Is it okay to hold your pee when you don’t have the time or can’t find a toilet?
Are you more prone to urinary tract infections or a burst bladder if you hold it in too often? CNA Lifestyle speaks to an expert and finds out some surprising results.
There may be a long queue snaking from the washroom. Or the boss caught you for a quick update on your way to the bathroom. Maybe you simply couldn’t bring yourself to use the public toilet (we completely understand). Or perhaps you’re lying in bed debating whether or not you’re too tired to get up and relieve yourself.
Yes, we’ve all held our pee from time to time.
On average, people urinate five to 10 times a day, and once or twice a night, said Dr Tan Yung Khan, Mount Elizabeth Novena Hospital’s urologist. A few factors can determine how much and how often you have to visit the bathroom. As you may already be aware, working or exercising in a warm environment makes you lose fluid more from perspiration, and less from urination.
Conversely, diuretics such as beer, coffee, tea and certain artificial sweeteners can increase your body’s production of urine. Irritation to the bladder, such as a urinary tract infection (UTI), bladder tumour or urinary stone, can also cause you to visit the loo more frequently, said Dr Tan.
But is it okay to hold your pee? Doesn't that cause the stones? First, a lesson in biology.
HOW YOUR PLUMBING WORKS
Anatomically, an adult’s bladder capacity such as yours is about 300ml to 400ml (roughly one-and-a-half to two cups), up from just 30ml when you were a child. It’s no wonder that very young children are constantly asking to visit the bathroom or wetting their pants as their bladder capacity only starts to increase from around age two.
On average, people urinate five to 10 times a day, and once or twice a night.
Your urine is more than the drink you had a few hours ago. Sure, the yellowish liquid has excess water that your body doesn’t need but it also contains waste that your kidneys filter from the blood, such as urochrome, a pigmented blood product that gives urine its colour, as well as urea (a waste product when protein gets broken down), creatinine (another waste product but from the normal breakdown of muscle), the by-products of bile from the liver, ammonia, and salts.
When the bladder fills up with urine, it sends a signal to the brain that it is time to pee. The brain creates the urge to urinate, and at the same time, instructs the bladder to hold on. That usually works out fine while you go in search of a bathroom. But with age, hormonal changes, pregnancy and muscle laxity, especially in the pelvic floor muscles, leakages can sometimes happen despite your best effort to hold it in.
Interestingly, you could also set yourself up for urinary incontinence if you often go to the bathroom before you feel the urge to urinate. Over time, your body learns that even with less volume in the bladder, you feel the urge to go, leading to more frequent visits to the toilet, according to an article by Harvard Medical School.
Conversely, you can condition your bladder to hold your pee for longer. Bladder training, where you follow a schedule to urinate, may sound ridiculous but it is used by patients who have been diagnosed with overactive bladders, said Dr Tan. By delaying going to the toilet in longer and longer intervals, you’ll train your bladder to gradually increase the amount of urine it can comfortably hold. The schedule can be paired with medication and exercises to strengthen the pelvic floor muscles.
CAN YOU OVER-STRETCH OR BURST YOUR BLADDER?
So what if you have to cross your legs real tight because the bathroom is occupied, or have to finish some urgent work and can't nip off to the loo? Should you be concerned if you often hold your pee?
“Actually, there is little evidence to say you cannot hold your pee. In most instances, there are no complications,” said Dr Tan. “But there are some possible ill effects. Firstly, there may be an increased risk of urinary tract infections (UTIs). I have seen this in patients who take long-haul flights and who are not keen to use the in-flight toilets.”
You’ll know you have an UTI if you experience a burning sensation during urination, increased frequency and urgency of urination, fever, and see blood in the urine, said Dr Tan.
"Women tend to be more prone to UTIs. The infection can be treated with antibiotics," he said.
Actually, there is little evidence to say you cannot hold your pee. In most instances, there is no complications.
Those with diabetes may also be more susceptible to health issues if they delay going to the bathroom. “In patients with poorly controlled diabetes, I have encountered diabetic cystopathy, where the affected nerves to the bladder don’t let the bladder contract well, leading to incomplete emptying. This can be due to a number of factors, one of which is postulated to be the over-stretching of the bladder when it is too full,” said Dr Tan.
What about non-diabetics? Can the bladder over-stretch if you hold your pee for too long, too often? According to Medical News Today, “regularly holding in pee can cause the bladder to stretch” in the long term. “This may make it difficult or impossible for the bladder to contract and release pee normally.”
As for the notion that the bladder may burst, that’s less likely to happen. The same website noted that it is much more likely that the bladder will override the muscles holding the urine in, causing the person to have an accident instead.
In short, if you are healthy, not pregnant, and do not have diabetes, you shouldn't worry if you have to hold it in once in a while. If you have to, don’t do it for more than three hours in the day. At night, your body secretes a hormone that pauses the kidneys’ production of urine when you sleep.
Of course, this doesn’t work 100 per cent as you sometimes still get up in the middle of the night to visit the loo.