Whether you remember the feeling from grade school, long family road trips or more recently, as you returned to working at an office rather than your kitchen table and realized your restroom is no longer conveniently near you, we’ve all had to “hold it.” It’s a terrible feeling and even worse idea. We’re talking about delaying urination or — as your 5-year-old self would call it — holding your pee.
This practice, often in response to strict restroom-use policies in schools and sometimes even in the workplace, can lead to urinary tract infections, incontinence and damaged kidneys. It can also cause children of all ages — from kindergarten to high school — physical and emotional pain if it leads to accidents in the classroom, bed wetting during sleep, or issues related to urinary and bowel incontinence in the aftermath of frequent refusals of bathroom breaks during the school day.
“Abnormally holding urine can cause an increase in bacterial load and increased incidence of urinary tract infections, or UTIs, for people of all ages,” says Dr. Rebecca Smith, a Sharp Rees-Stealy family medicine specialist. “Most commonly, if someone isn’t able to urinate, the urine backs up and causes swelling of the kidneys and often infection. This can damage the kidneys, and the infection can spread to the bloodstream and become very serious if the urinary obstruction is not relieved.”
Dr. Smith explains that we need to urinate approximately eight times per day on average, and if we don’t heed nature’s call, the following concerns are real possibilities:
- Urinating helps eliminate bacteria in the urethra, which is the tube that transports urine from the bladder as it empties. Holding it in for too long gives bacteria the chance to multiply and settle in the bladder, leading to infection.
- Holding urine can overstretch the bladder and lead to voiding dysfunction, which is a lack of coordination between the bladder muscle and the urethra. This can result in an overactive bladder and urine leakage.
- When we hold our urine by contracting the sphincter against an already strained bladder, the bladder wall can thicken and break down the normal one-way mechanism of urine flow from the kidneys into the bladder. This can increase the risk of infection and lead to long-term kidney and bladder issues.
- Abnormal urinary voiding is often accompanied by abnormal bowel voiding (feces leakage) or constipation, which can be painful and emotionally distressing.
- While holding urine for normal amounts of time during the day can help small children develop bladder control at night, holding urine for prolonged periods once the bladder is full — and you have the urge to urinate but do not do so on a regular basis — could lead to bed wetting for all ages.
Talk to your doctor if you have concerns about frequent holding of urination or the need to urinate often, which can be a sign of infection, prostate enlargement in men, or due to the onset of diabetes, kidney stones or other health conditions that should be addressed. And remind your children to get into the habit of regularly using the restroom during breaks at school, a practice they may have forgotten while attending school virtually during the pandemic. A doctor’s note can often resolve a situation in which a student or employee is not allowed to use the restroom as needed.