Active item (infinite use)Makes Isaac pull out (or put away) the Bladder that, while out, can be fired by holding the shooting buttons in any direction. Charging the Bladder will upgrade it to the next stage up to Bladder 6.
Charging the item is done by clearing rooms unless playing as Tainted !!! in which case charging requires dealing damage. Taking damage will lower the Bladder's level by 3.
Bladder level 0 No effect.
Bladder level 1 Shoots a widespread amount of 6 tears that deal 1.75 damage, similar to a shotgun. Pushes back Isaac on shoot.
Bladder level 2 Shoots 3 tears in a row with a high shot speed and Isaac's damage.
Bladder level 3 Has a low fire rate and, on shoot spawns a kidney pee mine that will explode with a small rain of yellow tears, damaging yellow creep and spawning 2 Pisslings.
Pisslings are pee counterparts to friendly Dips, which will jump on enemies while splashing a few low-damage yellow tears.
Bladder level 4 Launches a giant lemon-shaped kidney stone in an arch similar to Ipecac that explodes into a rain of tears and spawns creep on contact that deals 2 damage per tick (20 per second).
Bladder level 5 Shoots a long wave of creep, similar to Blood Cultists' attacks, with tears shooting out of the creep which deal 7 damage. The creep deals 1.25x Isaac's damage, 10 times per second.
Bladder level 6 Shoots a constant Brimstone beam that is fully rotatable, dealing 1.25x Isaac's damage, 15 times per second.
Using the Brimstone continously for long enough will cause it to burn out, making it unusable. Burnout reduces while the Bladder isn't used.
Unlock: Defeat Delirium as Tainted !!!.