Why “Holding On” Could Be Damaging Your Bladder, According to a Urologist

Whether it’s sitting through back-to-back meetings, driving long distances, avoiding public toilets or feeling awkward about asking to leave the room, many Australians regularly ignore the urge to go to the toilet.

While holding on every now and then isn’t a cause for concern, urologists are warning that making it a habit could have lasting consequences for your bladder health.

The warning comes from the Urological Society of Australia and New Zealand (USANZ), which fears unhealthy toilet habits are becoming more common as workers return to the office for long meetings and some school children feel unable to leave the classroom to use the bathroom.

Dr Sandra Elmer, a urologist and member of USANZ’s Female Urology leadership team, said the occasional delay isn’t the problem.

“Holding on occasionally isn’t a problem. It’s when it becomes a habit that we start to worry,” Dr Elmer told Starts at 60.

“Once your bladder feels genuinely full, regularly delaying going to the toilet for another hour or more can gradually overstretch the bladder muscle. Like an elastic band that’s stretched too many times, it can lose its strength.”

Over time, repeatedly delaying toilet trips after your bladder is full can make it harder for the bladder to empty properly, increasing the risk of urinary tract infections (UTIs). In more severe cases, prolonged poor bladder emptying can contribute to permanent bladder damage.

“It can be very difficult to restore bladder function once the bladder muscle has been significantly damaged, which is why prevention and maintaining healthy bladder habits are so important,” Dr Elmer said.

“As a general guide, most adults should be emptying their bladder every four to five hours during the day, although this depends on how much you’re drinking.”

While anyone can develop poor bladder habits, Dr Elmer said older Australians are particularly vulnerable because bladder muscle strength naturally declines with age, particularly after the age of 65.

She is also concerned about people whose jobs make it difficult to access a toilet, including truck drivers, teachers, healthcare workers and anyone working long shifts, as well as people living with diabetes, neurological conditions or those who have previously undergone pelvic surgery, as these conditions can affect the nerves and muscles that control the bladder.

“For adults, we usually only see them after the damage is done when they complain they can no longer empty their bladder, or have developed urinary incontinence because their bladder has now become overstretched and dysfunctional,” she said.

One mistake Dr Elmer often sees is people deliberately drinking less water because they’re worried about finding a toilet or experiencing bladder leaks.
“It’s understandable, but it often has the opposite effect,” she said.

“When you don’t drink enough, your urine becomes much more concentrated. That can irritate the bladder and actually make urgency, discomfort and bladder symptoms worse. It also increases the risk of urinary tract infections.”

Instead of cutting back on fluids, she encourages people to stay well hydrated and seek medical advice if they find themselves rushing to the toilet far more often than expected.

“If you find you’re constantly needing to rush to the toilet or you’re going much more frequently than you think you should, don’t just respond by drinking less,” she said.

“That may be a sign of an overactive bladder or another underlying bladder problem. These conditions are common and often very treatable, so it’s worth discussing your symptoms with your GP.”

Although getting up once during the night to use the bathroom or noticing your bladder doesn’t hold quite as much as it once did can be a normal part of ageing, Dr Elmer said people shouldn’t dismiss more significant symptoms.

A persistently weak urinary stream, needing to strain to empty the bladder, feeling like the bladder never empties properly, recurrent urinary tract infections, passing urine very frequently in small amounts, or constantly rushing to the toilet because you can’t hold on or leaking before you get there are all signs that should be discussed with a GP.

“People often accept bladder symptoms as an inevitable part of ageing, but they shouldn’t,” she said.

“Early assessment can identify the cause and, in many cases, simple treatments can make a significant difference to quality of life.”

While much of the focus is on adults, Dr Elmer said healthy bladder habits begin in childhood and she is particularly concerned about primary school children developing toilet avoidance.

“Their bladders are still developing, and they shouldn’t feel they have to ‘hold on’ because they’re worried about asking to use the toilet,” she said.

“The biggest thing is to make going to the toilet feel completely normal.”

She said children shouldn’t be encouraged to do regular “just-in-case” wees if they don’t actually need to go, as the bladder works best when they learn to recognise and respond to their body’s natural signals.

“We don’t want children ignoring the urge to urinate, but we also don’t want them emptying their bladder before it’s appropriately full,” she said.

For adults, Dr Elmer said the advice is straightforward: don’t ignore a full bladder, stay well hydrated and don’t assume ongoing bladder problems are simply part of getting older.

“If you have a weak stream, difficulty emptying your bladder, recurrent urinary tract infections or persistent leakage, see your GP,” she said.

“Early assessment gives us the best chance of preventing long-term bladder damage.”