Is holding a full bladder harmful for divers?

It doesn’t matter how carefully you monitor your fluid intake before a dive, or how close to dive time you leave the last toilet visit, we have all got out from a dive ready to rugby tackle anyone standing between us and the toilet. It’s well known that going for a dive causes an increased need to urinate. There are some interesting physiological changes that come to play. Immersion and temperature changes cause a narrowing of the blood vessels in the extremities. This results in an increased volume of blood to the central organs which is interpreted by the body as fluid overload. This causes the production of antidiuretic hormone (ADH) to stop, signalling to your kidneys that they need to produce urine to lower the blood volume. So even if your last toilet visit was only minutes ago, you can quickly find yourself feeling the need to go again.
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It’s almost impossible to give an exact measurement for the volume of the human bladder as everyone’s ability to hold urine varies. Normal adult bladders hold between 300 and 400ml but can hold up to 600 or even 1000ml in some cases. The need to urinate is stimulated by the expansion of the bladder which triggers the Micturition reflex centre in the spinal cord. Most adults will feel the need to urinate when their bladder is only around a quarter to a third of its normal capacity. In normal circumstances, adults will feel the need to empty their bladder about every 3 hours, but as divers we know the effect that immersion plays.

There’s always a big debate in the wetsuit diving community about whether peeing in a wetsuit is acceptable or not. In a drysuit, the debate becomes somewhat redundant unless you have a P-valve fitted. But is there any danger to ‘holding it in’? When you first feel the need to pee, your bladder probably has quite a way to go before it’s completely full. As your bladder fills up the muscles around it will contract to keep urine from leaking out until you’re ready – just make sure you can get out of your suit fast enough!

The dangers of holding your pee are mostly cumulative, so the occasional episode probably isn’t harmful. However, if you are diving frequently and often find yourself ignoring the need to pee you run the risk of urinary tract infections, urinary retention (the muscles can’t relax even when you want to pee) or bladder atrophy (leading to incontinence). But for most people, you can hold your bladder full for a few hours without serious complications, even though its uncomfortable.

If you dive in a wetsuit, you can of course make the call as to whether you pee in your suit or not. The old saying is that 50% of divers pee in their wetsuits and the other 50% are liars. So whichever camp you fall into, just make sure you flush your suit through before you get out of the water and start to take it off, and please wash your suit thoroughly between dives.  If you’re a drysuit diver, there’s always the option of adult nappies to ensure that you can relieve yourself. If that seems a little retrograde, or as you march middle age a little too prophetic, then perhaps a P-valve is an option.

Not surprisingly there are hazards associated with P-valves too. Ignoring the issues with getting a stick-on condom or the female cup attached successfully, so that the urine does actually enter the tubing to leave suit, there are reported cases of urinary sepsis. The tubing used to connect the urine to the P-valve is the ideal breeding ground for Pseudomonas bacteria, and it only takes a small amount of backward flow to introduce those bacteria into the body. If you think rinsing your wetsuit is a bit of a faff, syringing antiseptic through P-valve tubing should give you some perspective.