Mind over bladder: to hold or not to hold

By Michael Huckabee, Ph.D., professor and director of the University of Nebraska Medical Center Division of Physician Assistant Education. Dr. Huckabee has 30 years’ experience as a physician assistant, mostly in rural Nebraska.

Be warned, reading this may cause an unavoidable urge to go to the bathroom. Don’t look any further unless you can take the necessary break.

Mind over Bladder. Thinking about voiding too often creates the impulse. The urinary bladder, typically the size of a pear, can expand to the size of a large grapefruit when needed. When it reaches about half full, nerves in the bladder tell the brain it’s time to go.

Knowing the bladder usually has more room to spare, the brain can override the call of nature. When the bladder keeps firing signals, some people squirm and tightly their cross legs if they can’t find a toilet. If the brain can focus on something else, the need to void may lessen. Distracting the brain will take the urge away, at least for a while.

So, on the next day trip when someone in the car needs to potty 30 minutes in route, changing the subject may be the best solution. However, if you’re driving along the surf (which keeps the mind focused on water), or if the siblings start teasing each other about “small” bladders so that’s all anyone is thinking about, it may be impossible to keep from pulling over to empty out.

Dangers in Holding Urine? Many people think fighting the urge to go leads to urinary tract infections. That’s not really true, as the urinary system is a clean, sterile environment. Bacteria can’t get into the system unless there are other problems such as a recent infection, hygiene issues or trauma. Women have a higher risk of bladder infections than men because the small tube allowing urine to leave the bladder (the urethra) is just a couple inches long, so bacteria from outside don’t have far to go.

The other worry is the sensation of holding the urine so long that the bladder will burst. While overactive signals to the brain will threaten an explosion, it’s not likely. The worst thing that can happen to an overfull bladder is a bit of uncontrolled leakage. If the bladder muscles in charge of tightly clamping the bladder shut get interrupted, such as with a hearty laugh or a bumpy road, urine might escape out the urethra. Remember that repeatedly ignoring the bladder’s call may dull those signals which can lead to other serious problems.

Dribble Troubles. Excessive dribbling after emptying the bladder can indicate a weakness of the bladder muscles in women as they age. In men it’s called “after-dribble” and can occur at any age. After the bladder empties, the longer male urethra may still have a few residual drops. Exercising those bladder muscles can help with this, such as purposely stopping the urine flow once or twice each time you void. Called Kegel exercises, they have lots of benefits and will strengthen the muscles needed for both the urinary and reproductive systems. If that doesn’t help, it’s best to see your health care provider for advice.

All this toilet talk may lead to an urge that can’t be resisted; that’s how the bladder and brain work. Next time you’re on an extended car ride and someone needs to go, you might now have some tricks to help stay on the road a bit longer.

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First featured on livewellnebraska.com