Early this morning after a night of drinking I woke up and really had to pee. I’m sure you know what I’m talking about. But what happens if I don’t? Is there a long-term health risk if I regularly choose to hold it? If alcohol is thrown into the equation, are there other effects or considerations? –Matt Groves, Valdez, Alaska
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When you drink, liquid passes from your stomach and small intestine into your bloodstream. Your body monitors how dilute your blood is and varies urine production depending on salt content and volume consumed. A night of tippling gives you a lot of liquid to unload, and while you’re in bed your kidneys are going to be busy.
Now for the complications. The ureters, the tubes that feed from each kidney to the bladder, don’t have valves to prevent reverse flow. If your bladder gets too full, the fluid can back up into the kidneys, leading to potentially serious medical issues. Kidneys work by a pressure differential system involving a fine network of capillaries and tubules, and fluid backup will make them less effective at filtering your blood. Depending on how high the back pressure gets, your kidneys could be damaged. The area at greatest risk is the kidney’s central collection region, the pelvis and calyces, which may become dilated, a condition called hydronephrosis. Another risk from high bladder pressure is kidney infection due to bacteria forced up from below, called pyelonephritis.
In the last analysis, however, the issue isn’t physiological but psychological. I mentioned voiding dysfunction, which sometimes develops in children who refuse to go to the bathroom for extended periods, leading to incontinence (hey, there are physical limits), infection, and other problems. Freud made a career out of people who held in what they shouldn’t have. Spare yourself years of therapy, Matt–when your body tells you to go, go.
