Paruresis – A Condensed Overview Of Shy Bladder Syndrome: Paruresis is typically characterized by either the difficulty or, in many cases, the complete inability to urinate in the presence of others or in social circumstances or, as officially recorded, “the inability to initiate or sustain effective urination (micturition) in situations where there is a perception of scrutiny, or potential scrutiny, by others”. It’s also accompanied by the paruretics (those suffering with paruresis) avoidance of such situations and it’s this effect that can be life changing.
The condition itself is the fear of NOT being able to urinate and having people notice. It goes by many other names – shy bladder syndrome, bashful bladder, urophobia, pee shyness, public piss syndrome (not my favourite term!) amongst others. It effects both men and women but is more prevalent in men. The condition was first officially recognised back in 1954 by psychologists Williams and Degenhart who conducted a survey of paruresis symptoms in over 1400 university students.
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The Cause Of Paruresis
When I ask paruretics to pinpoint the exact catalyst for the onset of their condition most struggle. But there’s always something that set it off. Some event at some stage along the lifeline that started the anxiety. In my case it took me a while to identify what started it as it was a long time ago and the symptoms developed gradually over the years since then.
Often, as in my case, this initial trigger stems right back to childhood. It typically relates to one of the following categories:
- Physiological Factors. The condition itself is not a physical one but the cause could be a result of a catalogue of historical medical conditions which has left a psychological scar.
- Genetic Anxiety. Is anxiety passed down through the genes? I personally don’t believe it is but it’s true you’re very likely to inherit parental traits. And so, if your parents were prone to anxiety, it is possible that you have picked this up as you’ve gone through childhood.
- Environmental Factors. This represents the main stimulus and is worthy of it’s own section below:
Environmental Factors Causing A Shy Bladder
By environmental factors I’m mainly referring to some historical event that first cause the mind to “malfunction”. This in turn then progressed and developed into a significant anxiety disorder. Typically this can be traced back to some form of traumatic event involving the individual and, as I already said, often in childhood years.
The most common restroom related events are; embarrassment, bullying, harassment, teasing and peer pressure. In very extreme cases it’s known to relate to sexual abuse.
I’ve written an article that explains things in more detail called; Understanding The Triggers Of Shy Bladder Syndrome.
The actual event that kicked things off for you may, especially looking back at it, be something you regarded as fairly trivial at the time. But the issue festers in the back of the mind and the anxiety increases over time.
What Actually Happens In Your Body – Causing This Inability To Pee?
You weren’t born with a shy bladder, it’s developed from a specific cause as discussed above. What has happened is that your mind has malfunctioned and the automatic rational response that you first had in relation to going to the toilet in a public restroom has been replaced by an irrational response that decides you should not pee and you’re being judged.
When the social phobia is triggered it causes a tensing of the muscles. The anxiety that comes with it can also affect your pulse and blood pressure (you may be interested to test this out). This tensing of the muscles in turn affects the urinary sphincter. This is the muscle that prevents urine to leak out and needs to be relaxed so that the urine can pass. But in public, when you start feeling ‘shy’, this muscle refuses to relax and you cannot clear your bladder.
What Situations Can Trigger A Paruresis Reaction?
There can be a whole range of different situations. I’ll explain it up by giving a few examples:
- A busy toilet in a public arena. Typically this could be a restaurant, bar, sports arena, theatre or concert hall. Any public restroom where others are either in the room or highly likely to come in.
- At someone else’s house or apartment. This could be a party or dinner party when there will always be other people around.
- In more extreme cases this could even be in your own home when you have visitors or guests.
- Even single, lockable toilets can represent a problem. Especially if there’s someone waiting or likely to try the handle!
You get the basic idea; anywhere there are people to either see or hear you passing urine the reaction triggers.
Paruretics are irrationally believing that those who can hear or see them are judging them or thinking unkind things about them. In fact, like all phobias, this fear is quite beyond rationality. The other person also goes to the loo and pees – but you will never stop to think that! The paruretic knows that deep down but can’t control the thoughts.
The result – an inability to pee.
Shy Bladder – Just How Bad Is It?
The severity differs from person to person. Left unchecked, will worsen over time.
There are varying degrees of severity. To some men it’s only an issue when in a compact, busy and full public restroom where they cannot choose where to stand and the urinals are close together with no privacy screens, to those higher up the scale it could be a smaller empty restroom with just a couple of urinals meaning that if someone else came in they would have to stand right next to them. To others, men and women, it could be that even if using a private cubicle they still have an issue and, at the most extreme level, even a restroom for one with a lock on the door presents an issue.
You get the picture I’m sure. The worse it gets the more restrictive life becomes.
The Effects Of Paruresis
The anxiety has the power to affect quality of life significantly. Many paruretics have reported that they have limited, restricted or even turned down travel because of their condition. It’s commonly reported that a third of sufferers avoid parties, public events, social events and even dates as a direct result of shy bladder syndrome. In more extreme cases job offers have been turned down because of urine drugs testing and jobs have been lost for the same reason.
So, you can see, that whilst the condition may first seem trivial and a source of amusement it can be life restricting or even life changing.
I’ve written a feature on the Impact Of Shy Bladder Syndrome which you may want to check out.
Shy Bladder Treatment
There’s always a cure so take heart. Sure, it may not be instant, it may not be easy but you CAN overcome the condition. At this point I need to add that whilst Paruresis is a psychological condition it is always recommended that you first consult with a medical professional to ensure there’s no underlying medical condition behind the symptoms.
All treatments are about relaxation in challenging environments and building confidence of situations. Most importantly though, it’s about changing your mindset and re-programming your minds irrational, sub-conscious response to the normal, rational response that we were all born with.
There are a number of popular and proven paruresis treatments which you may want to look at in more detail:
- Cognitive Behavioral Therapy For Shy Bladder
- Graduated Exposure Therapy For Shy Bladder
- Breath Hold Practice
- The Shy Bladder Water Cure
- Hypnosis To Treat Shy Bladder
- The Self-Help Shy Bladder Treatment Program
This is not an exhaustive list but it does cover the top recognised shy bladder treatments.
What Worked For Me
I personally preferred the self help route as I couldnt bring myself to talk about it. There were two secific programs that I found to help – the second of which is called Overcome Shy Bladder Syndrome and I still use it today: