Overcoming a Shy Bladder: How to Deal with Paruresis

Shy bladder – sometimes known as bashful bladder or, if you’re feeling technical, paruresis – ranges from being an inconvenience to a big issue in your life.

We all get a shy bladder every now and then – that’s perfectly normal because so many factors affect our ability to pee or pass urine – but when it becomes the norm it’s time to do something about it. I was going to say take matters into your own hand but that could just sound corny.

The first thing to remember is that you’re not alone if you’re suffering from this problem.

It’s difficult to get accurate figures (surprisingly not everyone tells the truth when they’re questioned about this kind of problem) but the best guess is that around 21 million Americans suffer from shy bladder.

Extrapolating that across the globe gives a figure of about 220 million although presumably a bashful bladder could be classed as a first world problem so maybe the second figure is an over-estimate.

But however you look at the numbers, this is a big issue.


What Causes Bashful or Shy Bladder?

Technically, shy bladder is a social phobia.

And in theory, if you’re a sufferer, you know that it’s irrational but that doesn’t mean you can easily do anything to make yourself change. Sometimes it seems that the harder you try, the more embarrassed you get and the worse the syndrome gets. A kind of vicious circle that doesn’t help you – but our minds are good at that kind of perverse logic.

The quick definition of paruresis is that you have difficulty urinating when other people are around.

The longer definition is that this varies enormously.

If you’ve got a mild case then the solution could be as simple as using a cubicle rather than standing in line with everyone else at the urinals.

But if you’ve got a more severe case, things can get a lot more awkward. There have been people who’ve waited and held their bladder for a dozen hours or more because they couldn’t find anywhere safe to pee.

That’s not pleasant at all.

Sometimes it’s possible to trace your symptoms back to one event.

Contrary to your memories of school, we learn fast. Evolution has made sure of that – after all, if our ancestors hadn’t learned to deal with life threatening events then they wouldn’t have survived long enough to have children.

Quite often our learning takes place in our early years. That’s one of the reasons they’re called formative. This works well most of the time but it does mean that some things “stick” in our minds long after the rational explanation says we’re being dumb.

To the extent that there are some weird (but very workable) techniques out there that deal with this kind of problem that we learned in our childhood and sort it out once and for all in about 10 minutes.

If you’re open to this kind of new-age stuff, it’s well worth investigating as it can deal with any fear or phobia. To the extent that when I was taught how to do it, the instructor said that they didn’t even need to know what the problem was in order to be able to cure it. And they then proved it with an on-stage demo where the subject had told us (the seminar members and also the audience) but not the instructor. If I hadn’t been watching live, I’d never have believed it.

Quite often the learning experience is at school. Because schoolchildren can be nasty creatures – they don’t yet know the power of the words they use and they don’t always know how to moderate things.

Besides, it’s often seen as fun to mock someone else.

The problem then manifests because our natural survival instinct is to avoid the kind of situation that puts us in danger or – in our modern lives – stresses us out.

So we learn that our bladder needs to be shy if other people are too close.

And because we learn fast, that lesson is usually taught in one go.

And we then use that response every time thereafter. It’s very simple: you learned once that peeing when other people are close by is bad news, you use that knowledge every time the likelihood appears. So you avoid public rest rooms and just hold on until you’re safely back home.

Even years later when you haven’t seen those teasing “friends” for years and when the chance of that happening is lower than a lightning strike.

But logic doesn’t come into this kind of survival instinct – if our ancestors had stopped to re-analyze potentially life threatening events, chances are that sabre toothed tiger would still have been savage.

Regardless of when you learned that your bladder needed to be in a safe place before it would allow you to empty it, the problem remains.

And incidentally, although roughly 9 out of every 10 paruresis sufferers are male – hence my reference to urinals – that still leaves 1 in 10 females who also suffer from this syndrome. That’s nearly 2 million people in America and a lot more across the globe.

In the Western world, we don’t tend to talk about this kind of problem in public. Especially since it involves a bodily function. We repress that kind of discussion most of the time. Partly because it’s just not considered polite to do anything other than that.

In large cities there are support groups and the internet makes them easier to find. If you’ve got a local support group it could be worth tracking it down – it really is good to talk sometimes and it’s a relief (no pun intended) to find that you’re not the only person suffering from a shy bladder.

Is Shy Bladder a Medical Condition?

Opinions vary on whether or not shy bladder is a medical condition but it’s definitely being acknowledged as existing in people.

Wikipedia give a few references to support this view but when I checked the ones they claimed for the UK’s NHS (National Health Service) and the American Urolological Association the links were broken and the sites didn’t give any clue as to where the pages had moved to. Which is annoying but happens every now and then when sites move things around.

That said, shy bladder syndrome is certainly known about and is being taken into account.

There are even charities who exist to help spread the word.

Part of the problem is that bladder shyness doesn’t have an on/off switch. Which means that sometimes it happens, other times it doesn’t.

And much like the idea that a watched pot never boils, if you’re being observed while you pee – for instance for a drug test or even sometimes if you’re being tested in hospital – then your anxiety level goes up and your ability to pee goes down.

This isn’t unique to urinating.

Doctors routinely allow for white coat syndrome when they carry out blood pressure checks. It’s thought that as many as one in 5 people register a higher blood pressure when their doctor is taking the measurements.

So it stands to reason that we’re affected in other situations as well. After all, having an electronic equivalent of a boa constrictor put around your arm is nowhere near as publicly unacceptable as having someone saying “pee now” and watching you. Whether they’re actually physically watching (to make sure you don’t try to cheat a drug test) or whether your mind just thinks that they’re peeping around the door even though you know it’s closed.

There are also other reasons your bladder could be shy – years ago I had to give a urine sample after I’d had a general anaesthetic and it took forever to happen because I’d had nil by mouth for the best part of a day. In that instance, the nurse eventually turned on a tap and let the water run so that my bladder could take the hint.

Regardless of whether or not your bashful bladder is a full blown medical condition, most health professionals are fully aware of the syndrome and will be receptive to the idea that you have an issue peeing somewhere that’s perceived to be public and should be considerate about your condition.

Incidentally, that phrase “perceived to be public” is a big clue.

We really don’t know how our minds work. Computers can’t model them with any degree or accuracy.

Which means that a phobia can be superficial and silly for one person but very real and potentially devastating for another person.

Modern medicine is gradually coming to terms with the idea that there is no one-size-fits-all cure for lots of things. Doctors already know that the same drug can have different reactions in different people and they’re slowly becoming aware that other symptoms (including paruresis) have variable reactions.

If your health professional won’t acknowledge your condition, it’s probably time to change to one who does.

The International Paruresis Association (IPA) has lots of resources that you can use and you can point your health professional at their fact sheet if they need to know more about your condition.

How to Get Diagnosed with Paruresis

The specialist who makes this kind of diagnosis is called a urologist.

Their job is to check all sorts of things including whether there’s a physical impediment to urinating that’s showing up as a shy bladder. So it makes sense to get tested, just in case there’s a deeper seated problem than “merely” social anxiety.

They can also run through some of the standard advice that’s offered such as men using a stall rather than a urinal – more of that advice later on this page as there are quite a few self help options available that can be very effective and don’t involve endless visits to therapists.

If they think it’s appropriate for you, a urologist could even teach you the art of self-catheterization. That’s not something you’d want to learn from YouTube but it can be a relatively easy way to cope if you’re regularly away from home for long periods of time and don’t have easy access to private or secluded toilets.

They may also advise various therapies: cognitive therapy (also referred to as cognitive behavioural therapy or CBT) deals with various types of anxiety problems and there have been lots of cases where it has reduced the problems associated with shy bladder.

Another therapuetic approach is graduated exposure therapy which is exactly what it sounds like: the therapy is a course of sessions where you’re slowly but surely exposed to conditions where you’re able to urinate more publicly. Like most therapies, the course of sessions will be tailored to you and will go at a speed that you’re comfortable with.

Your urologist will be able to talk you through all the different options and help you decide which course of action will suit you best. That’s a good idea in itself – they’ll have helped lots of other people suffering from the same syndrome and they’ll already have a good idea of how effective the various options are on different people.

Sure, you could self-diagnose on sites like WebMD but those can run the risk of turning you into a hypochondriac and escalating the problem rather than helping it.

Plus a self-diagnosis is unlikely to cut the ice if you have an issue with something like a routine work drug test – they’ll almost certainly insist on more proof than just your word that you’re suffering from paruresis.

Shy Bladder Drug Test Tips

If your place of work routinely or randomly does drug testing then it’s best to alert them to your shy bladder issues as soon as possible. After all, if you’ve been working for the company for a while, then are called in for a drug test and suddenly remember that you suffer from bashful bladder, that would understandably seem suspicious to them,

Make sure that your problem is noted on file as soon as you become aware of it, even if it’s not something that you’d normally tell your firm about yourself.

Your doctor or urologist will be able to provide you with a letter stating their medical opinion of your condition.

Whilst this won’t let you off the hook of the test entirely – there’s currently no legal requirement for firms to take into account your inability to provide a urine sample – it should help. There are other drug tests available including blood, hair and saliva so it’s not beyond the bounds of medical science to use a test that doesn’t involve urine but it may well be outside the realm of the testing your company usually carries out.

If that’s the case – since drug tests can seem very close to “guilty until proven innocent” – you may have to pay for a separate test to be carried out and present the results to your company. If you go down that route, remember that drugs work their way out of people’s systems so if you get an independent test it should be done as close as possible in time to the random one that was carried out.

If your shy bladder forces you to go down the route of an independent test, a hair test is the best to go for because traces of drugs stay in our hair for up to three months whereas our blood gets purified a lot quicker.

Even if you don’t suffer from a shy bladder, it’s actually strongly recommended that you get your own independent test done as soon as possible after your company tests you. No testing system is 100% perfect and although it’s unlikely that you’ll need to challenge a drug test it’s a lot easier to do that if you have independent evidence rather than just the feeling of being hard done by.

Rules regarding drug tests vary from country to country and even by state so if your employer is likely to test you, make sure you read up on your rights and double check any evidence you may need to provide to prove that you’re suffering from shy bladder syndrome. There’s also increasing awareness that shy bladder is actually a disability and there is often extra legislation to ensure that people with disabilities aren’t discriminated against.

Take the time to do your research and make sure that the sites you use are official ones (often there’s a .gov or sometimes a .org part of the site’s url) so that you know the information you get is first hand rather than second hand.

Dealing with Shy Bladder – How to Make Yourself Urinate

Regardless of whether it’s for a drug test or something else, there are occasions when you really must urinate.

A few things you can do that will help you to urinate more easily include:

  • Drink more fluid. This may sound self evident but if you’ve spent lots of years making sure that you don’t drink much in the way of fluid so that you can stop yourself from urinating so that you don’t have to visit a public washroom then even this small step can take some getting used to. There’s almost certainly a back of mind thought that if you drink too much you’ll be forever going to the toilet so gradually build up the amount of fluid you drink and be careful what it is. As you almost certainly already know, drinks such as coffee act as a diuretic which causes you to pass fluids, which may not be something you want to add to the mix when you’re slowly recovering from this affliction.
  • Keep yourself hydrated. Again, this should be self evident but years of practice to the contrary may well mean that you are currently de-hydrated. Apart from anything else, if you’re not properly hydrated you probably won’t be thinking as clearly as you should be. The best option for hydration (and the drinking more fluids point earlier) is plain water. Tap water is fine so long as your local supply is good, filtered can help get rid of most of the impurities that too often creep in to our water supply, bottled water can add variety if it’s the fizzy sort. If you find plain water too boring, add a slice or twist or lemon to it.
  • Learn to relax. Part of the problem with any social anxiety is that we’re not relaxed. Relaxation is something that we seem to un-learn as we get older and it can take a conscious effort on our part to chill out. If you’re winding yourself up – whether it’s about not being able to pee in public places or anything else – then it’s worth using a relaxation technique. The simplest – and one you can do anywhere – is deep breathing. Just consciously slow your breathing down and take longer breaths in and out. The next simplest is what your mother probably told you as a child – count to 10. But longer term it’s worth setting some chill time aside to relax as this will positively knock on to other things in your life including your paruresis. A lot of people use hypnosis for relaxation as it helps you to calm down. Other people, myself included, use a daily meditation (this can take as little as 10 minutes) to get some personal time to relax.
  • Use hypnosis. Hypnotizing yourself is easy – you don’t need to book an appointment at a local hypnotherapist, all you need to do is download a professionally recorded hypnosis MP3, put on your headphones and press “play”. No-one other than you will know what you’re listening to unless you decide to tell them. The hypnosis track will take you into a relaxed state and then put ideas in your mind that will help you to overcome your fear of peeing when other people are around. It’s quick (the track lasts just over 16 minutes, start to finish) and highly effective because hypnosis is something we already do naturally. If you’ve ever day-dreamed, you’ve hypnotized yourself. The main difference here is that instead of it “just happening”, you’ve made a conscious decision to track down a hypnosis track that will help you overcome your condition without drugs.
  • Use graduated exposure. This is probably best done with the help of an understanding friend who can act as a lookout or as a shoulder to lean on. Start by finding a place where you’d not be totally comfortable to pee – maybe a 1 or 2 out of 10 on an “eek” scale – but that would allow you to pee if you really, really had to. Use that location a few times and notice whether or not the fear scale has moved down a notch or two – chances are that it has and that you’re almost happy to use the location now. Then move up a notch – because fear is weird like that. Chipping away at the edges of your fear – picking off the easiest things to dismiss – weakens the overall ability of fear to control you. Most people find that once they get past roughly the half way stage the rest of the fear melts away. Combined with hypnosis, this can be a really effective way of getting rid of your bashful bladder once and for all.

Shy Bladder Medication

I’m not personally a fan of taking medication for anything unless I really have to.

And since a lot of evidence points to paruresis not being a physical condition, my view is that any medication you take is most likely to work on the placebo effect.

if you’re happy with that – and there’s a lot of evidence that placebos work at least as effectively as actual drugs – then medication is worth considering.

Your doctor or urologist will be able to talk through the medication options available to you, including any side effects that could possibly affect you.

They’ll also be able to check up how likely the particular drug they suggest is to be able to help you.

They may also suggest using a catheter instead – they’re not particularly easy to insert yourself at first but if you’ve been properly trained then they can be an effective solution and have the added benefit that they don’t come with the same kind of side effects as drugs do.

But I’d still suggest that taking medication is a short term solution whilst you’re working on ways to reduce the effects that your shy bladder has on your life. A bit like taking a sleeping pill every once in a while – not an everyday habit that potentially stays with you for a whole life time.

By all means, talk to your medical professional about the various drug options that are potentially available but remind them (and yourself) that you’d like that to be a short term solution while you find a better way to cope with things.

The main thing to remember is that lots of people have managed to at least reduce their fear of urinating in public restrooms and quite a large number of those people have got over their phobia completely.

It’s time for you to do the same – I wish you every success with this.