How can you help your bladder? Depends

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This column first appeared in Ante Up Magazine in January 2009.

Recently I was watching a rerun of a 2005 WSOP event and I noticed Josh Arieh seemed very nervous. As he glanced at his cards, a tiny bead of sweat formed on his forehead. He sighed and then rubbed the back of his neck. He glanced briefly over his shoulder toward his wife behind the rail and gave her a slight nod. He was giving off a series of significant tells but I wasn’t sure what they meant.

Clearly Josh was under considerable stress. Did he have a big pair? Was he contemplating a bluff with rags? Maybe he was going to shove. If fellow Ante Up columnist Joe Navarro were watching this, he’d know what was going on.

When the action came around to Josh, the cause of his distress became clear. He tossed his cards into the muck and leaped up from his chair knocking it over. He sprinted off toward the rail reaching it just as his wife unhooked the velvet rope. He then dashed toward the bathroom, a victim of too many bottled waters, coffees, Red Bulls and/or beers.

Bladder control: the nemesis of tournament poker. Jack McClelland, director of poker operations at the Bellagio once said, “To be a poker champion, you must have a strong bladder.” The breaks are too few and too short; the distance to the facilities is too far and the lines are too long. Are there any solutions to this dilemma?

First, let’s establish some baseline information. The kidneys dump about 50 cc (a little less than two ounces) into the bladder every hour. This number can change a lot depending upon how much you’ve had to drink and whether you’ve taken in anything with a diuretic effect (more on this later). The average bladder feels the urge to go at about 350 cc (about 12 ounces or 1.5 cups). This urge can be voluntarily suppressed up to about 600 cc before it becomes unbearable. There are some muscular exercises to suppress that urge, but ignore it too long and the muscular wall can become overstretched and may not be able to empty completely. Incomplete emptying is a common cause of infection.

There are some sex differences. Any guy who has taken a lady on a road trip knows that generally men have larger bladders than women. (“Would you pull over at the next McDonald’s, Sweetheart?”)

Also, external male anatomy provides an extra measure of muscular control. If you don’t understand this difference, you are playing far too much poker.
Normally, in a cash game, there’s not too much of an issue. Skip a hand or two. Hit the head. Get back in action.

Tournaments, live and online, are what cause the problem. Once the blinds and antes start eating up a significant portion of your stack, missing even a few key hands can really affect your chances to cash. So, what can you do?

First, cut back on the fluids. Despite what you’ve heard, there’s absolutely positively no medical literature to support the common belief that you should drink some magic number of glasses of water every day. If you can find a real medical research paper that says otherwise, show me. Otherwise, as you near the final table, you can cut back on your fluids. It’s OK.

Second, avoid things that make you want to go (called diuretics) like caffeine, colas, coffee, tea, chocolate, artificial sweeteners and beer. Of course, if your doctor has you on a prescription diuretic for health reasons, for gosh sakes, take it. Also, you should avoid spicy and acidic foods like citrus juices and fruits and especially tomatoes that can irritate the bladder wall and give you that urge to go.

Now, for a radical idea, what about a catheter? At first look, it seems a bit extreme to have a tube inserted into your bladder and attached to a bag just to play poker, but there are some people with control problems who truly need this level of help. There have been armless players and blind players in the WSOP. I’m guessing there are probably dozens of players discretely using catheters and leg bags.

“Not for me!” you say? Well, what about something not quite so extreme? There is a medical device that resembles a condom with a very long reservoir tip that ends in a leg bag. The name of this device is oddly appropriate: the Texas Catheter. Nothing is inserted anywhere and it’s relatively comfortable (I’m told).

So, maybe this has gotten a little out of hand. The point is you don’t want to overstress your bladder by holding it too long, yet you don’t want to miss too many crucial hands because you need a potty break. Cut back on fluids, avoid diuretics and understand that if your control isn’t as pristine as you’d like, there are some devices that can help. Then buy a round of drinks for the table and smile as they squirm.

— An avid poker player, Frank Toscano, M.D. is a board-certified emergency physician with more than 28 years of front-line experience. He’s medical
director for Red Bamboo Medi Spa in Clearwater. Email your poker-health
questions to ftoscano@redbamboomedispa.com