Dr. Yaniv Larish, a urologist and surgeon at Fifth Avenue Urology in New York City, begins every patient consultation with a disarmingly simple question: "Is your bladder being nice to you?" In a recent interview with HuffPost's "Am I Doing It Wrong?" podcast, hosted by Raj Punjabi and Noah Michelson, Dr. Larish unpacked this query, revealing it's a gateway to understanding a wide array of urinary health issues.
What Does a 'Nice' Bladder Feel Like?
According to Dr. Larish, the concept of a bladder being "nice" or "not nice" encompasses everything from frequency and sensation to what's left in the toilet bowl. He emphasizes that there is no universal "normal" number of daily bathroom trips. Hydration levels, environment, and activity drastically influence output.
"If you are stranded in the Sahara desert under the baking sun and 120-degree heat, your kidneys are going to do everything possible to hold on to every drop of water," Larish explained. Conversely, "if you're pounding those beers on a Saturday night ... you're going to make a lot more." The real question, he says, is whether you are properly hydrated or overly hydrated.
The Golden Rule of Urination: Relaxation, Not Pushing
One of the most common misconceptions Dr. Larish addresses is the act of urination itself. Healthy urination is about relaxation, not force. "You should be thinking about nothing when you're peeing," he advised. "It should be blank Zen. That's the golden rule."
A healthy voiding experience, he notes, involves a stream that starts easily, flows out completely in one quick go, and then stops cleanly. Warning signs include hesitation at the start, a prolonged standing time, or dribbling afterward. An urgent need to go again immediately after finishing is also a red flag.
Visual Clues in the Toilet Bowl
What you see after you pee can provide vital health information. Dr. Larish was unequivocal about one symptom: "The presence of blood in the urine is abnormal — always. It needs to be investigated." For younger people, concentrated, bloody urine can signal a kidney stone. For older individuals with a smoking history, it could indicate something more serious, like cancer.
Other concerning sights include mucus or what looks like gravel or sand at the bottom of the bowl. "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 warned.
An Unexpected Sign: Passing Gas While You Pee
Dr. Larish highlighted a lesser-known indicator of potential problems: if you consistently pass gas while initiating urination or trying to finish. "The bladder needs to contract on its own," he said. "If you're farting, that means you're using abdominal musculature... to squeeze on the bladder." This use of extra pressure suggests the bladder isn't emptying efficiently on its own and merits a medical evaluation.
Staying Attuned to Your Body's Changes
The cornerstone of Dr. Larish's advice is mindfulness. Being tuned in to changes in your body's baseline patterns is crucial. A sudden shift, like waking up multiple times a night to urinate after decades of uninterrupted sleep, is a significant change that warrants attention.
His final tips for urologic health are straightforward: stay hydrated in moderation, avoid overdoing unnecessary supplements, and seek an expert opinion if you notice persistent changes. The full podcast episode also covers topics like pee-shyness, the myth of sterile urine, and much more.
