressure gets transmitted up to the upper tracts of the kidney, which are then damaged as well. If that goes on long enough, it will start to damage kidney function. So if you’re in a social situation where you can’t void, and voluntarily hold your urine in too long, you may over-distend the bladder and damage the wall; but if you can’t pee because your prostate is swollen, or because of some other blockage in the system, you could cause the second- and third-order damage, depending on the duration. And if you routinely distend the bladder, you could start to see blood in your urine.
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