I think I am going to pee my scrubs.
How many times do you find yourself running around in a shift that is so demanding that you simply do not have time to go and empty your bladder?
You can feel an expending cannon-ball of discomfort in your lower abdomen, but there seem to be far more important things pressing for your attention.
Are you putting yourself in mortal danger here? Is it possible to rupture your bladder if you don’t empty it?
Well, not only might you rupture it, but you might be at risk of causing a significant explosion. Yipes!
Fill her up:
The maximum volume of the human bladder is widely debated and often fiercely contested during Saturday night drinking sessions. â€¨In fact it is somewhere around 500-1000 mls varying from person to person.
As the bladder begins to fill with urine, the scrunched up rugae making up the bladder surface begin to flatten out, stimulating stretch receptors on its surface. Eventually a volume is reached at somewhere between 150-400 cubic centimetres that stimulates the Micturition reflex.
The Micturition reflex center, located in the spinal cord, stimulates rhythmic contractions of the detrusor muscle which wraps around the bladder somewhat like a ball of wool. This leads to increasing discomfort as the desire to pee escalates.
If your current situation1 means you cannot go to the toilet, you have a voluntarily controlled external sphincter that will buy you a little extra time.
In nurses, this sphincter has evolved into a muscle with the clamping strength of a large boa constrictor.
Even so, once the bladder reaches 100% capacity, all voluntary control of this sphincter is lost, and the urine is immediately extruded, expunged, expelled. Code yellow.
In a healthy individual with no pathology in their plumbing, the chances of actually holding onto your wee long enough to bust your bladder are small.
Turns out to be a lot smaller than the chances of you waiting so long to get to the toilet that you end up having an involuntary pee in your scrubs.
Eruptions and explosions:
But rupture of the bladder does occur.
Severe intoxication can numb the increasing discomfort of a voluminous bladder, and when stretched to capacity, it can be far more susceptible to relatively minor trauma such impact from an over enthusiastic air guitar on the dance floor, orÂ falling onto angular objects.
In 2007 the British Medical Journal reported onÂ alcohol induced bladder rupture in three women the day after a big night on the booze.
Historically this had been considered largely a male only phenomenon2.
Initially diagnosed as urinary tract infections or appendicitis3 all three in fact had ruptured bladders that required surgical intervention.
And then there is the danger of explosions:
A 64-year-old Jehovahâ€™s Witness â€¦. suffered from severe hematuria from a bladder tumor, so that a transurethral monopolar electrocoagulation and insertion of an irrigation Foley catheter was performed under general anesthesia. â€¨After the procedure, the irrigational solution showed no further bleeding.
A few hours later, a drop of the hemoglobin concentration to 6 g% and unstable vital signs were encountered and the patient was transferred to the ICU. The irrigation of the bladder via infusion suddenly stopped and manual irrigation was impossible. The patient was immediately transferred to the operating room with a suspected tamponade of the bladder. During the 4 h of transurethral coagulation and extraction of blood clots, a noise like a dogâ€™s bark was heard.
Upon returning to the ICU, a drop in the oxygen saturation occurred. Breathing sounds were attenuated. The chest x-ray showed a bilateral (double-sided) pneumothorax and retroperitoneal air bubbles. For treatment, chest tubes were inserted in both pleural cavities.
Two main reasons may explain this dramatic event. First, during the long electrocoagulation of the bladder, a significant amount of hydrolysis with a consecutive production of a small amount of detonating gas (oxyhydrogen) occurred. This mini-explosion caused the introduction of air retroperitoneally up to the inter- pleural space and the double-sided pneumothorax. Second, the shock-wave caused by the explosion in the bladder induced a barotrauma by direct rupture of alveoli on the surface of the lungs.
:: Emergencies In Urology ::
Take home message. Try to take regular breaks to keep your bladder out of the explosion zone. Its one thing to be covered in your patients urine…quite another to be covered in your own.
- ie you are running around the ward answering the call-bells of 10 other patients that all need to urgently use bedpans and urinals at the same time. [↩]
- It was thought that the shorter urethra in females would make it difficult to resist the building pressures. Bladder rupture in males may carry a 1-5% mortality rate due to sepsis [↩]
- The symptoms from a ruptured bladder include nausea, vomiting and generalised lower abdominal pain, the person may also experience haematuria, or dysuria [↩]