A Complete And Definitive Guide To Paruresis Or Shy Bladder Syndrome
written by: Ashley Hunt
Over 17 million people, in America alone, suffer from paruresis, which is a debilitating phobia that prevents a person from urinating in the presence of others, in a public restroom, or any bathroom that is not their own. Bodily functions continue to be a highly stigmatized topic in today’s society, even though millions of paruresis sufferers battle with the inability to urinate around other people every single day of their lives. For the majority of paruresis patients, the phobia stems from a particular traumatic event that occurred in their adolescence; for example, an episode of sexual, physical, or emotional abuse. While others trace back their first bashful bladder experience to an embarrassing moment during their school days where other classmates teased or harassed them while urinating in a public bathroom. It is imperative for all people who are afflicted with this harrowing disorder to become informed about paruresis and seek out treatment immediately in order to put an end to their silent suffering.
What Is Paruresis And Who Suffers From It?
As mentioned above, paruresis is a disorder that prevents a person from urinating in the presence of others in a variety of situations; however, this problem is not experienced in the same manner for each individual. Psychologists often classify paruresis as a social anxiety or an avoidant anxiety disorder with severe physical symptoms. For instance, many paruresis patients literally cannot urinate around others or in a public bathroom, even if their life depended on it. Certain people with bashful bladder describe feelings of anxiousness and fear that someone may be listening or watching while they urinate, which provokes a natural bodily reaction. When a person feels fearful, the body reacts accordingly, the internal sphincter closes, and urination becomes virtually impossible. Only when a “safe” bathroom (a bathroom the patient feels comfortable urinating in) is reached can the affected individual relieve themselves, which on some occasions equates to waiting upwards of 16-20 hours.
The president of the, “International Paruresis Association”, Steven Soifer, MSW, PhD, has reported that 9 out of 10 patients he treats are men. Some experts believe that the fact that men’s public restrooms have little to no privacy is a major cause of the disorder itself and a reasonable explanation as to why more men suffer than women. Most patients describe their first shy bladder incident as occurring during their early teen years; even so, shy bladder syndrome can strike at absolutely any age and the resulting consequences are devastating. Out of the 17 million shy bladder syndrome patients, approximately 1-2 million report a substantial and severe affect on their social and professional lives.
What Are The Causes And Symptoms Of Paruresis?
The majority of paruresis causes involve a traumatic situation, in regards to urination in general, or in a public bathroom in the presence of another person or people. Even a single psychologically damaging event relating to urination can lead the individual to avoid public bathrooms, which after a period of time becomes more than a hindrance, but an actual physical inability to urinate publicly. In certain cases of paruresis, a patient experienced a negative form of potty-training or were chastised during urination. Those with co-existing issues, such as depression, anxiety, or other mental disorders, are more susceptible to developing shy bladder syndrome as well.
It can be an immensely arduous process for a paruresis sufferer to obtain assistance for their disorder. Many refrain from seeking out help for several years and sadly, most suffer in silence until a friend of relative encourages or convinces them to see a professional. Individuals with bashful or shy bladder can sometimes be so used to their affliction that it becomes a normal part of their daily lives, which is why it may require the assistance of an outside source to initiate treatment. There are several signs to look for in a person who has paruresis, and some examples are as follows:
(1.) The person will urinate as much as they can before leaving their home.
(2.) Fluid intake may be restricted in order to prevent the need for urination.
(3.) Avoidance of situations where a “safe” bathroom isn’t located.
(4.) Always choosing a bathroom or stall that is located as far as possible from other people.
(5.) Consistently runs water or supplies another form of background noise while using a bathroom.
What Are Treatment Options For People With Paruresis?
Seeking out treatment for shy bladder syndrome can be intensely disconcerting; nevertheless, it is paramount in improving the quality of life for a person with the disorder. More often than not, a urologist is consulted first in order to determine the exact cause; for example, an inability to urinate could be related to a certain drug or medication, such as methadone, heroin, or other forms of opiates. Furthermore, a urologist can perform tests that may also rule out a physical cause, such as a blockage in the urethra or a disruption of the nerves between the bladder and the brain. Although, it is possible for a physical cause to explain an inability to urinate, it is more likely to be paruresis if urination can be accomplished in certain places, but not around other people or public places.
Once a physical cause is ruled out conclusively, the patient will usually be referred to a therapist who specializes in paruresis, and to one of the numerous branches of the, “International Paruresis Association”, support groups. It is key for the patient to realize they are most certainly not alone in their struggle, as well as to discern where their inability to urinate normally originated. Participating in a paruresis support group has shown ample success in assisting people with the affliction. A therapist may also recommend a form of cognitive behavioral therapy known as graduated exposure therapy. This entails the patient being slowly reintroduced into the situation that they abhor the most, including urination in a public restroom, or urination with someone outside the door. For example, a therapist will ask that a friend of the patient be somewhere nearby while the patient urinates, such as the next room, the next building, or even down the road, if so desired. After each successful session, the therapist instructs the friend to move to a closer location until the patient can relax and urinate with a person right outside the door. The final step involves urination in a public restroom, or whatever situation the patient fears the most.
There are paruresis treatment systems that can be utilized by the patient alone, which usually involve detailed instruction on how to incorporate graduated exposure therapy into their daily life. Certain other effective methods include subliminal recordings, instructional videos, and detailed information that provide the patient with the necessary skills and coping mechanisms to overcome their shy bladder syndrome. Not every mode of treatment is going to have the same level of efficacy and much depends on the severity of paruresis that the patient experiences. In addition, the 1/4 of bashful bladder sufferers that also have a co-existing condition that exacerbates their problem, may have an exceptionally difficult time ridding themselves of the disorder. Many patients employ various treatment methods, as opposed to only one, because a well-rounded treatment plan has been proven to be highly effective.
In conclusion, the only answer to solving the detrimental problem of paruresis is to seek out help. No matter how ashamed, embarrassed, or frightened the patient may feel asking for assistance for the first time, those temporary feelings are quite small compared to the potential horror of living with paruresis for an entire lifetime. Fortunately, there are a multitude of options for those with shy bladder syndrome, and even treatments that can be implemented solely by the person with the disorder, if that is what they prefer. There is no need for paruresis sufferers to continue on in silence. The hardest part is to ask for help for the very first time; however, it is one step that no paruresis patient has ever lived to regret.