Dr. Yaniv Larish sees dozens of patients each week at Fifth Avenue Urology in New York City. A urologist and surgeon, he treats all kinds of conditions, from complex kidney stones to incontinence to urologic cancers. But no matter why someone ends up in his exam room, he asks the same question at every initial consultation: “Is your bladder being nice to you?”
That’s what he recently told us — Raj Punjabi and Noah Michelson, the hosts of HuffPost’s “Am I Doing It Wrong?” podcast — when he dropped by our studio to talk about all of the ways we might be peeing wrong and how to do it better.
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“They go, ‘What do you mean?’” Larish said of his patients. “It’s meant to be an open question, right? This is your moment to tell me about your bladder. So, is it nice or not nice?”
It turns out that “nice” and “not nice” can apply to a lot of different things — like how often we’re peeing, what we feel while we’re peeing, and what we might be seeing when we look into the toilet after we’ve finished — and can involve more organs than just the bladder.
As for how many times a day you should be peeing, “there’s no magic number,” he told us.
“There’s no ‘normal.’ It doesn’t work that way, because if you are stranded in the Sahara desert under the baking sun and 120-degrees heat, your kidneys are going to do everything possible to hold on to every drop of water that they can,” he said.
“On the other extreme, if you’re, say, a college-going frat guy or gal, and you’re pounding those beers on a Saturday night … you’re going to make a lot more. So I think that the question is not ‘how often are you peeing?’ It’s more ’are you hydrated enough or overly hydrated, and what is the point at which everything is sort of normal?”
One thing Larish is certain about is what a typical healthy person should experience when they’re urinating.
“Most people associate peeing with pushing, and in reality, peeing has to do with relaxation. … The most important thing is you should be relaxed,” he told us. “And you will know [that everything is working correctly] if it’s coming out easily, if it all comes out in one shot very quickly and then stops. We don’t want to see hesitation before it comes out. We don’t want to see a prolonged standing time where you’re just sort of there. … And at the end, we don’t want to be dribbling after or having the urge to pee two seconds after we peed. So it’s not so much ‘am I doing it wrong?’ It’s more ‘is there an issue?’ And if you’re not just peeing all in one shot in a relaxed way, then there’s probably an issue that can be dealt with.”
We also might become aware of an issue based on what our pee looks like or what we see in the bowl.
“The presence of blood in the urine is abnormal — always,” Larish told us. “It needs to be investigated … regardless of whether you see your urine being red in color. When we find a young person with blood in the urine and concentrated urine, it’s a pretty good predictor of having a [kidney] stone. If you’re an older person and you have blood in the urine, and you have a smoking history, that may be a good clue that there’s something more nefarious going on, that maybe there’s a cancer somewhere.”
Other things to watch out for are the presence of any sort of mucus, which Larish said is “concerning,” and gravel or sand at the bottom of the toilet.
“If you then see little sand particulate in your toilet, that’s a pretty big red flag” for the beginning of a kidney stone, he said.
Another unexpected sign that there might be something wrong? If you’re passing gas every time you urinate.
“The bladder needs to contract on its own — it’s a muscle on its own, not connected to anything else,” Larish noted. “So if you’re farting, that means that you’re using abdominal musculature, right? You’re increasing the entire intra-abdominal pressure in order to squeeze on the bladder. So I tell people, if you find yourself farting in order to initiate a pee or in order to get the last third of your urine out, there’s something going on that needs to be evaluated.”
Ultimately, Larish’s advice for keeping all things urologic as “nice” as possible boils down to just a few tips.
“[You] should be thinking about nothing when [you’re] peeing,” he said. “It should be blank Zen. That’s the golden rule. I think you want to be hydrated, but not overly hydrated. Everything has to be in moderation. Not overdoing it with supplements, if they’re not necessary. Being tuned in to your body is probably the most important part. If you see that something has changed, like, ‘I haven’t woken up at night in 20 years to pee, and in the last three weeks, I’m waking up three times a night to pee, and it’s really disruptive,’ yeah, that’s a big difference in baseline. That’s abnormal, so something is happening. And if you have changes to your body that you’re attuned to, then getting an expert opinion and figuring out if there’s an issue is a reasonable thing to do.”
We also chatted about why some people are pee-shy (and how to help overcome this feeling), whether urine is truly sterile, whether you should drink it if you’re marooned on a desert island, and much more.
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