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Do You Have a Shy Bladder? Updated

Allan Schwartz, LCSW, Ph.D.

This is an update and an elaboration of an article written on April of 2008. It includes more information including useful links and literature for those with the disorder and those who want to understand.

Since the initial article was written on Shy Bladder, many people have commented about their difficulties with this disorder. I have heard from men and women, soldiers, mothers, fathers and, in fact, people from every walk of life. It is hoped that those who are too ashamed to tell anyone of this problems, will be better able to do so and get help as a result of this posting.

People with a shy bladder or paruresis feel extremely ashamed of themselves for having the disorder. Their sense of shame is so very great that they will go to any lengths to keep it secret. In fact, the life of shame and secrecy seems to become a secondary type of disorder all to itself.

In addition, many men and women with the disoder report that they are at war with themselves, attempting to force themselves to urinate and castigating themselves for having the problem.

Concern about urination becomes so pervasive that paruretics make elablorate plans to avoid problems. Some of these plans unfortunately include living a life style that cleary resembles those with agoraphobia, never wanting to leave home. For example, some people will only take a job located close to home so they can run home when they need the bathroom. Others will avoid travel of any kind, whether in cars, airplanes or buses. There are also those who will not visit the homes of friends or relatives for fear of being heard urinating in the bathroom. This includes not inviting others to visit.

It is common for paruretics to delay going to the bathroom as long as possible, until they get to a place where they feel comfortable, usually home. The problems is that the accumulation of urine in the bladder becomes quite painful. Even then, it is impossible to urinate if the individual goes to the bathroom. Under these circumstances, panic can set in along with the pain. 

Basically, Shy Bladder is an anxiety disorder. As long as nothing is wrong organically, it is intense social anxiety and embarassment that causes an individual to tighten the urinary sphincter muscle so that they cannot go. This tightening of the sphincter is involuntary and it is the inability to control the flow of urine that frustrates paruretics.

There are many types of thoughts that those with paruresis have when the enter a public bathroom. Some examples of distorted types of thoughts but that add to the sense of emergency felt by the person with this problem are:

1. People can hear me and know what I am doing in the bathroom.
2. I am taking too long to go and the people outside will become angry with me.
3. Everyone is watching me or listening to me urinate.
4. People are judging me for the way I urinate or for the fact that I urinate.
5. People will make "fun of me, laugh at me, ridicule me."
6. I'm a man and people will think I'm homosexual if they know I can't urinate in public.

What is completely lost on the paruretic is the fact that each and every human being urinates and many times per day.

Problems created by Paruresis:

Public Urinals:

1. Many males have a particularly difficult time with this disorder because public mens rooms are often constructed with no barrier between urinals. In fact, men without paruresis can find it difficult to urinate in such close quarters.

Armed Services:

2. This problem can and does affect men and women who serve in the military. The nature of the armed services is such that there is often very little privacy, especially when it comes to bathroom issues.

Employment 

3. Today, many places of employment demand drug testing as a requirement for hiring. Failure to give a urine sameple under supervised circumstances can result in failure to qualify for a job. In addition, there are many areas of employment where annual medical examinations are requrired of all employees. Bringing a urine sample to the examination is not acceptable and the sample must be provided on the medical premises. This is problematic for men and women with shy bladder.

There was a recent court decision that allows those with Paruresis and who have a note from their doctor to give the urine sample at their private physician's or psychiatrist's office and submit the sample to the medical office at work. In other words, employers must provide alternate means of paruresis patients to submit samples. Therefore, someone with paruresis is not attempting to avoid submitting a urine sample in order to hide drug abuse. People with paruresis, according to the Federal ruling, have a real medical dysfunction.

Hospitals:

4. When one is a hospital patient there is an ongoing process of having to urinate either out of individual need or to provide samples for the doctors. Surgery can make it necessary that a patient not be allowe to leave bed and have to use a portable urinal. These common situations are also diffcult for paruretics.

Ambulatory Surgery:

5. Many surgeries are now performed in one day and patients sent home. However, before being allowed to leave for home, they must prove that they can urinate. The reason is that anesthezia can inhibit urination. As a precaution, hospitals want to be certain the anesthetics have worn off before sending a patient home. Here, too, there is a major challenge faced by someone with a shy bladder who cannot urinate on demand. This can increase panic unless the patient admits to the staff that they have paruresis.

Prisons:

6. Prisons are notorious for their lack of privacy. However, the fact that a man or woman is guilty of a crime does not mean they are free from this or many other psychiatric disorders. Somehow, accomodations need to be made for those who suffer with Shy Bladder, but, in ways that are safe for all in a prison environment. By the way, this concern includes jails that hold people overnite or until they come before a jury or a judge.

What Causes Shy Bladder?

It is not known for sure what the cause is of paruresis is. Men and women equally suffer from the disorder. It is thought that some type of humiliating process may have occurred during childhood or that it is part of a larger General Anxiety Disorder.  Paruresis can start any time during life. For some, it may be temporary but for most it develops into a major difficulty. Whatever the causes, it is very common and nothing to be ashamed of. Here are some treatment options for this problem:

Treatment:

1. Cognitive Behavioral Therapy can be useful in this. In this way an individual is helped to alter their thoughts and feelings about urination and public bathrooms.

2. Systematic Desensitization in which therapy is used to help a patient develop pleasant associations, when totally relaxed, about the need to urnate in bathrooms away from home.

3. There are now medications that can be used in conjunction with psychological treatments. In fact, for some people, the use of medications increases the chances of success with the therapy.

4. There are now many paruresis support groups. The value of support groups is that it validates that paruretics are not alone with this and are not unusual. In fact, some studies estimate that as many as 7% of the population struggles with this disorder. There are excellent Online support groups that require registration to participate in order to keep them private.

5. Self Help Suggestions are given such as: 1. Turn on the faucet while urinating, 2. Wear Ipod ear phones and listen to music while in the bathroom, 3. Breathe deeply, slowly inhaling and exhaling to promote relaxation while in the bathroom.

6. The same relaxation techniques that are applied to all anxiety disorders can help with this: Yoga, Meditation, Muscle Relaxation, Exercise, Listening to soft music, etc, all to promote overall decreased anxiety levels.

Here are some important links for those with pauresis. These links are to helpful books for men and women and to some internet support forums:

http://www.paruresis.org/    This site if filled with useful information.
It is actually the International Paruresis organization and inlcudes many links, including for Women.

Bathrooms Make Me Nervous, book at this link:
http://www.bathroomsmakemenervous.com/  This manual is extremely helpful for women with this problems. It is the best spent twenty dollars you can imagine.
The book is available at:
http://www.amazon.com/Bathrooms-Make-Nervous-Guidebook-Urination/dp/0615240240/ref=sr_1_1?ie=UTF8&s=books&qid=1226534696&sr=1-1

http://www.ukpt.org.uk/  UK Paruresis Trust.

Shy Bladder Syndrome, Stephen Soifer, excellent book at:
http://www.amazon.com/Shy-Bladder-Syndrome-Step-Step/dp/1572242272/ref=sr_1_1?ie=UTF8&s=books&qid=1252694004&sr=1-1/ Best 13 dollars you ever spent.

http://www.shybladder.org/ Shy Bladder Center.