My Friends Worst Nightmare – (Paruresis)

This post is being written to help out a friend. It is her worst nightmare and constantly bugs her day in and day out. I hope this helps a little bit for others suffering with the great Paruresis.

Paruresis is the phobia of using public bathrooms to urinate. This condition, which is also referred to as “shy bladder syndrome” affects people who find it impossible to urinate in the presence of other people. Paruretics (victims of paruresis) suffer from idiopathic form of urine retention that is not caused by any blockage but out of fear to urinate when they do not have privacy.

Paruresis affects the quality of life as those affected suffer in silence when travelling, working in public places or even when they are requested to submit a urine analysis. Paruresis can affect kids in pre-school, children in early or late adolescence and adults in middle or advanced age.

Causes of paruresis

Some paruretics cannot point to any incident that triggered the disorder while others believe it was caused by traumatic incident that took place before or during adolescence. The incident could be harassment in public bathrooms, sexual abuse and teasing by siblings or classmates. Paruresis can also be triggered after humiliation by a parent. Results of recent studies in neurology show that paruresis can be triggered by somatic and psychiatric components.

Although there are many kids who are teased by their peers when using urinals or public toilets, not all of them become paruretics. There is some evidence showing that paruresis could be hereditary. Parents should therefore realize that if one or both of them have disorder, there is higher chance that their child or children can develop it.

Symptoms of paruresis

You can conclude that paruresis exists if the following cycle has occurred:

After an unpleasant experience, the victim anticipates there will be difficulty to urinate after entering a bathroom. Efforts to forcefully control the failure in urinating process and related anxiety with performance will reduce confidence of an individual to urinate when in public facility.


People with paruresis adjust their urinating schedule and try to do it as much as possible at their homes, restrict intake of fluids and do their best to locate vacant public bathrooms. They also avoid extended social invitations so that they do not have to urinate away from privacy of their homes. When paruretics engage in avoidance, it may temporarily reduce their fear to urinate in publicly but this only reinforces the phobic pattern.

Those who suffer from paruresis deny that they feel overly anxious in public bathrooms. They insist that they are just unable to initiate urination. Some paruretics may report psychological symptoms of anxiety such as sweating, dizziness, shaking, faintness and heart palpitations.

 Is there treatment for paruresis?

Most people are searching for the all inclusive shy bladder cure, but it doesn’t exist. There are things you can do to help though. Paruresis can be treated more by sorting the psychological aspect that causes fear to urinate in public. If you are a paruretic, it is important to first visit an urologist to determine if there something wrong with you physically. An urologist will do the following:

  1. Test if there is any underlying physical ailment
  2. Reassure patients that they are not alone in facing the disorder
  3. Discuss behavioral approach   like scheduling urination and   for the men, using private toilet instead of a urinal
  4. Teach self-catheterization if a patient desires
  5. Refer the patient to anxiety disorders specialist for graduated exposure and cognitive therapy.

Of the above treatment methods, it is self-catheterization that provides paruresis patients a way to relieve their problem and improve the quality of their lives. Behavioral exposure therapy has also been reported to have complete or partial success in many cases over the last 4 decades.

Other methods that have in the past been used to treat paruresis with mixed results include hypnotherapy, paradoxical intention and sphincter borulinum toxin injection. Based on limited sample, paruretics can also be treated with adjunct drug therapy. Selective reuptake inhibitors (SSRIs)   seemingly help to reduce anxiety levels and enables graduate exposure therapy to work well for some paruresis sufferers. In some instances, a doctor can also do a surgery ie transurethral resection of prostate (TURP) or transurethral microwave therapy. Bashful bladder can also be treated with alternative remedies like breathholding techniques and hypnosis.

Since paruresis is rarely discussed in public, many people suffering the disorder think they are the only ones who are affected. They are therefore ashamed of their condition therefore choose to hide it from their spouses, friends and physicians. The sense of shame, isolation and depression as a result of paruresis can be devastating.

There is hope for parerutics as cognitive behavioral therapy is 80-90% effective and with adjunct drug therapy, it is kept under control. Patients who seek help are not alarmed by the paruresis and know the right measures to control it if it reoccurs.

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