How Bad It Is to Wait Too Long to Use the Bathroom
From infections to leakage, this is what happens when you hold in your pee, and why you need to stop ignoring the urge to urinate.
Consider this the next time you order a coffee: Your bladder, when full, can hold between 20 and 30 ounces of liquid—somewhere between a Starbucks “venti” and “trenta.” It is an incredibly flexible organ. When it’s empty, it’s only about two inches across. But when you down a supersize drink, your bladder can stretch to more than six inches.
However, just because you can hold this much urine and stretch your bladder to the size of a grapefruit doesn’t mean that you should. Holding in your pee is necessary for functioning in your daily life but routinely pushing your bladder to its limits can have serious consequences, says Michael Ingber, MD, urologist, female pelvic medicine surgeon, and assistant clinical professor of urology at Weill Cornell Medical College, in New York.
How your bladder works
The bladder is a muscle that sits in the pelvis. It’s connected to your kidneys by two small tubes, called ureters. The kidneys filter waste out of your blood and pass the leftover liquid through the ureters into your bladder. From there, waste is expelled as urine from your body through a tube called the urethra. There’s an internal sphincter, or valve, between your bladder and urethra to prevent leakage and backflow. When your brain gives the signal to urinate, the sphincter opens and you pee.
Proper peeing is a learned skill
As your bladder fills, nerve fibers in the bladder sense the level of liquid and send signals back to the spinal cord which travels up to the brain. When it senses that your bladder is one-quarter to one-third full (6 to 10 ounces), your brain will give you that familiar urge to urinate.
Once you hit about 20 ounces, you’ll start to get that “I have to go right now, it’s an emergency” feeling, says Austin DeRosa, MD, urologist with UCHealth Cancer Center in Highlands Ranch, Colorado, and chair of robotic surgery at the University of Colorado Medicine. However, peeing is a voluntary motor response, meaning that you can train it and even override the signals, says Dr. Ingber.
Infants and young children simply let go of their urine whenever their brain signals, but part of “potty training” is learning when to listen to that urge and when to override it. Over time, they learn to inhibit this reflex with the frontal cortex in the brain and only “let go” when it’s appropriate.
How long should you hold your pee?
How often you should go really depends on your individual physiology and how much fluid you eat and drink throughout the day, says Dr. DeRosa. (Water from foods you eat counts too.) On average, you can expect to urinate between six and 10 times daily but it can vary widely between people and even from day to day, he adds.
This means that healthy, properly hydrated people generally feel the urge to go every two to four hours during waking hours but it’s possible to go much longer. How long you can hold your urine is individual but it’s not uncommon for people to go a whole work day without peeing, says Dr. Ingber. “I have many patients who are teachers and can hold their urine for eight hours during the day. My colleagues who do 10-hour surgeries can hold their urine the entire time,” he says.
Risks of holding your pee for too long
There isn’t a strict definition of what is “too long” when it comes to holding it in but you should aim to pee at least five times per day, says Dr. DeRosa. If you aren’t urinating that often you may be dehydrated and need to drink more water. You may need to urinate more often depending on your age, gender, size of your bladder, and other individual factors. Medications (like diuretics), medical conditions, and what you eat or drink (like caffeine or alcohol) can increase your urine output.
If you have to pee more often than every two hours, or wake more than once to urinate at night, you may have an overactive bladder. Also called OAB, that’s a condition where the urge to urinate is hard to control. Holding your pee every once in a while (like a long car ride with no rest area in sight) won’t hurt you, but it isn’t a good idea to chronically override your urge to urinate for extended amounts of time, says Dr. DeRosa. There are both short- and long-term consequences to holding your pee for too long.
The main side effect of holding in your pee is urine leakage, also known as incontinence. Eventually the natural reflex of your bladder will take over and release urine spontaneously, says Dr. Ingber. This can be anything from a small squirt to a full pants-drenching.
The bladder is a muscle and it’s possible to overextend it, says Dr. Ingber. “Over time if the muscle gets stretched too much then it will become weakened and not function as well,” he says. You may feel a lessened capacity for retaining urine and/or functional problems when urinating.
The bladder muscle can cramp and spasm just like any other muscle except that this can be a lot more uncomfortable than, say, a calf cramp. Bladder spasms can cause pain, discomfort, and leakage.
Not peeing often enough increases your risk for both bladder and urinary tract infections (UTI) as it allows bacteria to stay inside longer and grow, says Dr. Ingber. Dehydration, which often happens when people don’t want to drink to avoid peeing, also increases your risk of infections. Pregnancy can increase urine production due to a change in hormones in early pregnancy and pressure on the bladder in later pregnancy. Holding your pee for too long when you are pregnant can increase your already elevated risk of UTI.
Loss of the urge to urinate
Just like you can “potty train” your bladder, you can also undermine that training with bad habits. If you ignore your bladder’s signals too often, you may lose the ability to recognize them, which can make it difficult to know when you really need to go and when you don’t, says Dr. DeRosa. This is also one of the reasons that going to the bathroom “just in case” is a bad idea.
On the flip side, consistently allowing your bladder to get too full can cause you to have constant feelings of needing to use the bathroom. In some cases you can even damage the nerves in your bladder which may require surgery to correct, says Dr. DeRosa.
(Related: 7 Reasons Why You Need to Pee All the Time)
Can you actually die from holding your pee in?
“Spontaneous bladder rupture is quite rare but it can happen,” says Dr. Ingber. “More often we see these kinds of problems happening in automobile accidents when blunt force trauma causes a very full bladder to rupture.” Needing to pee and being unable to, called urinary retention, can happen as a result of an illness or injury. If you have the urge but cannot urinate, see a doctor as this can be treated. “If you go to the emergency room in time, we can fix it with a catheter before your bladder bursts,” says Dr. Ingber.
What it means if you can’t hold it very long
Some people have the opposite problem—they have to pee a lot and are unable to hold it in. Here are a few common reasons you might not be able to hold it:
In women, the most common cause of this is an overactive bladder, affecting about 20 percent of Canadian adults. The bladder becomes overly sensitive, causing people with an overactive bladder to have the urge to urinate every hour or two.
For men, the most common cause of frequent urination is an enlarged prostate gland, the walnut-sized gland that surrounds the urethra in men. The prostate grows with age and can press on the bladder, obstructing the urine flow and making it more difficult to empty the bladder.
This is an inflammatory bladder condition that causes discomfort and the inability to retain urine for very long. “Not only do patients have difficulty holding it but trying to do so may cause severe pain,” says Dr. Ingber.
Bacterial and viral infections of any part of the urinary system can cause you to have a sense of urgency but feel unable to go or only produce a small amount of urine. This is one of the hallmark symptoms of a urinary tract infection, along with burning and pain during urination.
Symptoms for some illnesses and chronic diseases can include the inability to hold urine properly (either too short or too long). These conditions include muscular dystrophy, multiple sclerosis, Alzheimer’s disease, lupus, some cancers, and diabetes.
Now that you know what happens if you hold in your pee, here are 5 small lifestyle changes to ease your perimenopause symptoms.