In the hospital we care a lot about urine. While we no longer taste the sweetness of diabetes mellitus compared to the flavorless diabetes insipidus, we measure urine output (UOP), volume (per kilo per hour), color, red cells, white cells, nitrites, bacteria… Pee-related reasons for sticking around the hospital range from the anatomic (a kid has valves that grew backward and needs surgery) to the behavioral (a kid had penis surgery and refuses to urinate until the stitches are out).
As a kid I fit into the latter camp, giving myself a UTI (urinary tract infection) on more than one occasion because I was too “busy” playing to take a break. “Do you have to go to the bathroom?” my mother would ask, the obvious answer betrayed by my uncomfortable squirming. “No,” I would lie, intently focused on arranging my Matchbox cars, “I’m busy”: a behavior Pediatrics would later teach me falls under “voiding dysfunction.”
In a throwback to those bladder-filled childhood days, as a result of all my running around the hospital—dealing with, among other things, patients’ urine—I often completely forget to pee. Sure, the intention to visit the restroom arises—only to be interrupted by a page to bedside or an admission that consumes hours before the afferent signals bombarding the periaqueductal gray are again able to break through to conscious awareness.
Withholding urine is a common residency problem: It starts by not drinking enough water and becoming acutely dehydrated. We solve this by bringing water bottles, but then forget to void. Cue coming home at the end of the day, finally relaxing the external urethral sphincter, and experiencing the sweet relief of micturition. Along with about a liter of retained urine comes the unsettling thought, “is this the first time I’ve gone today?” Otherwise healthy adults should not be considering getting their phone out for entertainment because the pee is taking so long. And we haven’t even gotten to the issue of constipation.
Is there a solution? I’m not sure. We’ve advised each other to set periodic phone alarms to “drink water and/or pee,” with mild to moderate success (we’re pretty good at snoozing alarms, both natural and artificial). As for me, I’ve considered the possibility of placing my own Foley catheter—I could definitely use the practice.