Before You Flush
Look inside the bowl to learn about your health.

April 20, 2009

By Diane Suchetka

Making it to the bathroom before it's too late is a subject that slips into the news every now and again.

Usually it's because the authorities have gotten involved. Who can forget the astronaut who reportedly wore a diaper (her lawyer later denied it) on a cross-country drive to confront her romantic rival?

And last month brought us the story of the guy (from Concord Township, by the way) who was hit with a bad case of Montezuma's revenge in the middle of a flight to Atlanta from Honduras. FBI agents arrested him after he had the gall to try to use the easier-to-get-to, business-class lavatory instead of the one in the cheap seats, where he was sitting.

Turns out, bathroom issues do more than create rap sheets. It's rare, but they can cause health problems, too. "The vast majority of people can confidently hold it and there aren't any consequences whatsoever," says Dr. Frank Marrero, a Cleveland Clinic gastroenterologist.

"That's why we have a reservoir, which is the rectum. It's there to hold it until you're ready to go."

That's also why we have bladders.

"What will eventually happen," says Cleveland Clinic urologist Dr. James Ulchaker, "is that you may leak some urine to lessen the bladder pressure. But you're not going to burst your bladder."

There are, as always, exceptions. Dr. Anthony Smith, a urologist at the University of New Mexico School of Medicine, has performed surgery more than once to repair a burst bladder when a driver with a full one hit the brakes, slamming the engorged organ against the back of the pubic bone.

"It's not that common, but it's common enough that we see it," Smith says. "And we tend to see it in guys who are pretty well sauced up when they come in."

Repeatedly refuse to go and you can end up in the doctor's office with something called chronic overdistention injury. Think of a Slinky, Smith says in explaining the ailment. Stretch the toy too hard or one too many times and it won't spring back. The same is true of your bladder. Once it expands beyond its elastic limit, it becomes weak and doesn't empty well, which can lead to more frequent urination and, some doctors say, an increased number of urinary tract infections.

The rectum can develop similar problems, says Dr. Anish Sheth, a gastroenterologist, assistant professor at Yale University School of Medicine and co-author of the book "What's Your Poo Telling You?"

Holding it in chronically, he says, can lead to pelvic floor dyssynergia.

"The muscles that are involved in going to the bathroom basically become uncoordinated," Sheth says. "They begin to lose the ability to function normally."

It's a disorder most often seen in women who've had lots of babies, those who've undergone pelvic surgery, truck drivers, soldiers and adolescent girls too embarrassed to use public restrooms.

"When this condition is particularly severe," Sheth says, "you can give them all the laxative in the world and they still won't go."

The treatment? Biofeedback, so the muscles learn how to work again. A more likely consequence of holding it, says Dr. Fabio Cominelli, chief of the Division of Gastroenterology and Liver Disease and director of the Digestive Health Center at University Hospitals Case Medical Center, is a case of chronic constipation.

"And constipation leads to bloating, abdominal pain and other things," Cominelli says.

His advice? It's the same thing we heard from every doctor interviewed on the subject.

"When you feel the need to go, I think it's a very good thing to go."

Hold it right there

Bathroom facts you might find helpful:

Bladders are as varied as the people who have them. Some hold a lot, some a little. On average, though, they can store about a pint of pee.
Humans were designed to excrete solid waste after every meal. It's called the gastrocolic reflex, says Dr. Anish Sheth, co-author of "What's Your Poo Telling You?"

Children do this naturally. But as we grow up, school and work get in the way.

"Our bodies have learned to suppress this very natural reflex," Sheth says. "As we get older, we suppress this." Have an overactive bladder? Worried about repeatedly having to use the bathroom during a flight? Take the advice of University Hospitals Case Medical Center urologist Dr. Donald Bodner:

Hit the head before you board.
Request an aisle seat.
Stay away from caffeine and alcohol.

"They function as diuretics, so they'll make you actually produce more urine and have to go more often," Bodner says.

If you have an inflammatory bowel disease that puts you in immediate need of a bathroom, you can join the Crohn's & Colitis Foundation of America and get the "I Can't Wait" card.

"Thank you for understanding," the card says. "The bearer of this card has a medical condition that requires him/her to use bathroom facilities urgently. Thank you for your cooperation."



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