Lifelong Urinary Tract Wellbeing

We've all experienced that uncomfortable feeling - the overwhelming urge to use the restroom, but being unable to do so right away. Whether it's a tight work deadline, sitting through a lengthy movie, or being far from a convenient bathroom, there are times when some external factor prevents us from addressing that pressing need immediately, despite our body's insistent signals.

This is a common experience that can arise due to a variety of physiological and situational factors. In this article, we'll explore the reasons behind this common dilemma and provide tips for managing those "gotta go" moments when you simply can't get to a bathroom right away.

BLADDER BASICS

As your bladder accumulates liquid, it communicates with your brain, notifying it of the need to evacuate. When the timing is inconvenient, your brain responds by instructing your bladder to retain the contents. While occasionally "holding it" may be unavoidable, it is not advisable. Here are some answers to common questions about this universally human experience!

1. Is ‘holding it’ bad for you? Why is it not good?

Holding in your urine regularly can have several negative effects on your health. For those with a history of urinary tract infections (UTIs) or compromised immune systems, delaying urination can increase the risk of UTIs. The bladder can typically hold up to 400 ml of urine, but frequently stretching it by holding in urine can damage the bladder walls, potentially leading to conditions like bladder diverticulum.

If the urine becomes infected, it can lead to a more serious kidney infection or even urosepsis, a dangerous blood infection. Additionally, urine contains salts and minerals, and keeping it in the bladder too long can promote the formation of bladder stones. Overfilling the bladder can also make it difficult to pass urine due to the reflex contraction of the pelvic floor muscles, particularly in men with enlarged prostates. In some cases, holding in urine too long can result in an overdistended bladder, causing urgency and incontinence.

2. How long is it safe to delay urination? What happens if you wait for too long?

It’s generally acceptable to urinate every two to three hours, but this varies based on fluid intake. Drinks like caffeinated beverages, carbonated drinks, and alcohol can stimulate the bladder and lead to more frequent urination. Over-consuming fluids (more than three litres daily) or exposure to cold temperatures can also cause increased urination. People with conditions like urinary tract infections or interstitial cystitis may urinate more often. Habitually holding in urine for extended periods can lead to bladder and kidney damage, as well as a higher risk of urinary tract infections.

3. Can delaying urination lead to cancer? What about UTIs?

No, it will not cause cancer. However, holding your urine can result in urinary tract infection in both men and women. 

4. How do you treat urinary retention?

Urinary retention can be treated with an in-dwelling urinary catheter or intermittent self-catheterization to drain the urine. Currently, there is no medication that is effective enough to stimulate bladder contraction to allow patients with bladder failure to pass urine. A device such as a bladder pacemaker (sacral neuromodulation), once implanted, allows the patient to pass urine in a normal way.

5. What is considered a risk factor for a UTI?

Poor personal hygiene, immuno-compromised patients (cancer, being bed-ridden, autoimmune diseases), congenital urinary tract abnormalities, neurogenic bladder dysfunction (strokes, spinal cord injury, Alzheimer's, Parkinson’s, etc.). Consuming certain medications resulting in poor bladder contraction and hence stasis of urine in the bladder are the risk factors for urinary tract infections.

6. What are the symptoms of UTI in females and males?

Burning sensation while passing urine, urgency and frequency of urination, foul-smelling urine, cloudy-coloured urine, and difficulty in passing urine are the signs and symptoms of a UTI. In severe cases, patient may experience loin pain, fever, weakness and nausea, suggestive of urosepsis.

7. The Kidney and Urology Foundation says that if urine travels back to the tubes that connect your bladder to your kidneys, it can cause infections and kidney damage. How does that happen?

If one is not able to empty the bladder, this will result in an over-distended and high-pressured bladder due to urine accumulation. Ultimately the bladder will get over-stretched and thinned out (trabeculated bladder). If the bladder is no longer able to contain the pressure, the urine will reflux into the kidney, bringing the potentially infected urine up to the kidney causing kidney infection. The urine pooled in the kidney will start to stretch the kidney tissue resulting in a thinning of the kidney, converting the kidneys into storage just like the bladder and ultimately the patient ends up with damaged non-functioning kidneys.

Dr. Warren Lo Hwa Loon

Consultant Urologist

Gleneagles Hospital Kuala Lumpur