Emily Wade (Host): Picture it, it's a common scenario. You're out with friends and you're having an adult beverage and suddenly nature calls, and you have to pee. So, you go to the bathroom. A few minutes later, you have to go again. And then, a few minutes later, you have to go again. This is the phenomenon known as breaking the seal. But what is actually happening behind the scenes to open those flood gates? And is there anything we can do to prevent it? To help us understand our own plumbing, I'm excited to welcome Dr. Jeffrey Held, one of our primary care providers at MIT Health. Thanks for coming to the show, Jeffrey.

Jeffrey Held, MD: Very excited to be part of the potty discussion. The 12-year-old in me is very excited about the concepts.

Host: All right. I'm really happy to have you here. Thanks for being game to talk about bathrooms, the unsung heroes of the medical world, truly. We're trying to keep it classy. I'm going to get to our question

Dear Office Hours, is breaking the seal a real thing? It seems real to me. But is there any physiological basis for this phenomenon? When I go drinking with friends, once I go pee for the first time, I swear I have to go back to the bathroom every 15 minutes. So, I have a strategy. I always try to put off my first trip to the bathroom for as long as possible. Is that a good strategy or should I just heed nature's call? So, what do you think, Jeffrey?

Jeffrey Held, MD: I get a kick out of the concept. I'll confess, when you shared the topic with me, I had to look it up because in my day we called it renting beer, not owning it. And we didn't talk about the seal. There is no concept of breaking the seal in that your body has the urge to go, you need to go. There's nothing you need to do differently about your life. Just plan a little more strategically when it comes to your bathroom breaks.

Host: So, there is no watertight hatch inside us that's like bursting forth? This is very disappointing.

Jeffrey Held, MD: Your bladder is not like a ship where it's sealed. You have a muscle that holds things in check. And when the bladder gets full, it sends a signal to your brain saying it's time to empty.

Host: Whoosh. I love it. So, what is going on behind the scenes then to make one beer equal three trips to the bathroom?

Jeffrey Held, MD: The body has this kind of really cool mechanism to regulate your fluid balance. You know, we maintain a level of osmolality, you know, the electrolyte level, so that it functions well. We have a hormone a that is released in the body called antidiuretic hormone, or our ADH, also known as arginine vasopressin or AVP or my personal favorite is vasopressin. It is released at times when you're either fluid status is you're well hydrated, or you're not perfectly hydrated and you need to go empty your bladder or get rid of extra fluid. And then, there are times where it will be released, and it'll prevent that from happening.

The concept that I like to share is, if you're out hunting a wooly mammoth—so a little while ago before my time—you didn't want to feel the urge to go to the bathroom, hinting To that wooly mammoth, that there's humans downwind trying to hunt it. So, your body would release the antidiuretic hormone during times of stress or fluid hydration that is satisfactory with the idea that you'd kind of not have the urge, maintaining that fluid balance.

Host: I'm really excited. We had a little anthropology going on in here.

Jeffrey Held, MD: That was my first degree, and undeclared without having to tell my parents. See, alcohol interferes with that process. And so, when you drink, it kind of shuts down that process that releases the anti-diuretic hormone. And therefore, the kidneys who are responding to this say, "Okay, nobody's telling me not to." And they start emptying out that excess fluid. And that fills your bladder, sends you that stretch reflex and says you need to go to the bathroom.

The alcohol does two things there. Not only does it inhibit the release of anti-diuretic hormone, but it also kind of shuts down that frontal lobe that is telling you, "Oh, hold it, or ignore the stimuli." So, you're kind of more acute to things. you're not as focused because you're slightly drunk. And you have a full bladder, so that kind of gives you the urge to go to the bathroom more often.

Host: This is making a lot of sense. And also, that hormone came up in a conversation I had with Ali Sherwood about hydration. And I'm just wondering, is that kind of like dehydration also something that's actually going to contribute toward, like, having a hangover the next day?

Jeffrey Held, MD: Absolutely. So, you should always kind of fill up not only prior to drinking, but during drinking with pure liquid, not alcohol, assuming it's liquid. With the idea that you're going to get rid of more fluid more than you anticipated, more than your body needs you to get rid of. So, having some water nearby or alternating between your cocktail and your Voss water.

Host: It's always, always a handy, handy thing to just order a drink, order some water. Just rinse, repeat. Just to advocate on behalf of our strategic MIT listener, there's no value in holding it as long as possible and just delaying the inevitable. You're just making yourself uncomfortable, right?

Jeffrey Held, MD: Yeah, you're not only making yourself uncomfortable, but in some cases, put yourself at increased risk of urinary tract infection, depending on urethral size. So, my recommendation is you got the urge, just take advantage of it and go and just be prepared to run between conversations.

Host: That's right. Let's like embrace it as an opportunity to like get some steps in.

Jeffrey Held, MD: There you go.

Host: Just kind of like take a breather. Embrace the seal, the breaking of the seal.

Jeffrey Held, MD: The lack of a seal.

Host: Well, the utter lack of a seal. Well, I have to say to our listener, I'm so sorry to let You know that, you know, our body does not have a submarine-like hatch inside it that is waiting to be broken. And so, your strategy isn't really backed by science, but at least we know why now. So, make sure to use the bathroom, avoid those UTIs. But if you have one, come see us. We're here for you Jeffrey, thank you so much for being on here today. And just to kind of do a quick check, do you have any sort of suggestions for ways to go out to the bar and, you know, party responsibly as it were?

Jeffrey Held, MD: Absolutely. Although I'll confess it's probably been 20 years since I've done bar hopping, but great memories and experiences. I would recommend, one, you kind of eat before you go and drink, so your stomach is able to tolerate the alcohol. Hydrate well. Moderation is the key to life. Never push yourself in drinking and don't try to keep up with your friend who can down six drinks fairly quickly. There's no good outcomes from that.

If you're going to leave to go to the bathroom for any reason, no matter who you are. Give your drink to a trusted friend. Never leave a drink unattended. make sure you have somebody with you who you can trust while you're drinking, who will look out for you. And if you're somebody who has a tendency to drink too much, just realize you're young now, those are habits that don't work well as you get older. And so, thinking about moderation now and how to pace yourself more appropriately.

And the other is you don't need five drinks to have fun. One or two is fine. Stay young and healthy. Even though that's against my own financial interest to tell you to stay healthy, I'm still going to recommend it.

Host: Thank you for your sacrifice. I really appreciate those recommendations. And of course, if you need to see us over at MIT Health just for any reason, you can, always make an appointment with us. And in fact, we are always accepting new patients in primary care. You can make an appointment at health.mit.edu. And also, Jeffrey, thank you so much for being on the show. You've been so awesome. So, thank you. I am excited to have you back again soon.

To our audience, thank you so much for listening. And we've had some really cool questions come in in the last few weeks. So, keep them coming in. Go to health.edu/thrive and you can submit your question. It doesn't have to be a big one. It doesn't have to be esoteric. We accept all questions and we're really excited to get you some more fun episodes out in the next few months. Thanks for listening.