Frequently Asked Questions About Shy Bladder Syndrome. Everything you can possibly want to know about Paruresis … and more!
If you can’t find the answer you’re looking for then just ask!
How Is Paruresis Pronounced?
Paruresis is pronounced Parr-yur-ee-sis. Anyone suffering from the condition is called a Paruretic.
What Is The Origin Of The Word?
The term Paruresis was first used by Williams and Degenhart back in 1954. This is when they wrote a paper entitled “Paruresis: a survey of a disorder of micturition”. It was published in the Journal of General Psychology 51:19-29 and first officially recognised the condition.
It’s the official medical term which stems from Latin origin where it means abnormal urination.
What Is The Definition Of Paruresis?
According to Collins Dictionary Paruresis is simply “a psychological inability to urinate in the presence of others”. This doesn’t just mean when in the physical presence of others it could also be in the imaginary presence of others. For example when there is a danger of someone walking in or someone else may be around. This could be when in a public rest-room. It can also prevent urination when under time pressure, or on trains, planes or other vehicles.
Is Paruresis Known As Anything Else?
There are a number of common alternative names for paruresis (see The Different Names Of Paruresis):
- Avoidant Paruresis.
- Shy Bladder Syndrome.
- Shy Bladder.
- Bashful Bladder.
- Pee Shy.
- Psychogenic Urinary Retention.
Is Paruresis A Medical Condition?
Shy Bladder Syndrome is not a medical condition in the physical sense. Instead, it’s a common type of social phobia also known as Social Anxiety Disorder (SAD). This, in turn, is defined as a fear in one or more social situations which causes: “considerable distress and impaired ability to function in at least some parts of daily life”. (Taken from Wikipedia)
The American Psychiatric Association (APA), is the professional organization that develops and publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM). They’re currently on version 5. It is this that is used by clinicians and researchers to diagnose and officially classify all mental disorders.
If you want to purchase the latest DSM you can do so via the Psychiatry Online website.
Is Shy Bladder All In The Mind?
In basic terms, yes. It’s your mind that’s causing the issue which is why it’s officially diagnosed as a Social Anxiety Disorder or SAD as it’s often referred to for short.
To qualify as an official SAD, any social anxiety disorder must not be caused by a medical condition or as a side effect of drugs or medication. It has to be proven to be a persistent (usually going on for more than 6 months), continuous, recurrent fear of some kind of social situation This is whereby the person is exposed or even just potentially exposed, to possible scrutiny by others and the resulting fear that they will show signs of anxiety and, as a result, be ill judged, embarrassed or ridiculed in some way.
Any exposure to the unreasonably and excessively feared situation will result in symptoms of anxiety. Left unchecked these symptoms can worsen to the point whereby exposure to the situation will be avoided or anxiety becomes extreme. This can result in great distress and affects everyday life, social life and relationships.
There’s a really good summary over on the Social Anxiety Institute website.
How Does Shy Bladder Stop Me From Peeing?
As we said, there’s no medical condition and there’s nothing wrong with the workings of the urinary tract. Basically there are two muscles which control the flow of urine from the bladder to the urethra. These muscles are called the urethral sphincters. They must be relaxed to allow flow. Paruresis causes anxiety about peeing in public which stimulates the nervous system to clamp these muscles shut and prevents urination.
It’s a vicious circle too. Failure to pee increases anxiety and makes matters worse!
Do I Need To See A Doctor?
Whilst Paruresis isn’t a medical condition similar symptoms can be caused by a physical ailment such as prostate problems. For that reason we always suggest this should be your starting point.
Your practitioner or urologist will also be able with help and advice in relation to therapies and support groups too.
How Common Is Shy Bladder Syndrome?
It’s probably a lot more common than you’d think. Believe it or not it’s actually one of the most common forms of Social Phobia.
Whilst there could be a strong argument for further studies right now, historical research suggests that it affects:
- Up to 17 million Americans.
- 3.25 million Canadians.
- 51 million Europeans.
That’s around 7% of the population who suffer from Paruresis … to varying degrees. !
I’ve Never Heard Of It Before – Is It Really That Common?
Is it the sort of conversation you overhear in public places? Have you ever discussed it with your friends or family? That’s right, it’s one of those conditions which people are embarrassed or ashamed to discuss. But that doesn’t mean it’s not out there. Believe you me … it is! It’s nothing to be ashamed of and it should be discussed more and awareness needs to be increased (we’re trying to do our bit!).
So, the answer is yes! It really is that common and is probably one of the least spoken about social phobia there is.
Does Bashful Bladder Only Affect Men?
No. Paruresis affects both men and women although it tends to affect men more. This is because of privacy issues … women don’t have a row of open urinals to contend with!
When you think about it, shy bladder probably affects people in just 3 ways:
- Difficulty in peeing in a public urinal but fine in a public restroom cubicle.
- Can’t start a stream in a public toilet cubicle but no problems at home.
- Difficulty when people are around at all times … even the home environment.
So, that means that women can only be affected by 2 of the above 3 symptoms.
In addition, it’s also probably true (again for the reasons above) that there is a reduced awareness of the condition amongst women.
How Is Shy Bladder Syndrome Diagnosed?
In a position where you find it hard to start a flow? It’s important to first check it out with a medical professional before you do anything else. Whilst, as stated previously, paruresis is a form of social anxiety you should ensure there’s no underlying medical condition behind the symptoms. Whilst not too common there are certain issues (often relating to the kidneys, bladder or prostate), that need to be checked first by a urologist.
If there’s no medical condition then it’s a question of trying to establish the root trigger that started the paruresis ball rolling. This is often easier said than done!
What Causes Paruresis or Shy Bladder Syndrome?
This is the big question and the answer is going to be different every case! It’s specific to each individual paruretic.
It’s a social anxiety – a kind of phobia. As such some thing, or some event, at some historical stage triggered the sub-conscious mind into programming itself to prevent the easy flow of urine when others are present or if there is a chance of others being around.
Typical triggers can occur at any stage of life. That said, they are most often associated with childhood or adolescence. It could have been as simple as criticism or pressure during potty training. Maybe it was some form of teasing or bullying in a school bathroom or public restroom. Alternatively it may have been triggered as a result of time pressure surrounding a urine test. It was some specific time when the person was ridiculed, judged or made to feel embarrassed about something relating to the way they pee or the time it took. Something historical is causing the mind to clamp shut the urethral sphincters. Establishing the root cause will make it easier to effectively re-program the mind to function normally.
Think back to recall an event that may just have been the start.
Can It Or Does It Get Worse?
Yes – most definitely. Paruresis will normally worsen if left untreated.
The mind is a complicated thing that recalls historical events which in turn can trigger a natural (but irrational) reflex in the body.
The first time you’re affected by shy bladder or have trouble peeing can be the start of that snowball rolling downhill and getting bigger and bigger. Next time you go to the toilet in similar circumstances your mind will pipe up “hey … remember last time you couldn’t start a flow cos someone was next to you?” and your body will shut off the flow. Next time you’re on your way to the restroom it could be you get this reminder before you even reach the restroom. It can further develop into thoughts like “so … you’ve been invited out on a hot date … but what if you need to pee?” In quite a number of cases paruretics don’t go out because of the condition!
It can affect life to that degree so it needs treatment as quickly as possible to stop it taking over your life.
Is There A Cure For Shy Bladder Syndrome?
Paruresis, as we’ve stated several times, is NOT a medical condition but a Social Anxiety Disorder. It can be fairly complex too. There’s no magic pill. No miracle drug that’s going to cure it. However, in answer to the question, we state a resounding YES … there IS a cure.
The cure itself lies in re-setting the mind. To make it automatically react in a rational manner and not to shut down the flow of urine when presented with certain situations. It’s a simple as that!
There’s various ways to do this. It’s no an overnight cure but, we can assure you that, with a little patience and full commitment, you can be cured.
Is Avoidant Paruresis Something Different?
Not really. It’s the same condition but this name refers to the fact the the paruretic avoids exposure to certain environments because of the condition. An avoidant Paruretic will therefore avoid situations that make it difficult or impossible for them to be able to pee. This may mean not attending social events, not going out with friends or, in extreme circumstances, rejecting a job offer because of urinary drugs tests.
What Is The Treatment For Paruresis?
Treatment is based around fixing the mind to respond rationally when presented with a situation which currently causes anxiety. There are several proven and recognised ways in which we can do this:
Cognitive-Behavioral Therapy For Paruresis:
CBT (as it’s better known): A highly recognised type of psychotherapy. The process examines a person’s thoughts, beliefs and attitudes in relation to paruresis and looks at how they affect their emotions and behaviours. Sounds complicated but it isn’t! It’s basically looking at how the sub-conscious reacts right now and then teaching the mind to act in a different way automatically. Put simply it modifies and corrects dysfunctional emotions, behaviors, and thoughts. It’s recognised as one of the most effective ways of treating all kinds of social anxiety.
Read more about Cognitive-Behavioral Therapy For Paruresis >>>.
Graduated Exposure For Shy Bladder Syndrome:
Graduated Exposure Therapy: Basically about practising and gaining confidence. It’s a process in which the paruretic is gradually introduced to using public restrooms in circumstances which gradually get more and more challenging. Gaining confidence in each situation before progressing to the next even more challenging environment. This is often much easier with the support of a trained therapist or an understanding friend known as a “pee buddy”.
Read more about Graduated Exposure For Shy Bladder Syndrome >>>.
Breath Hold Technique For Bashful Bladder:
Proceed with caution! Always discuss with a medical professional before taking this route. This technique is proven to work but better results have been reported from paruretics who are OK with urinating when others are around – but only when they can get a flow started and that’s where they often have a problem.
The process, as the name suggests, involves holding your breath for as long as you can and need to in order to allow your muscles to relax. Thus resulting in a urinary sphincter so relaxed it will allow you to pee. Holding your breath results in an increase in carbon dioxide in the bloodstream which has been reported to help reduce many forms of anxiety and create a more relaxed bodily state.
Read more about Breathe Hold Technique For Bashful Bladder >>>.
Water Cure For Paruresis:
Often talked about but this is a technique that we’ll tell you about but do not endorse. Basically, water cure works on the principle that if you really need to pee then your body will let it go … no matter where you are. This treatment therefore involves drinking more water to the point where you simply HAVE to go. Whether it works or it’s simply a myth it comes with its dangers.
Read more about Water Cure For Paruresis >>>.
Self Hypnosis For Shy Bladder:
Hypnosis For Shy Bladder – an underrated treatment we feel! Hypnosis can teach you to re-train your subconscious mind to easily urinate when in the presence of others. We suggest you try out a self hypnosis treatment which can be much more cost effective than expensive sessions with a professionally trained hypnotherapist. It will also enable you to do it at your own pace and at convenient times. There are specific self hypnosis programs for shy bladder syndrome.
Read more about Self Hypnosis For Shy Bladder >>>.
Drugs To Help Against Pee Shyness:
Whilst a simple pill is not going to cure paruresis there are certain types of medication that your physician may prescribe in order to help. There are basically four types of medications which can help. But only in certain situations and when prescribed professionally:
- Medication to relieve anxiety.
- Muscle relaxants which target the bladder muscles.
- Medication to reduce urinary retention.
Under no circumstances should any such medication be administered without medical supervision.
Paruresis Support Groups:
A problem shared is a problem halved as the saying goes! And that’s pretty true we feel. It’s always good to open up to others in a similar situation to you, or someone who’s already been through what you’re going through right now. Find support and advice, practise different techniques and share stories with others who understand.
Believe it or not there are more than 80 such support groups across the US, a full network in the UK and all over the world.
Find out more about Paruresis Support Groups >>>.
Paruresis Treatment Programs:
There are a number of comprehensive treatment programs which cover all treatments, establish the optimum treatments that prove effective in individual cases and that really do work.
We have one which we particularly recommend – it’s aptly called the Overcome Shy Bladder Program.
Read more about our recommended Paruresis Treatment Program >>>.
Does Hypnosis Work For Shy Bladder Syndrome?
Yes, it really does. We’ve witnessed some great results through hypnosis and even self-hypnosis. There are even specific self- hypnosis programs for paruresis.
We suggest you Read more about Self Hypnosis For Shy Bladder >>>.
How Long Does Shy Bladder Treatment Take?
That’s completely down to you. It depends on your commitment and the severity of your particular symptoms.
If you’re hoping for an overnight solution prepare to be disappointed. It’s simply not going to happen that fast. You’re looking at reprogramming your minds automatic responses and that’s going to take a little time … and plenty of repetition.
That said, some sufferers have reporting significant improvements after just a few days of workshops or professional therapy. Many more report improvement after a few months. But for the older, long termers then you could be looking at over a year to fully recover.
Don’t set yourself a time target – find a treatment that suits you, stick to it and you WILL make a full recovery.
Do I Need To Tell Anyone That I Have Paruresis?
No, not if you don’t want to.
We understand that it’s one of those conditions that’s rarely discussed or in the public eye. It’s stigmatised and can be the subject of ridicule or embarrassment. But it really is nothing to be ashamed of and, with it being so common, it should be talked about more.
There are so many people out there who suffer just like you (and many have symptoms which are far worse) so, whilst you don’t have to tell anyone, why not find others in a similar situation and connect with them. This could either be through the likes of support groups or social media. Sharing, opening up and talking is proven to aid faster recovery.
With regards to your nearest and dearest? Again, you don’t have to tell them as you can treat yourself in complete confidence. But why not share it with them – it could really help? They’re not going to judge you and, after all, they’ve probably already noticed! At least then you’ll have someone to talk to and who can help and encourage you with the treatment.
There is always the exception and, in this case, if you are going to be facing compulsory urine testing for whatever reasons you’ll need to it officially recorded in advance and get a doctors letter. See question and section below regarding paruresis and the urine test.
I Need To Take A Urine Test – What If I Can’t Pee?
This is a tough one. Urine tests are required for a variety of reasons – police, prison, work place, sporting or medical. They may be compulsory or optional. However, they always provide that extra pressure to perform.
Facing the prospect of urine testing (either a single test or a regular regime)? You’re going to need to tell someone. That’s because, right now, an inability to provide a urine sample is treated as refusal to provide one. Get it officially recorded and documented via your own doctor, medical specialist or legal representative. You need to cover yourself.
Work is going on behind the scenes to get this changed. The International Paruresis Association is pushing hard to reform what they regard as discriminatory treatment of paruretics. Yo can read their article on Urinalysis Drug Tests & Disability Discrimination Under the Americans with Disabilities Act (ADA). Their position is simply: “If a person with paruresis needs a drug test for any reason, a method must be provided that doesn’t require a urine sample.”
What You Can Do Now:
But that’s for the future. Right now the onus is on you to provide the urine sample. That’s why your only other option may be to use a urinary catheter. You’ll need to schedule an appointment with a urologist who will be able to teach you how to use one and you will be able to practise before any testing. Basically, suitable for both men and women, this is a very thin and flexible tube which is inserted into the bladder via the urethra. Once in place it allows the free flow of urine from the bladder.
Sounds painful but it’s not. Sure, it’s a little uncomfortable but with a little practice you’ll soon get the hang of it and this may be your solution to testing concerns.
So, if you know of impending urine testing:
- Record and document to shy bladder condition with your doctor. Ask for an official letter to that effect and confirming your diagnosis.
- Familiarise yourself with current relevant rules with regards to the tests you will be facing. Know your rights.
- Start a treatment program right away. You may have the situation under control in time for the test.
- Consider the use of a urinary catheter.
What Are The Best Paruresis Books And Resources?
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International Paruresis Association: www.paruresis.org/.
UK Paruresis Trust: www.ukpt.org.uk/.
Paruresis Association of India: www.paruresisassociationofindia.org/.
The Paruresis Association Of Australia: www.paruresis.org.au/.
National Library Of Medicine: https://pubmed.ncbi.nlm.nih.gov/.
Medical Net News: https://www.news-medical.net/health/Paruresis-Shy-Bladder-Syndrome.aspx