Shy bladder syndrome, or paruresis, may not be terms that you are familiar with. But, if you’ve ever tried to use a busy public restroom and found that you’re too shy or embarrassed to relieve yourself, chances are you’ve experienced it for yourself. Shy bladder syndrome is a condition that involves the inability to urinate around others.
Dealing with paruresis can be embarrassing but understanding the condition and taking steps to treat it will help you handle the symptoms and move on.
What Is Shy Bladder Syndrome?
Shy bladder syndrome is a condition where someone is unable to, or afraid to, urinate in the presence of other people, whether these are real or perceived. Consequently, the person experiences serious anxiety when using public restrooms. It may also be called paruresis, bashful bladder, or pee shy, although the medical description is Psychogenic Urinary Retention[ii].
Officially, shy bladder syndrome is recognised as a social anxiety disorder instead of a social phobia, and it can affect men and women of any age and background. As a result of shy bladder syndrome, people may withdraw into themselves, avoiding travelling, socialising, and sometimes even working. Fortunately, shy bladder syndrome is highly treatable.
What Are the Symptoms of Shy Bladder Syndrome?
Symptoms of shy bladder syndrome can range from mild to severe. However, they usually get worse over time. Some of the most common symptoms of paruresis are:
- The desire for complete privacy when using a bathroom
- Fear of people hearing their urine hitting the toilet water
- Fear of people smelling their urine
- Negative self-talk when trying to use the toilet
- The inability to urinate at other people’s houses or in public toilets
- Feeling anxious about needing to use the toilet
- Experiencing symptoms of anxiety when thinking about or trying to use a public toilet, like an increased heart rate, shaking, sweating, and potentially even fainting
- The inability to urinate at home with guests present
- The inability to urinate at home when someone is waiting outside the toilet[iii]
Those with shy bladder syndrome may also change their behaviour and social habits to avoid having to use public restrooms or even urinating at all. Some behaviour changes of paruresis include:
- Avoiding socialising, travelling, or work opportunities
- Drinking less
- Looking for public toilets that are empty or only have one toilet
- Going home during breaks to use the bathroom and then returning to an activity
- Using the restroom more frequently at home, so they don’t have to in public[iv]
What Causes Shy Bladder Syndrome?
Unfortunately, medical experts aren’t sure what causes paruresis. However, there is a correlation between the condition and post-traumatic stress disorder (PTSD). Some people who have PTSD after an uncomfortable or traumatic experience, like sexual harassment or abuse in a public toilet, may suffer from paruresis. Alternatively, someone may have teased or bullied them while they were urinating in the past.
Also, people who are already shy, embarrassed, or self-conscious may feel uncomfortable urinating around others. However, feeling anxious or getting emotional can make it more challenging to start the urine flow, worsening the condition in the long run[v].
What Happens If Paruresis Is Left Untreated?
As well as social problems and work troubles, paruresis can also lead to serious health issues and other unforeseen difficulties. Some of the side effects and complications of untreated shy bladder syndrome include:
- Stomach Pain – If urine gets backed up in the urinary tract system, it can cause severe pain in the stomach and bladder.
- Urinary Tract Infection (UTI) – A backup of urine also gives bacteria more time to grow, which will increase the chances of developing a urinary tract infection.
- Hydronephrosis – The blockage of urine can also cause swelling in your kidneys, known as hydronephrosis. In severe cases, this can lead to kidney damage.
- Damage To Bladder Muscles – Holding in urine can damage the muscles of the bladder, which may lead to urinary incontinence.
- Burst Bladder – In severe cases, the backup of urine can lead to a burst bladder.
- Difficulty Providing Urine Samples – If urine samples are required for medical tests or drug testing at work, someone with shy bladder syndrome may be unable to provide their sample. [vi]
How To Treat Paruresis
Since paruresis can be challenging to overcome on your own, it’s in your best interest to get in touch with a healthcare professional. Your GP will be able to give you an examination to rule out any health conditions that may be causing your symptoms, and this may involve the requirement of a urine sample. Finally, your GP may recommend several treatment methods once they have diagnosed you with shy bladder syndrome.
Dealing With Paruresis at Home
If you are waiting for an appointment with your GP or your treatment to begin, there are a few things you can do for yourself to aid your symptoms. For example, you could try working on techniques to relieve anxiety, such as meditation and breathing exercises. You may find an approach that helps ease your mind in a public restroom and ease anxiety. Alternatively, you could wear discreet incontinence pads to protect yourself against any leakages or accidents.
Finally, several online forums and charities can provide help with shy bladder syndrome. For example, the UK Paruresis Trust is dedicated to helping those with shy bladder syndrome overcome their condition through workshops and online forums that connect those with paruresis.
1) Cognitive Behaviour Therapy
Cognitive behaviour therapy (CBT) is a structured type of talk therapy used to manage mental health disorders like anxiety. CBT is a type of psychotherapy that focuses on achieving small goals to help you gain a new perspective.
Through CBT, you will learn how your thoughts and emotions affect your actions and how you can reshape negative behaviours and thoughts. This way, you can adopt healthier habits and thought processes to understand how best to respond to stress, anxiety, and pain[vii].
2) Graduated Exposure Therapy
Graduated exposure therapy is a psychological treatment that helps people confront their fears. It aims to break the pattern of avoidance and worry by exposing that person to their fear, either physically or psychologically. Graduated exposure therapy will involve a psychologist helping you to build a fear hierarchy, where feared situations or objects are ranked according to their difficulty level. Then, you will work through the mildly difficult situations, building up to facing the harder ones.
Although your GP may recommend a therapist, the International Paruresis Association offers graduated exposure therapy workshops that you may find helpful.
Hypnotherapy is the use of hypnosis to help treat conditions or alter habits. There are several different types of hypnotherapy. However, a common appointment will include your therapist leading you into a deeply relaxed state, using pre-confirmed methods to help you reach your goals, then gradually bringing you out of the trance state. Although it may sound intimidating, you are fully in control during a hypnotherapy session, and will be able to bring yourself out of the hypnotic state if necessary[viii].
As well as a form of therapy, your GP may prescribe medications that will treat shy bladder syndrome. You may be given medications that will target urinary retention or focus on relieving anxiety depending on the severity of your condition. Although there are several medications that you may receive, some of the most commonly prescribed medications for shy bladder syndrome are:
- Anxiety-relieving medications, like alprazolam (Xanax) or diazepam (Valium)
- Antidepressants, such as fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft)
- Alpha-adrenergic blockers to relax your bladder muscles, like tamsulosin (Flomax)
- Medications used to relieve urinary retention, such as bethanechol (Urecholine)[ix]
5) Practice Mindfulness
Experts have long recommended mindfulness to relax the mind, reduce muscle tension, and relieve feelings of anxiety and stress. Through mindfulness, you can become aware of your body’s feelings, thoughts, and sensations without judging them. Fortunately, you can practice mindfulness in any activity, making it perfect for relieving shy bladder syndrome as well as other symptoms of anxiety.
Here’s how to practice mindfulness no matter where you are:
- Bring Your Attention To The Present Moment – You have to bring your attention to the current experience in an open way. Rather than analysing and evaluating, try and become an observer of your thoughts and feelings.
- Focus On The Breath – Next, hone in your attention to your breathing. This can be the breath of the belly, chest, or nose; just focus your attention on the sensations of your breathing. This will help you anchor yourself in the present moment and control feelings of anxiety.
- Become Aware Of Your Body – Finally, allow yourself to become aware of sensations in the body as a whole, including things like the feeling of you sitting/standing and breathing. Doing so will help you identify tension and signs of stress, so you can work to relieve them[x].
Dealing With Shy Bladder Syndrome
Although paruresis may be embarrassing to discuss, a healthcare professional will be able to help you. With a combination of therapy, medication, and determination, shy bladder syndrome can be a thing of your past!
Do you have any advice on dealing with shy bladder syndrome? Let us know.