As a child, most of us were told at some point to “hold it in”, “cross our legs”, “tie a knot in it” or “just wait”. From my own experience this was usually said through gritted parental teeth as I was dragged through some store or shopping area without adequate toilet facilities.
It is also a frequent problem at schools with supervisors reluctant to let charges out of their sight, or children too embarrassed to admit their need in front of the class.
Even as adults, many people will reduce the need for frequent urination by drinking less or waiting for extended periods of time to reduce disruptions at work or to avoid unpleasant toilet facilities (if you have visited public toilets in Greece or China, you know just how long you’d wait to avoid them).
But can repeated delays lead to long term urinary problems?
The bladder is a balloon-like organ which expands to hold fluids. Once it contains a certain amount (for adults around 200 ml of liquid) the urge to urinate becomes apparent. However, unless people have incontinence problems, most people can wait up to 5 hours before urinating. So long as you continue to drink, the longer you wait, the more liquid is put into the bladder. This means that the bladder keeps expanding. Indeed this is part of toilet training for children – their bladders expand over time.
If you do this too often, or wait too long, the bladder may become oversized and weak, leading to dribbling or incontinence. For children who are forced to hold on, often employing characteristic behaviours such as holding genitalia, squatting or pressing their legs together, tension in the pelvic floor muscles may make it harder to squeeze all the urine out of the bladder and thus some may be retained – leading to more frequent urges to urinate.
Infections of the kidneys and urinary tract may also be affected, with one study showing significantly higher levels of urinary tract infections in women who voided three or less times per day compared to those who urinated 4 or more times. However, this may be due more to reduced fluid intake than urine retention.
It seems that there needs to be a balance between toilet training children by teaching them to delay urination for a while, and asking them to hold on “too long”. Also city designers should perhaps increase access to clean, public toilets.
BTW on a more cultural note, I have noticed a significant lack of public amenities in New York City and a general American tendency to avoid the word “toilet” – instead people here use euphemisms such as “restroom”, “bathroom” or the strange “comfort station”.
Anyway, I must go, I feel an urgent bathroom visit calling…
Nielsen AF, Walter S (1994) Epidemiology of infrequent voiding and associated symptoms. Scand J Urol Nephrol Suppl. 157:49-53.
Nygaard I, Linder M (1997) Thirst at work–an occupational hazard? Int Urogynecol J Pelvic Floor Dysfunct. 8(6):340-3
Smith, D.B (2004) Female Pelvic Floor Health: A Developmental Review, Journal of wound, ostomy, and continence nursing 31(3):130–137