Maybe you want to avoid using the portable toilet at a rock concert. Or you’d like to get some miles behind you rather than visit the rest stop on your cross-country trip. Or maybe you just don’t want to get out of bed when duty calls in the middle of the night.

We’ve all “held it” before, for whatever reason. But does holding off on urinating do any damage to our bodies? And what about the notion that your bladder can actually explode if you hold it too long—is there any truth to that?

Though it’s something most people don’t think about often, how the bladder works is pretty remarkable. Before a child is potty trained, a simple reflex controls the timing of urination. A layer of smooth muscle lines the bladder, and as the bladder fills with urine, the muscle stretches. The stretch signals the spinal cord to tell the bladder muscles to contract and the urethra (the tube that brings urine out of the body) and pelvic muscles to relax. These changes allow urine to exit a baby’s body. Babies can’t control the process—which, of course, is why they wear diapers. 

As a baby grows, the bladder enlarges and can hold more urine. The child also learns to sense when the bladder is filling, and to control the muscles of the bladder, urethra, and pelvis. Eventually, the child can reliably decide when and where to “go.”

So what about those of us who take our potty training to the next level, and try to hold it long after our bladders tell us it's time to empty them?

The worst that’s likely to happen is that you’ll become increasingly uncomfortable until you finally give up and empty your bladder. The idea that your bladder can burst by waiting too long to urinate is largely myth. True, there is the story of the Danish astronomer, Tycho Brahe, who supposedly died of a ruptured bladder in 1601 after “holding it” because he didn’t want to leave a banquet. But, there are other possible explanations (and rumored causes) for his demise, including prostate enlargement that led to an overwhelming infection, and mercury poisoning.

There are also rare reports of bladder rupture among heavy alcohol users. It’s thought that alcohol allows the bladder to fill beyond its usual limit and depresses the urge to void. But if the link between bladder rupture and alcohol use were strong, I’d expect this problem to be common among the world’s party animals. It’s not. My guess is that some of the people who suffered bladder rupture after heavy alcohol use not only had a full bladder, but also experienced a trauma related to their inebriation. In general, a full bladder is more easily injured than an empty one.

The bladder is a mighty strong muscle and is unlikely to rupture just because you declined the opportunity to urinate. It’s much more likely that well before the bladder burst, the urge to void would simply take over, and you would urinate whether you wanted to or not. However, the bladder can rupture under certain circumstances, such as:

  • Major trauma, for example a pelvic fracture
  • Surgical complication
  • A bladder tumor that weakens a portion of the muscular bladder wall
  • Damage to the bladder from radiation

While it’s highly unlikely you’ll burst your bladder just by holding it, there are potential health consequences of making it a habit. An oft-quoted study published in 1979 compared a long list of lifestyle factors among women who had frequent urinary tract infections (UTIs) with those of women who did not have infections. The one big difference between the two groups was that those with recurrent UTIs reported frequent “voluntary deferral of micturition” (that is, they tended to hold it).  So, women who regularly delay urination may be more prone to UTIs.

The bottom line: If you get the urge, find a restroom. Avoid the discomfort that’s only going to get worse over time, even though waiting is not a serious danger to your bladder or your health. And before the long car trip, follow the advice of mothers everywhere and try to go, even if you don’t feel you need to. Hours later, when the distance between exits seems endless, you’ll be glad you did.

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