Is holding on bad for you?

Host: Grant Hackett and Dr Andrew Rochford
Wednesday, July 8, 2009

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At some stage, we've all experienced not being able to find a toilet when we really need one. In fact, it's something that we inherently know that we shouldn't do. But can holding on for too long actually cause long-term damage?

Our presenters, Dr Andrew Rochford and Grant Hackett, took on the healthy challenge of putting their bladders through their paces to get to the bottom of this issue once and for all.

To find out who may indeed be the stronger and healthier of the two, Andrew and Grant each consumed more than a litre of water an hour before having an ultrasound of their full bladders. This helped determine what kind of volume they're capable of holding and if there were any irregularities.

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Despite Grant feeling the urge to go to the bathroom during the ultrasound, the 583ml that are calculated in his full bladder is considered normal and it looked to be in perfect working order. However, when it came to bladder strength, Andrew came in at a staggering 762ml when he had his ultrasound, reinforcing that the tolerance level is different for individuals.

Andrew and Grant then relieved themselves and had a second ultrasound with their empty bladders. This showed if they were "voiding" or emptying them properly and what the bladder looks like when not full with fluid.

Andrew was first to be tested and went from 762ml to 25ml, while Grant had only gone from 583ml to 259ml, indicating that the fluid in his bladder has accumulated fairly quickly. Grant relived himself again, so that his bladder resumed to a walnut size.

So we now know that Andrew has the ability to store more in his bladder for a greater length of time. But is that doing him harm and is holding on bad for us?

Urologist and president of the Urological Society of Australia & New Zealand, Dr David Malouf, discussed the ultrasound results with Andrew and Grant.

Dr Malouf explained that the ultrasound shows that Andrew could certainly hold more urine than Grant, and that Andrew could also empty his bladder better.

"The reality is that both those volumes are in excess of what you'd normally feel comfortable with," Dr Malouf said. "Typically a full bladder is somewhere between 400ml to 600ml, so you're both off the scale in that department, and whether your bladder empties properly depends on how full it is and whether they are any underlying problems in the urinary tract."

Why did Grant's bladder have more trouble emptying than Andrew's?

Dr Malouf explained that it's probably related to what you are used to as an individual. As Andrew is a doctor he's used to long periods of time without going to the toilet. "But Grant on the other hand is probably not used to holding on to large amounts of water and he was struggling," Dr Malouf said. "His toes were wiggling and the legs were crossed and he looked uncomfortable and if your bladder is over-full it can be difficult to empty too completion."

Is it bad for us if we hold on for too long?

"Not if a one-off occasion. Not if you do it every now and then, but if you were to consistently hold on to your urine for too long it can cause long-term problems, so it's to be avoided," Dr Malouf said.

So why do we feel discomfort when we hold on?

Dr Malouf explained that the bladder is a muscular sack that has a waterproof lining. It also has muscle and in the layers of the bladder are nerve fibres which feel pain. "They feel stretching, so the more stretched the bladder is, the more painful it is," he said.

What are some of the good bladder habits that we can adopt?

According to Dr Malouf the most important thing to do is to drink plenty of fluid. "You should be aiming for eight to 10 glasses of fluid a day, predominantly water, and that should enable you to pass urine every three or four hours and the clearer the urine the better," he said. "The other thing is if you feel the need to go don't put it off for long periods of time, because in the long-term that could lead to bad bladder habits and even to injury to the bladder muscle."

So now we know that as long as we don't make it a regular habit, holding on isn't as bad as we first thought. But can you train your bladder to be a better performer?

As Grant didn't perform as well as Andrew in the ultrasound, he visits pelvic floor physiotherapist Shan Morrison. She teaches both women and men what they can do to improve and maintain the health of their bladders.

What is the pelvic floor?

"The pelvic floor … is a group of muscles, my favourite muscle in the body," Shan said. "It attaches from the front of the pelvis to the pubic bones and it slings underneath like a hammock to attach into the tailbone at the back of the pelvis."

Why do we need to exercise these muscles?

According to Shan the function or the role of the pelvic floor is to hold everything in place. In men, it's the bladder and the bowel and in women, it's the bladder, bowel and uterus, which also helps you to hold on. "This is why it's good to have strong muscles and it gives you control of your bladder and bowel," Shan said.

Why is it so important for men as well as women to exercise these muscles?

"In women, pregnancy and childbirth are the things that can weaken the pelvic floor muscles," Shan said. "We see a lot of men before and after surgery for prostate cancer, so that usually leads to having bladder control problems, so they need to exercise their pelvic floor muscles."


So what's considered normal when it comes to healthy bladder habits?

According to the experts, it's normal to relieve your bladder between four to eight times over a 24-hour period, including once during the night (or twice if you are older).

But remember, don't get in to the habit of going just in case. Go when you feel the need to.

And if you are someone that suffers from incontinence, you're not alone. Apparently it's a condition that affects up to 13 percent of Australian men and around 37 percent of women.

For further information on bladder health see:

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