Medical Examiner

To Pee, or Not to Pee

Can holding in your urine really give you blood clots? Only sometimes.

Matt Harvey.
Mets pitcher Matt Harvey walks off the field during Game Five of the World Series at Citi Field in New York on Nov. 1, 2015. Maybe he should make a pit stop at the restroom?

Elsa/Getty Images

When New York Mets fans found out Monday that their star pitcher, Matt Harvey, was suffering from an “unspecified ailment,” they quickly assumed the worst. Was he out of practice indefinitely? Was his arm permanently damaged in some way? Would he have to be replaced at this Sunday’s season opener? Fortunately, the problem fixed itself quickly. At a press conference on Tuesday, Harvey announced it had been nothing serious: He’d just been holding his pee too long … which led to a bladder infection … which led to a blood clot in his bladder. NBD!

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“I guess the main issue is I hold my urine in for too long, instead of peeing regularly,” Harvey informed the group of reporters who had inadvertently gathered to learn more about his bathroom habits. Fortunately, there’s a long-term solution: “I have to retrain my bladder to use the restroom a little bit more, instead of holding it in.”

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We here at Slate were horrified to hear that a person could actually excrete bloody pee (yes, this happened) merely because that person had been holding it in a little too long (because let’s be real, we’ve all been there). To find out more, I called up Anne Schuckman, director of urologic oncology at the University of Southern California’s Keck School of Medicine, because this is my real-life job that I get paid to do.

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“People can definitely have blood in the urine with a bladder infection—there’s no question,” Schuckman told me. A bladder infection, which is usually caused by the bacteria E. coli, results in the weakening and inflammation of your bladder’s mucus lining. Infected bladder linings are inflamed, and irritated, and can bleed, just like an infection of the mouth. (By the way, a bladder infection is the more severe form of a urinary tract infection, or UTI, which encompasses an infection anywhere along the urinary tract, including in the kidneys, urethra, or ureter.)

It’s the holding his urine “in for too long” part that raises questions. But it turns out that if you make a recurring habit of keeping it in or only emptying your bladder halfway every time you go (seriously, who does that?), you’re inviting infection—that leaves urine in the bladder long enough to become more susceptible to harboring bacteria. “If you are routinely holding in your urine for 12 hours at a time, that certainly could be a cause for urinary tract infection,” Schuckman says.

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But the key word there is “routinely”: We’re talking about chronic un-emptiers here. Schuckman stresses that holding it in just once or twice—you remember your last long road trip where you were too embarrassed to admit you had to make another pit stop 30 minutes after you stopped at a gas station—is really, quite probably, not going to give you a bladder infection. Or else we’d all be peeing blood by now, amirite?

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So Harvey must have been delaying pretty frequently to give himself a bladder infection—apparently he’s just that focused on perfecting his craft. (By the way, Mets fans, he is now “completely fine” and has been cleared to pitch at Sunday’s opening game against the Kansas City Royals.) But one thing still doesn’t make sense: After experiencing those initial, terrible symptoms of pain, burning, and overall discomfort that come along with a UTI, wouldn’t Harvey have realized he had an issue, gone to the doctor, and gotten antibiotics before it got to the level of blood-in-urine? I know I would have!

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That’s easy for me to say, because I’m a woman. Our urethras are shorter, meaning there’s a much higher chance that the wrong bacteria make it into the urinary tract. As a result, about 50 percent of women experience at least one UTI within their lifetimes (though, ladies, beware: Because the symptoms can be so similar, many emergency rooms wrongly diagnose STIs as UTIs). As a result, women are more likely to recognize what a UTI feels like. “Men in particular don’t really know the signs and symptoms of a urinary tract infection, so it may be that it gets to the point where there’s blood in the urine before they realize there’s a problem,” Schuckman says. Ouch.

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That’s worrisome, because blood in urine could indicate a deeper problem—like kidney stones, prostate cancer, or a tumor on the bladder, she adds. Luckily, when discovered, a bladder infection is easily treated with antibiotics.

OK, that’s probably plenty about Harvey’s UTI. But what about the possibility that holding it in too long can make your bladder explode? Legend has it that that’s what happened to Tycho Brahe, the 16th-century astronomer who mapped more than 1,000 stars and who died abruptly at the age of 54 after his bladder exploded like a supernova. Here’s the story: During a royal banquet in October 1601, Brahe was so polite that, despite being in immense urinary discomfort, he refused to recuse himself from the table to use the bathroom. For his consideration, he was rewarded with a ruptured bladder, and an untimely death. Or something like that.

Yeah, not so much, says Schuckman. “Before you get to the point where your bladder would burst, most people would be incontinent,” she says. “The pressure it would take to rupture your bladder would be tremendous.”

Delightful. Our bodies truly are our best friends.

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