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Office Hours: Is “the seal”...real? · MIT - Conversations with MIT Health

• 0:02
  Emily Wade (Host): Picture it.
• 0:02
  It's a common scenario.
• 0:04
  You're out with friends and you're having an adult beverage
• 0:07
  and suddenly nature calls.
• 0:10
  And you have to pee.
• 0:12
  So you go to the bathroom a few minutes later you have to go again, And then a
• 0:17
  few minutes later you have to go again.
• 0:20
  This is the phenomenon known as breaking the seal, but what is
• 0:25
  actually happening behind the scenes to open those flood gates and is there
• 0:29
  anything we can do to prevent it?
• 0:32
  To help us understand our own plumbing, I'm excited to welcome Dr.
• 0:37
  Jeffrey.
• 0:37
  Held one of our primary care providers at MIT Health.
• 0:41
  Thanks for coming to the show, Jeffrey.
• 0:43
  Jeffrey Held, MD: Very excited to be part of the, potty discussion.
• 0:46
  The 12-year-old in me is very excited about the concepts.
• 0:50
  Emily Wade (Host): All right.
• 0:51
  I'm really happy to have you here.
• 0:52
  Thanks for being game to talk about bathrooms, the unsung
• 0:56
  heroes of the medical world.
• 0:57
  Truly.
• 0:58
  we're trying to keep it classy.
• 1:00
  I'm gonna get to our question Dear.
• 1:02
  Office hours is breaking the seal.
• 1:05
  A real thing.
• 1:06
  It seems real to me, but is there any physiological basis for this phenomenon?
• 1:12
  When I go drinking with friends, once I go pee for the first-time, I swear I have to
• 1:17
  go back to the bathroom every 15 minutes.
• 1:20
  So I have a strategy.
• 1:22
  I always try to put off my first trip to the bathroom for as long as possible.
• 1:27
  Is that a good strategy or should I just heed nature's call?
• 1:31
  So what do you think Jeffrey?
• 1:33
  Jeffrey Held, MD: I get outta the concept.
• 1:34
  I'll confess, when you shared the topic with me, I had to look it up because in my
• 1:38
  day we called it renting beer, not owning it, And we didn't talk about the seal.
• 1:44
  there is no concept of breaking the seal in that your body has the urge to go.
• 1:48
  You need to go.
• 1:50
  There's nothing you need to do differently about your life.
• 1:53
  It just plan a little, more strategically when it comes to your bathroom breaks.
• 1:58
  Emily Wade (Host): So there's, there is no watertight hatch inside us.
• 2:03
  That's like bursting forth.
• 2:04
  This is.
• 2:05
  This is very disappointing.
• 2:07
  Jeffrey Held, MD: Uh, your bladder is not like a ship where it's sealed.
• 2:10
  You have a, muscle that holds things in, in check, and when the bladder
• 2:14
  gets full, it sends a signal to your brain saying it's time to empty.
• 2:18
  Emily Wade (Host): Whoosh.
• 2:19
  I love it.
• 2:20
  so what is going on behind this?
• 2:23
  The scenes then to make one beer equal three trips to the bathroom.
• 2:28
  Jeffrey Held, MD: The body has this kind of really cool mechanism
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  to regulate your fluid balance.
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  You know, we maintain a level of, OMFS, you know, the electrolyte
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  level so that it functions well.
• 2:41
  We have a hormone a.
• 2:42
  That is released in the body called Antidiuretic hormone, O-R-A-D-H, also
• 2:48
  known as Arginine, vasopressin or a VP or my personal favorite is Vasopressin.
• 2:53
  It is released at times when you're either fluid status is
• 2:58
  you're well hydrated, or you're not perfectly hydrated and you need to.
• 3:03
  Go to, empty your bladder or get rid of extra fluid.
• 3:07
  And then there are times where it will be released and it'll
• 3:10
  prevent that from happening.
• 3:12
  the, concept that I like to share is, if you're out hunting a wooly mammoth,
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  so a little while ago before my time, you didn't wanna feel the urge to go
• 3:20
  to the bathroom, To that wooly mammoth, that there's humans up downwind trying
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  to hunt it so your body would release the antidiuretic hormone during
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  times of stress or fluid hydration.
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  That is satisfactory with the idea that you'd kind of not have the
• 3:37
  urge maintaining that fluid balance.
• 3:40
  Emily Wade (Host): I'm really excited.
• 3:41
  We had a little anthropology going on in here.
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  Jeffrey Held, MD: That was my first-degree being an undeclared
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  without having to tell my parents.
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  See alcohol interferes with that process.
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  And so when you drink, it kind of sh shuts down that process that
• 4:01
  releases the anti-diuretic hormone.
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  And therefore the kidneys who are responding to this say,
• 4:07
  okay, nobody's telling me not to.
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  And they start.
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  Emptying out that excess fluid And that fills your bladder, sends
• 4:15
  you that stretch reflex and says you need to go to the bathroom.
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  The alcohol does two things there.
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  Not only does it inhibit the release of anti hormone, but it also kind of shuts
• 4:25
  down that frontal lobe That is telling you, oh, hold it, or ignore the stimuli.
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  So you're kind of more acute to things.
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  you're not as focused because you're slightly drunk.
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  And you have a full bladder, so that kind of gives you the urge
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  to go to the bathroom more often.
• 4:40
  Emily Wade (Host): This is, making.
• 4:41
  Lot of sense.
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  And also, that hormone came up in a conversation I had with
• 4:46
  Ali Sherwood about, hydration.
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  And I'm just wondering, is that kind of like dehydration also, um, something
• 4:55
  that's actually gonna contribute toward like having a hangover the next day?
• 5:01
  Jeffrey Held, MD: So you should always kind of fill up.
• 5:04
  Prior to drinking, but during drinking with pure liquid, not, alcohol is
• 5:09
  assuming it's liquid with the idea that you're gonna get rid of more fluid,
• 5:13
  more than you anticipated, more than your body needs you to get rid of.
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  So having some water nearby or alternating between your cocktail and your your VS.
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  Water.
• 5:25
  Emily Wade (Host): That's always, always a handy, handy thing to just
• 5:30
  order a drink, order some water.
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  Just rinse, repeat.
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  just to advocate on behalf of our strategic MIT listener, there's no
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  value in holding it as long as possible and just delaying the inevitable.
• 5:47
  you're just making yourself uncomfortable, right.
• 5:49
  Jeffrey Held, MD: Yeah, you're not only making yourself uncomfortable,
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  but in some cases put yourself at increased risk of urinary tract
• 5:55
  infection, depending on urethral size.
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  So my recommendation is you got the urge just.
• 6:01
  Take advantage of it and go and just be prepared to run between conversations.
• 6:07
  Emily Wade (Host): That's right.
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  Let's like embrace it as an opportunity to like get some steps in, just
• 6:13
  kind of like take a breather.
• 6:15
  embrace.
• 6:16
  The seal, the breaking of the seal.
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  Jeffrey Held, MD: The lack of a seal.
• 6:22
  Emily Wade (Host): well, the lack, the utter lack of a seal.
• 6:25
  Um, well, I have to say, to our listener, I'm, so sorry to let You
• 6:30
  know that, you know, our body does not have a submarine like hatch inside it.
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  That is.
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  Waiting to be broken.
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  And so your strategy isn't really backed by science, but at least we know why now.
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  So, make sure to use the bathroom, avoid those U UTIs.
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  But if you, if you have one, come see us.
• 6:51
  We we're here for you Jeffrey, thank you so much for being on here today.
• 6:55
  And just to kind of do a quick check, do you have any sort of suggestions
• 7:00
  for ways to, go out to the bar and, you know, party responsibly as it were?
• 7:08
  Jeffrey Held, MD: Absolutely.
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  Although I'll confess it's probably been 20 years since I've done
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  bar hopping, but, great memories and experiences I would rather.
• 7:15
  Recommend one.
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  You kind of eat before you go and drink, so your stomach is, able
• 7:20
  to tolerate the alcohol hydrate.
• 7:23
  Well, moderation is the key to life.
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  never push yourself in drinking and don't try to keep up with your friend
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  who can down six drinks fairly quickly.
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  There's no good outcomes from that.
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  If you, you're gonna leave to go to the bathroom for any
• 7:36
  reason, no matter who you are.
• 7:38
  Give your drink to a trusted friend.
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  Never leave a drink unattended.
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  make sure you have somebody with you who you can trust, while you're
• 7:46
  drinking, who will look out for you.
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  And, if you're, somebody who has a tendency to drink too
• 7:51
  much, just realize you're young.
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  Now, Those are habits that don't work well as you get older, And so
• 7:58
  thinking about moderation now and how to pace yourself more appropriately.
• 8:03
  And the other is you don't need five drinks to have fun.
• 8:05
  One or two is fine.
• 8:07
  stay young and healthy.
• 8:09
  even though that's against my own financial interest to tell you to stay
• 8:12
  healthy, I'm still gonna recommend.
• 8:14
  Emily Wade (Host): Thank you for your sacrifice.
• 8:15
  I really appreciate, those recommendations.
• 8:19
  And of course, if you need to see us over at MIT Health just for any reason, you
• 8:26
  can, always make an appointment with us.
• 8:29
  And in fact, we are always accepting new patient's in primary care.
• 8:33
  You can make an appointment@health.mi.edu.
• 8:38
  And also, Jeffrey, thank you so much for being on the show.
• 8:42
  You've been so awesome.
• 8:43
  So thank you.
• 8:44
  am excited to have you back again soon.
• 8:47
  to our audience, thank you so much for listening and, we've had some really cool
• 8:53
  questions come in in the last few weeks.
• 8:56
  So keep them coming in.
• 8:57
  go to health.edu/thrive
• 9:00
  and you can submit your question.
• 9:03
  Doesn't have to be a big one.
• 9:04
  Doesn't have to be, esoteric.
• 9:06
  We accept all questions and we're really excited to, Get you some
• 9:10
  more fun episodes out in the next few months, thanks for listening.