Paruresis, is a condition also referred to as “shy bladder syndrome”, “stage fright” and “pee shyness”. It is sometimes grouped along with other conditions under the term “toilet phobia”.

Paruresis occurs when you have trouble urinating when other people are around. It is thought that up to 4 million people in the UK could suffer from this condition to the extent that it has an effect on their lives.  It is not physical condition as there is nothing is wrong with the person’s urinary tract. In order for urine to flow from the bladder down the urethra, the urinary sphincter must be relaxed. Anxiety about urinating over stimulates the nervous system and ‘clamps’ the sphincter shut. Failure to urinate heightens anxiety, particularly if the bladder is uncomfortably full. Paruresis is believed to be a common type of social phobia, second only to the fear of public speaking.

 

Symptoms

Paruresis can be mild, moderate or severe. Signs and symptoms of severe paruresis can include:

  • The need for complete privacy when going to the toilet
  • Fear of other people hearing the urine hit the toilet water
  • Fear of other people smelling the urine
  • Inability to urinate in public toilets or at other people’s homes
  • Inability to urinate at home when guests are present
  • Inability to urinate at home if someone is waiting outside the toilet
  • Feeling anxious about needing to go to the toilet
  • Restricting drinks to reduce the need for urination
  • Avoiding travel and social events.

 

Depending on the severity, some people are unable to urinate without some or total privacy.  Sufferers are often called Avoidant Paruretics ( APs), because their paruresis causes them to avoid situations that make it difficult or impossible for them to be able to urinate. This avoidance behaviour lessens the fear around urinating but this only makes the pattern of fear stronger. Some deny feeling any worry in public bathrooms and insist that they merely have trouble starting to urinate, but others have signs of anxiety like a rapid heartbeat, sweating, faintness and shaking.

 

What causes Paruresis?

There are many unanswered questions about the causes of shy bladder. It can affect a toddler in preschool, someone in their early or late teenage years, or even in mid to late adult age. While some people cannot point to any single cause, others believe it was due to something that happened before or during the teen years, such as:

  • being embarrassed by a parent
  • being teased by classmates or siblings
  • being harassed in public bathrooms

Though many people go through varied types of embarrassment, not all people suffer from shy bladder syndrome. Recent research in the field of neurology shows that there may be physical as well as mental or emotional aspects of the problem. There is also some proof that shy bladder might be passed down from parents to children.

How can paruresis be treated?

No controlled studies of the treatment of shy bladder have been published.  A form of short-term Cognitive behavioural therapy called graduated exposure therapy seems to be effective in about 85 out of 100 people. Over the course of a few months, this treatment involves peeing in a comfort zone, and then slowly pushing that comfort zone until one can find relief even in their worst public bathroom situation. Sometimes the process is easier with a “pee buddy,” who will work with a sufferer to slowly close his privacy zone using comfortable settings and a trusting relationship. This process works regardless of whether the patient understands the roots of their paruresis.

Other methods that have been used with mixed results are:

  • drugs
  • hypnotherapy
  • paradoxical intention (worrying on purpose)
  • sphincter botulinum toxin injection (to control muscle activity)

Just because paruresis can be cured, that doesn’t mean it isn’t an issue. Knowledge about the condition and the ways it can be dealt with are quite sparse even among counsellors, urologists, and other healthcare professionals likely to first encounter people who have it. This lack of visibility and awareness means that sufferers may not find the help they need and instead sink into a sense of isolation and stigmatization that allows their condition to spiral.

Where can you get help?

As is the case with any medical condition, contact your GP and explain how you are feeling.  They will refer you to relevant professionals for help.  You could also visit https://www.ukpt.org.uk/  The UK’s paruresis Trust provides a wealth of information including an online forum.  There you can post anonymously as a guest or create a personal account and talk to others with this condition.