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we asked a urologist: is it bad to hold your pee, do kegels actually do anything, and other common myths about health 'down there'

dr. howard evans, a urological surgeon at the alberta urology institute in edmonton, sets us straight on some of the myths of urinary tract health.

by robin roberts

sep 15 2022

5 minute read

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cranberry juice for a bladder infection may cause kidney stones

from kidney stones to kegels, dr. howard evans, a urological surgeon, answers our questions. getty

can your bladder really burst from “holding it” too long? is red urine a sign of cancer or simply from eating too many beets? what’s the deal with midnight trips to the loo? can peeing on a jellyfish sting really help the pain? and can we clear up the cranberry juice for utis debate once and for all?

we asked dr. howard evans, a urological surgeon at the alberta urology institute in edmonton, about the health concerns he sees most in his practice and the most common myths when it comes to urinary tract health.

what health concerns do you see most?

the biggest thing we see are lower urinary tract symptoms in men, which are the inability to pass urine, or going to the bathroom too frequently, up at night having to go.

the prostate is an organ that wraps itself around the urethra, and when it grows it can pinch off or close the urethra. when you try to pee it doesn’t come out as strongly so you don’t empty completely. if you don’t empty completely, you have to go to the bathroom more often because you’re only getting so much out and your bladder fills up again. sometimes it happens during the day but it doesn’t bother you because you’re not trying to sleep. not everyone who gets older has this problem.

for women the problem is the opposite, they can have incontinence, they can’t control their urine, [often] due to having children. even just carrying a child can change the pelvic floor muscles, they can get weaker. mostly it’s stress incontinence, they leak when they cough, sneeze, or laugh. that can be corrected , so i encourage them to seek help.

bladder exercises help though, right?

absolutely, but it’s more important to make lifestyle modifications first. for people who have to void a lot in the evening, try not to drink so many fluids at night. [also] avoid things high in caffeine or alcohol because they’re natural diuretics. for incontinence, there are the classic pelvic floor or kegel exercises . if you do them the right way, it’s very helpful. weight loss, lifestyle modification, eating properly — all of these will improve your pelvic floor. unfortunately, some women may still need [minor] surgical intervention .

what about urinary tract infections, or utis?

it’s a common problem. a lot of people get the odd bladder infection, you treat it, you’re fine. recurrent or long-term bladder infections are less common. a quick simple work-up may show there’s no real cause, some people are just a little more prone. you can do some simple lifestyle modifications such as wiping appropriately, having better hygiene.

you’re more prone to bladder infections if you’re excessively overweight because the skin pulls [causing it to be] moist, and more bacteria can grow and it has an easier way to get into your bladder.

what other health issues do you advise on?

the bulk of our practice is oncology, including bladder, prostate and kidney cancer. there are some cancers that are more common, prostate cancer [for example]. kidney cancer seems to be more on the rise. now is it due to the fact we’re getting more cancers? is it because we have better imaging where we’re able to detect cancers earlier? is it because people are getting tests for other reasons and they find an incidental lesion on the kidney?

the mortality rate from kidney cancer has come down, probably because we pick them up a bit earlier now. they’re not uncommon in terms of a rare condition. rarer conditions in urology include testicular cancer, but it’s easy to detect because the testicles sit outside the body, you can feel if there’s a problem.

are there any new breakthroughs in cancer treatments?

the biggest area is probably in the very advanced prostate cancer realm. metastatic or advanced prostate cancer we still do not have a cure for, but each year we find something that lengthens life, improves mortality, even improves morbidity sometimes, so that people live longer and reasonably well. the goal is to find something that gets through the cancer and has no side effects. in kidney cancer, there’s minimally invasive surgery, where we remove small pieces of the kidney as opposed to the whole kidney.

dr. howard evans is a urological surgeon at the alberta urology institute in edmonton. supplied

how common are kidney stones?

they’re more common in the summertime because people get dehydrated and they make more stones. i’ve never had one myself, but i asked a woman who’s delivered a baby and she said she would have 10 more babies before she had another stone, which gives me an idea of how bad having a stone must be. it’s important to keep hydrated to avoid them.

is it bad to hold your pee?

not really. it can become a problem for people, especially for men, who have trouble emptying their bladders. if they hold it too long and their bladder gets too distended they won’t be able to void at all, and then they have to go the hospital to have a catheter put in to drain their bladder. if you do have ongoing problems and they haven’t been treated, holding it too long could cause a problem. but if you’re a young person who just needs to hold it to get through a movie, you’re not going to get into trouble.

how important is the colour of your urine?

it’s very important to stay hydrated and drink water, and if you drink enough water what comes out should look like water. first thing in the morning it will probably look a little more concentrated because you haven’t had water all night. as you get more dehydrated, you’re probably going to be a bit more concentrated.

red in your urine is suggestive of blood, which is alarming to people and one of the big reasons they see their doctor. it could [indicate] bladder cancer or some sort of malignancy within your urinary tract.

i still do ask people if they’ve eaten a lot of beets, although they can usually tell the difference when their urine is dark red and they haven’t eaten a lot of beets.

will peeing on a jellyfish sting or snake bite ease the pain?

that’s not going to do much for you. there are things within the urine that will anesthetize the jellyfish, so that actually is true with some jellyfish. [the cleveland clinic maintains peeing on a jellyfish sting can actually make it worse .] the snake bite, no. if you have a snake bite you need to get help right away.

and what about the age-old question about cranberry juice curing bladder infections?

cranberry juice is a very acidic drink and if you drink enough of it your urine will become more acidic. and if your urine is more acidic then you have less chance of having a bladder infection because bacteria can’t grow as well in an acidic environment.

however, cranberry juice is high in [the compound] oxalate, which is the partner to calcium in a stone. so yes, cranberry juice can help prevent — not treat — urinary tract infections, but it can cause [kidney] stones, and which would you rather have?

robin roberts is a vancouver-based writer.

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robin roberts

we asked a urologist: is it bad to hold your pee, do kegels actually do anything, and other common myths about health 'down there'