ברכות כב,ב
תָּנוּ רַבָּנַן: הָיָה עוֹמֵד בִּתְפִלָּה וּמַיִם שׁוֹתְתִין עַל בִּרְכָּיו — פּוֹסֵק עַד שֶׁיִּכְלוּ הַמַּיִם וְחוֹזֵר וּמִתְפַּלֵּל. לְהֵיכָן חוֹזֵר? רַב חִסְדָּא וְרַב הַמְנוּנָא, חַד אָמַר חוֹזֵר לָרֹאשׁ, וְחַד אָמַר: לְמָקוֹם שֶׁפָּסַק
The Sages taught in a baraita: One who was standing in prayer when, for some reason, urine is flowing on his knees, he must interrupt his prayer until the urine ceases, and then resume praying. The Gemara, asks: To where in the prayer does he return when he resumes his prayer? Rav Chisda and Rav Hamnuna disagreed; one said: He must return to the beginning of the prayer, and the other said: He must return to the point where he stopped.
It’s OK to talk about it - The Talmud did
Worldwide, it is estimated that over 120 million men and over 300 million women have experienced a degree of urinary incontinence. And the problem is growing rapidly. We may shy away about speaking about it, but let’s take a lesson from today’s page of Talmud, which took the first step: it acknowledged that the problem exists.
Estimated numbers of those with urinary incontinence. From Irwin DE. et al. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU International 2011:108; 1132-1139.
Prevalence and Causes of Urinary Incontinence in men
Today, incontinence in men is far less common than in women, and this would have been true in talmudic times as well. According to a 2009 survey of the field, the estimated prevalence of urinary incontinence in men varies from 11% among those aged 60 to 64 years to 31% in older men, and from 16% among white men to 21% among African American men. Daily urinary incontinence was reported by 30%-47% and weekly incontinence by 15%-37% of community-dwelling men (that is, men who do not live in a nursing home). Here is what we know about the risk factors for male urinary incontinence:
Things that are associated with an increased risk of urinary incontinence:
Age, body weight, poor health, depression, diabetes, use of diuretic medications, cognitive impairment, memory problems, urinary tract infections, prostate disease, prostate surgery (which would not have been a problem during talmudic times),
Things that aren’t associated with an increased the risk:
Ethnicity, education, marital status, alcohol, smoking,
Things that are associated with an decreased risk:
Physical activity, coffee
Prevalence and Causes of Urinary Incontinence in women
Urinary incontinence (UI) is far more common in women across the age span, as you can see in the graph below. In a review of population studies from numerous countries, the prevalence of UI ranged from about 5% to 70%, with most studies reporting a prevalence of any UI in the range of 25–45%. Even in women who have not had children, about 17% have experienced UI. There appears to be a degree of genetics involved, since having a first-degree female family member with stress UI increases the risk for a woman becoming afflicted by the same disorder.
The main risk factor for women is pregnancy. According to a 2019 review of the topic, “pregnancy in itself, independent of labor and delivery practices, seems to be a risk factor for postpartum UI, especially if the incontinence started during the first trimester. During pregnancy, the prevalence of UI increases with gestational age so that more than half of all women report UI during the third trimester.” The good news is that in uncomplicated courses of pregnancy and labor, UI usually declines rapidly during the first 3months following childbirth, which suggests that most symptoms are part of a normal pregnancy and delivery.
Comparison of the prevalence of urinary incontinence in women and men of the same age resident in the same urban population. From Milso, I. Gyhaged M. The Prevalence of Urinary Incontinence. Climacteric 2019: 22 (3); 217-222.
Can you Pray while attached to a Urinary Catheter?
From here.
A Foley catheter is a tube that extends from the bladder through the urethra and into a bag. There are many reasons that a person might need to be attached to one, like following abdominal surgery or a complication of childbirth. May a Jew pray but while attached to this device?
Among the first rabbis to consider the question of the Foley catheter and prayer was the late Eliezer Waldenberg, (d. 2006) who was the head of the Jerusalem Rabbinic Court (Bet Din). In a 1964 responsa he ruled that a person may indeed pray while attached to a Foley and a urine collection bag, and he cited today’s page of Talmud. Among his reasons was a sensitivity to the need of the patient to be able to pray, and the fact that the Talmud did not forbid prayer within four amot of urine, (unlike the ruling regarding excrement or a bad smell, which we will address in the next installment of Talmudology). In his responsa he reviewed multiple possible objections to his ruling, which is why it stretched to twelve pages (!), and he concluded that so long as the collection bag was covered during prayer, the patient may not only pray, but wear a prayer shawl and phyalcteries (a tallit and tefillin). Rav Waldenberg’s ruling is a reminder that urinary incontinence and a prayerful life can peaceably co-exist.
