Swollen bladder (can't urinate) when diving

[secretninjanut]

Hi!

I am a very novice (female) diver, with only 8 dives post-PADI open water certification. During my first dive of the day, my bladder swells, to the point where it protrudes dramatically like an inflated balloon (which it is I suppose). This happens even if I have urinated before diving. I have tried to urinate underwater, but can't. I don't have this problem with other water sports- I pee in my wetsuit when surfing and can urinate while swimming- but when my bladder swells diving, it doesn't happen.

Not only is this extremely uncomfortable and painful, but it also worries me when I see my lower abdomen inflated to the extent it has been when I dive. I've done some searching online but haven't found anyone posting or writing about the same symptoms. Has anyone here experienced or observed this?

Thank you!

 

[japan-diver]

I have never heard of it getting to that point- are you diving cold or warm water - how thick a suit?

When diving in colder water in a wetsuit the urge to pee is quite intense - you normally see divers here walk in to the water until it floods the suit a bit and then stopping to prewarm the suit before continuing on. I would try this on the surface before decending and you might eliminate the worst part of the problem. It is normally a relaxation issue as opposed to anything physical.

 

[DocVikingo]

Hi secretninjanut,

Japan-diver is likely correct that, "It is normally a relaxation issue as opposed to anything physical," especially where an entirely healthy and very new diver is involved.

Some divers find that kneeling undisturbed on the bottom facilitates the ability to urinate. Of course you'll need to be careful where you settle as you can damage marine life, and it you, if one is careless.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[secretninjanut]

Thank you both for your reply. I've only been diving in warmer waters (Caribbean and Mediterranean). It may be a relaxation problem- I hope so! I guess then the question becomes how dangerous is it to continue diving if my bladder is that obviously distended?

 

[cutlass]

Ugly things first. Yes, overfull, painful urinary retention can be dangerous. There is the risk of bladder or uretheal or ureter rupture, spilling contents into the abdominal cavity. However, there is usually a precipitating event such as childbirth, pelvic trauma, or bladder lesion. Slightly less bad is the possibility of kidney damage from excess urine backfilling up the ureters; e.g. hydronephrosis. Stones and sphincter incompetence are a couple of possible long term consequences.

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Some other thoughts after looking at the OP:

The reason submergence increases the urge to pee was explained here: linky

Since the OP didn't report urination problems outside of diving and for dives other than the first of the day (?), then a chronic process is a notch lower on the list of possibilities but is still not excluded; e.g. some kind of urethral obstruction or outer sphincter dysfunction (esp. pudendal nerve) or bladder stretch sensor/muscle control nerve system dysfunction (esp. pelvic splanchnic nerves).

As already suggested, the stress of diving could be distracting the desire to pee. Pushing this further, the urge goes unnoticed or ignored until it becomes painful and then the pain paradoxically inhibits one's ability to release. Suit compression around the pelvic region might also have a role by exerting some degree of counter-pressure to the bladder stretch, thereby blunting early signals to void. In females, the outer uretheral musculature also includes vaginal components so that sphincter control may be related to activity by either one or both together.

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A bit of the physiology behind doing "#1":

Basically, urination control is enabled by two muscular sphincters acting on the emptying tube (urethrea). For the one nearest the bladder (internal sphincter), control is involuntary; an extension of the bladder's surrounding smooth muscle (detrusor). For the one at the outlet (external sphincter), control is voluntary. In between these sphincters is the prostate gland. The average adult bladder fills roughly 1ml/min and has a top capacity of about 5-600ml or 1pt. The urge to urinate is usually triggered at roughly about 200ml; the internal sphincter passes urine to the upper urethea and this is relayed to the brain which registers the urge. If the urge is ignored, accumulation continues for another roughly 200ml and the urge is again triggered. This continues until the bladder is full. Bladder pressure can get up around 3-400mm/H2O at which point, the "pee" (micturation) center in the lower spinal cord (level S2-4) signals the detrusor muscle to contract which raises the bladder pressure roughly about another 100mm/H2O. The micturation center also coordinates automatic bladder contraction and relaxation of the inner and outer sphincters and -- Voila, the pause that refreshes....

 

[TSandM]

There is the risk of bladder or uretheal or ureter rupture, spilling contents into the abdominal cavity. However, there is usually a precipitating event such as childbirth, pelvic trauma, or bladder lesion. Slightly less bad is the possibility of kidney damage from excess urine backfilling up the ureters; e.g. hydronephrosis. Stones and sphincter incompetence are a couple of possible long term consequences.

Just a little more information . . . Bladder rupture from acute distention is a possibility, especially with trauma. (For example, were you to fall getting back on the boat with a hugely distended bladder.) Urethral or ureteral rupture are vanishingly unlikely in the acute setting described by the OP.

Kidney damage from obstruction to urine flow is a phenomenon which takes days to occur, not the 60 minutes of the typical dive.

Stones do not occur as a result of urinary tract obstruction, although they may cause it.

In the acute setting of a single dive, the most likely problem is discomfort. Assuming the OP is able to empty the bladder normally following the dive, no long-term problems should be expected.

 

[-Phoenix-]

You mentioned it started with your first dive. Does it also bother you now while on shore?

 

[Scubakevdm]

Just a little more information . . . Bladder rupture from acute distention is a possibility, especially with trauma. (For example, were you to fall getting back on the boat with a hugely distended bladder.) Urethral or ureteral rupture are vanishingly unlikely in the acute setting described by the OP.

Kidney damage from obstruction to urine flow is a phenomenon which takes days to occur, not the 60 minutes of the typical dive.

Stones do not occur as a result of urinary tract obstruction, although they may cause it.

In the acute setting of a single dive, the most likely problem is discomfort. Assuming the OP is able to empty the bladder normally following the dive, no long-term problems should be expected.

You didn't touch on sphincter incompetence, so I will.

While sphincter incompetence may very well be a problem for newer divers, eventually you'll find a dive op that does a good job and is pleasant to be around.

 

[dschonbrun]

If the issue only occurs on the first dive of the day, then tension/psychological stress is likely a contributing factor. I find visualization and slow-breathing techniques for 5-10 minutes before each dive help dramatically.. especially the first dive of a vacation, or a dive in sub-optimal conditions. You might consider doing some reading on these topics and see if they are helpful. Especially as a new diver, there is an increased level of mental and physical stress before every dive, particularly the first of the day.