What Is a Shy Bladder?

When you’re on the go and you have to go, a public restroom is where you head. For millions, though, that’s not an option. It’s a place where peeing seems physically impossible.

That’s because being near other people causes your sphincter muscles to lock up. Those muscles control the flow of urine from your bladder. Once they freeze up, you simply can’t pee. It can happen in a public restroom, a bathroom in someone else’s home, and even in your own place if other folks are nearby.

As many as 20 million Americans have this problem. It’s known as shy or bashful bladder syndrome. Your doctor may call it by its official name, paruresis.

Without treatment, it can affect your personal, social, and professional life. You might find it hard to be away from home for more than a short time. You could end up avoiding parties, sporting events, and dates. It might even limit your choice of jobs. But you can get it under control with therapy.

What Causes It?

It isn’t a problem with your urinary system. Rather, it’s nervousness about peeing when you’re around other people. It’s considered a social anxiety disorder.

Maybe it started when your parents criticized you during potty training, or in school when someone bullied you or made fun of you in the restroom. Or it could have happened at the doctor’s office, when you couldn’t pee on cue for a urine sample. At worst, it could relate to sexual abuse that happened in a restroom.

After it happens the first time, you worry about it happening again. In other words, you have performance anxiety. It snowballs from there. The more you try to force nature to take its course, the more your body refuses to cooperate. The anxiety fills a part of your nervous system with adrenaline, and the muscles that let you empty your bladder just freeze up.

Many people say they feel so anxious about using a public restroom that they’ll search for one that’s vacant. Some avoid shared bathrooms, and others can’t pee in public stalls or urinals at all.

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Three Main Triggers

Many people say a few key things keep them from being able to go in public:

  1. Lack of privacy: Public restrooms rarely offer it. This may be why shy bladder is more common in men than in women. The stalls in men’s rooms usually don’t have doors or walls like you find in the ladies’ room.
  2. Who’s in the restroom with you: Being surrounded by people you don’t know makes it hard to go. For some people, though, it’s family or friends who trigger the problem.
  3. Your emotions: Anxiety, anger, fear, or a sense of being pressured can make it hard to pee.

Can It Be Treated?

Yes, treatments can help. The most common one is a form of cognitive behavior therapy known as graduated exposure. You’ll be slowly re-introduced to the fearful situation. That helps lower your brain’s anxiety response.

You might see a major improvement after just 8-12 sessions with a trained behavioral therapist or even a friend or family member. The International Paruresis Association offers tips that can help.

You have other options too, and trying more than one boosts your odds of getting better. Among them are hypnotherapy and self-catheterization, after a urologist or other medical professional teaches you what to do.

Talk to your doctor before you try any type of treatment just to be sure nothing’s wrong with your urinary system.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on January 21, 2018

Sources

SOURCES:

Medscape: “Paruresis or Shy Bladder Syndrome: An Unknown Urologic Malady?”

International Paruresis Association: “About Avoidant Paruresis,” “Paruresis Fact Sheet,” “A Few Notes on Paruresis,” “Frequently Asked Questions.”

Vythilingum, B. Depression and Anxiety, 2002.

Urology Care Foundation: “Paruresis.”

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