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. 
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.
Code Yellow:
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, or falling onto angular objects.
In 2007 the British Medical Journal reported on 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 Jehovah’s Witness …. 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. 
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 dog’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 [↩]
I have recently been admitted to hospital after 7hours of not being able to urinate.
No matter how much I tried the fear of pain stopped me.
A catheter was inserted and within 15 mins I had filled the bag to the 900grams mark.
There was no alcohol involved no unusual activity my bladder would not open to release the urine, the pain holding the urine was intense.
My question is could my bladder burst holding this amount of urine??
I had to undergo a knee disarticulation (amputation) and was under a spinal block. During the surgery, they forgot to cath me. As a result, I had massive amounts of IV fluids going in with no output whatsoever due to the spinal block paralyzing the bladder and sphincters. I underwent an excrutiating amount of pain before the error was recognized. They immediately cath’ed me and drained 1005mL. While my bladder was being evacuated (VERY slowly to prevent collapse) the nurse informed me that bladder ruptures occure at the 1000-1020mL mark (for most patients). There are obvious exceptions to this as some may take more or less than that amount. I hope this helps.
More and more people these days are having complex urinary diversions such as a Neobladder, you will find these in younger people, women and men, it is generally becoming preferable to an ileal conduit.
Nurses, especially in emergency departments need to be aware of what a catheterisable channel is and the differences between a cathing neobladder/urethral neobladder(continent versus non continent.
This is where a patient has to place a catheter into their abdomen to drain urine. Just check the abdominal area, you may find a small piece of gauze covering a tiny stoma site. If someone comes in unconscious with a diversion such as this and you need to cath them, you may find catheterizing the urethra extremely difficult, they are sewn shut, or unusable, check the tummy. A male catheter must be used as female catheters are too short.
Why is this so important? Because in people with a catheterisable neobladder (two types one urethrally connected) if this gets obstructed then they do perforate, also the kidneys aren’t in general protected by valves(in ureters) and damage can be caused through a severe case of reflux induced by severe retention.
Its made of bowel(the pouch) not a bladder and quite often they are bacteremic so peritonitis is almost always guaranteed.
Keep an open mind when dealing with patients and retention.
From a personal perspective there is nothing worse than not being able to pee when you want too, especially after an operative procedure which involves a giant boa like instrument up your orifice. 8hrs post-op still not sign of the golden stream, start to worry, time is ticking 10, 12, then it creeps to 15hrs getting more anxious (which doesn’t help) warm baths, trying to pee in the bath, standing, swatting (i now sounds disgusting but i was desperate) futile… in the end I end up in ED the fun begins.
Wait, more waiting glimmer of hope am i next drats some comes in with chest pain, then an injured finger. Have i been forgotten i wonder 3hrs have passed the pain is getting worse, more waiting as another patient goes ahead first in the end 5 hrs had past before I do the sums and figure out that its been 20hrs post-op by which time the pain was getting unbearable, (unfortunately the lovely girls have been giving me more fluids in order to trigger a response, no luck).
The time has come to point the obvious i haven’t peed for 20hrs don’t you think you can shove a CATHETER up my Fannie? 5minuets later 1.2L thank you and i was bloody glad that it was over, then the whole waiting game to see if I had tone started, drink another liter of fluid and pee unassisted, success and a very tired RN patient in the end.
This post made me so thankful to be near a bathroom! I didn’t even know it was possible for a bladder to explode! It makes sense, since I’ve definitely experienced mine become uncomfortably full… but yipes! Owww!!!!
Thank you for posting this, I definitely learned something new.
-Aurora at MDiTV
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Oh.My.Heavens.
Our protocol makes us stop the cath at 1000, then resume after a short period. Our docs have a fit if patients are consistently high.
Ross, I’m with you on the AD…have seen more than a few kinked or clogged caths set it off.
I cared for a gentleman as a nurse’s aid in a community hospital who had a bladder explosion due to a clotted off CBI line that couldn’t drain following his TURB.
Also, a paraplegic I cared for who had to self cath had a bladder capacity (after many years of training) of over 3000cc’s.
a. Dear Sister Cusworth (Mona Vale Nursing School) warned my nursing year (and probably all the others) to make sure we emptied our bladders before travelling in a car. I still hear her when about to embark on a journey.
b. I have been promised the first born child of a young man following unkinking of his IDC first thing on a morning shift – handed over “he hasn’t drained much o’night”. It certainly drained then, I clamped it after about 800ml (as above) I seem to remember.
Will have to follow that up. How would I find a NZ farmer and would he really give me his child – could be 20 years old.LOL
Ross, in addition: Can anyone say trabeculated bladder?
Ross, I’m saddened – Spinal nurse that I am. You can mention he’s lucky it was two litres-ish. We encourage 2-4 litres of intake per day. It’s not unusual for me to get over two litres output in 6 hours, let alone 8 or so! I can say autonomic dysreflexia – go you for knowing it too. I like my nursing colleagues to appreciate how you can make a patient stroke out like that!
Hey there…
Reminds me of the time a fellow colleague delayed in getting an IDC into an unwell paraplegic spinal patient on an orthopaedic ward. Delayed, as in overnight…
I kid you not, there was over 2L that drained into the bag, it was just about bursting!
Can anyone say autonomic dysreflexia?
Hi! There appears nothing to be going on here, so I’ll add my two bobs worth while I’m taking a break from painting.
As I don’t have a toilet at the moment due to post-kids living at home renovations, my bladder is stretched to its limits at times until I relieve myself into an empty 215g jar of Maille Dijon Originale Mustard.
As for the capacity of a bladder, I have encountered more than 1000 mls coming from one poor old gentleman during catheterisation. On this the catheter was blocked to help retain tone. By the way, his smile afterwards reminded me of something I haven’t had for a while – which I won’t go into here!
Now, the only time I’ve heard of a bladder rupturing, besides the one in your article, is when someone was involved in a high speed motor vehicle accident and the seat belt cut into the lower abdomen, thus causing the rupture – all the best!