Paruresis (shy bladder)

Paruresis (shy bladder): Causes, symptoms, and treatment

Paruresis—or shy bladder—is a syndrome with many different names, and while it may sound silly, it is real. Paruresis, bashful bladder, pee-shy, bathroom phobia; no matter what term is used by the person who has the syndrome, the bottom line is that it can be very frustrating to live with.

Paruresis is a urinary disorder of psychological origin. If affects the sufferer’s ability to urinate. Basically, it is like an anxiety or a phobia where a person has difficulty peeing or just can’t urinate in certain situations. For example, if there is limited privacy in the public washroom or a person thinks that others can hear them, they may be unable to go. People with shy bladder syndrome often have a hard time at the doctor’s office when they are asked to provide a urine sample.

What causes paruresis?

Scientists have determined that people with paruresis don’t have poor functioning urinary systems; they do feel really nervous about peeing though. The question is why?

Shy bladder causes can be traced back to potty training or early school days. If you have the syndrome, it could be that you were criticized a lot during potty training or you were made fun of in the washroom at school.

When you have performance anxiety, part of your nervous system fills up with adrenaline and the muscles that let you empty your bladder just freeze up. When it comes to urinating in a public washroom, people with paruresis report that there are a few different things that prevent them from being able to go:

  • Lack of privacy—more common in men’s washrooms
  • Emotions—anger, fear, or a sense of pressure
  • Who’s with them—being surrounded by people they don’t know or don’t like

There are people who feel so anxious about using a public washroom that they will go to great lengths to avoid them. This may sound odd to those who have never experienced problems peeing, but research shows that at least 20 million Americans have this syndrome.

Is shy bladder similar in everyone?

As with most anxiety disorders, one person’s experience can be different from another. For some, going to the washroom is possible as long as there is a closed door, but for another, a door might not make a difference; it could be just the thought of someone hearing them that makes them too anxious to go. In the majority of shy bladder cases, urination is difficult or impossible with strangers around.

Another common factor is time pressure. When a person thinks they are being rushed and they have a limited amount of time to use the restroom, it can be hard for them to actually urinate. Performance expectations are also a big problem. For instance, if a person has to give a urine sample for a test, they might find themselves freezing up. In other words, they have a hard time peeing on demand even though their bladder is full.

Shy bladder symptoms

If any of this sounds familiar, then you just might be one of the millions of people who have a shy bladder. Symptoms usually begin mildly, but often become worse as a person becomes more aware of their condition. Here is how it can play out:

  • First unpleasant washroom experience
  • Worrying about not being able to go the next time
  • Voiding as much as possible when you are at home
  • Drinking less fluid so you don’t feel the need to pee
  • Searching for empty public washrooms
  • Avoiding social life so you are close to your home washroom

In extreme cases, rapid heartbeat, shaking, sweating, and even fainting can occur. The sad part is that many people who experience these symptoms think that they are the only ones who have this problem. They are very reluctant to discuss it with anyone, including their doctors.

Treatment for shy bladder

While there is no quick fix, there are options for paruresis treatment. A few common methods are outlined here.

  • Social: Some of us are not social, but those who have a shy bladder and become more social and get to know more people tend to find they are less affected by the syndrome.
  • Relaxation: Taking deep breaths, focusing on pleasant imagery, or meditating can relax the mind, make you less anxious, and thus able to perform.
  • Cognitive behavioral therapy: This can help you get to the root of the problem, through consultation with a therapist.

When anxiety is extreme, prescription medication may be necessary. Anti-anxiety medication should be a last resort, and if you are going to take it, you should be closely monitored by your doctor. Some people take medication temporarily while they work towards other coping methods.

Some may find that hypnosis can manage their paruresis. Hypnosis is described as altering your mental state or a trance, marked by a level of awareness that is different from your original state of consciousness. Hypnosis can be used to address the very issue creating your shy bladder, teaching you to use your unconscious mind to overcome the problem.

Hypnosis can be used to address anxiety, helping you relax and ignore your surroundings while you urinate. You can perform self-hypnosis or seek help by going to a hypnotherapist who can guide you and provide appropriate treatment measures.

Tips for overcoming paruresis

Shy bladder treatment can be a long process. Sufferers often find that one method of coping doesn’t work and they have to move on to trying a different one. The good news is that if you keep trying various methods, you have a good chance of finding something that will work.

Here are some tips worth considering if you are suffering from paruresis:

  • Trust your instincts and relax: Urologists say you should trust your natural body impulses. If we relax, our bodies often unconsciously carry out normal functions without us even thinking about it—this includes urinating. Yoga or some form of meditation can prevent or lower the level of anxiety being experienced and allow the bladder to do what it’s meant to do.
  • Graduated exposure therapy: This is when you intentionally expose yourself to the situation that is causing you anxiety to face that stress head on. The idea is that you will learn to cope.
  • Use distraction: Some people find that when they distract themselves with other thoughts or actions, they have a much better chance of voiding the bladder. How you distract yourself is up to you, but some people read, listen to music, or flip through their cell phones while they are using the toilet.
  • Take a friend: Taking a trusted friend who you know is not judgmental can be less nerve-wracking for some people who suffer from a shy bladder. If you are in stalls side-by-side, try talking while you are trying to urinate.
  • Hold your breath: This can increase the level of carbon dioxide in your body, which reduces stress. It also causes the urinary sphincter muscle to relax, which will help you urinate.

Complications and prognosis of paruresis

 Having a shy bladder can present with several complications, both physical and psychological. These include an increased risk of urinary tract infections, weakening of the pelvic floor muscles, and the increased chance of kidney stone development. Your behavior may also be affected, causing you to become more anxious and avoid going out in public. This may also make it difficult to maintain relationships or work alongside others.

Unfortunately, many of those with paruresis never seek treatment for their condition, causing the condition to go unresolved indefinitely. However, those who do take the chance of finding help have a good rate of success overcoming their fear and anxiety, with recovery times typically being a year or more.

Paruresis is a syndrome that can strike at any age, but the majority of sufferers who do come forward report that they developed the problem in their teenage years. It is also interesting to note that many people who suffer from shy bladder find that it becomes less of an issue as they get older.

It is important to see a doctor if you have any difficulties with urination. You may or may not have paruresis, but a proper examination by a health care professional can rule out any physical problems and steer you in the right direction.

Related: What causes bladder pressure and how to relieve it


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