You may come to this page and discover only after years that your toilet blockages have a name:
Paruresis or Shy Bladder for those in the know.
How do I know this?
I had Shy Bladder for 17 years and never knew it had a name. I thought I was the only one in the world who had this thing, I was wrong!
Do you sometimes have blockages on the restroom, but don't know why? Read this article, and you'll get a clearer picture of what shy bladder really is.
What is paruresis (shy bladder)?
Paruresis, shy bladder syndrome or pee shyness, is the impossibility or great difficulty to urinate when we can be seen or heard by others, or when we think we can be seen or heard by others, or when we are pressed for time.
In other words, public places and the presence of other people around or behind a door becomes a nightmare that blocks us from starting to urinate or, sometimes, cutting off the stream in the middle when we feel threatened.
However, there is no problem without these constraints.
Causes of shy bladder
The fact that you can urinate without any problem when you are alone rules out the presence of a physical problem. (Dysuria is the name of the urinary disorder with physical causes)
As for paruresis, it is rather which is at the origin of urinary freezes. Thus, shy bladder is considered a social phobia.
As is often the case with phobias, past traumas are linked to it, such as things experienced at school (mockery, intimidation, being surprised in the bathroom...) or in the family (remarks by an elder, remarks by parents...).
The causes are not always conscious. That is to say that we can have absolutely no idea where it comes from.
Characteristics of shy bladder
Each experience is different, but there are some common features that help to confirm the diagnosis:
- There is no urinary blockage when the conditions of intimacy are perceived as good: when we are alone at home, we use the restroom without problem.
- It is not an occasional discomfort that leads us to hold back from time to time, but a constant urinary blockage under the same conditions, often existing for many years at the time of diagnosis.
- The triggers of urinary blockage and the appropriate comfort conditions to prevent it from occurring are identifiable.
There are as many degrees of severity as there are people affected by paruresis. However, we can define 2 categories:
- Regular form: the urinary blockage occurs mainly in public places when the conditions of intimacy are degraded (queue at the urinals, insufficient isolation...)
- Severe form: severely affected people are unable to pee even in well-sealed toilets at friends' homes, in restaurants, on trains, etc.
It took me 16 years of paruresis before I dared to talk about it to someone, it was to my wife, and we had been together for 5 years. I didn't even know it had a name, and I thought I was the only one in the world with this problem.
Guillaume // Former Paruretic
Who is affected?
The taboo that surrounds paruresis and the few studies available make it difficult to estimate the number of people affected, but its frequency would be rather high.
According to the IPA (International Paruresis Association), an international organization created in the United States to develop the fight against shy bladder, this disorder would affect 5 to 7% of the populations studied, maybe more. 220 million people worldwide are affected, regardless of country or social background.
People who are anxious, shy, introverted, very conscious of themselves, strongly apprehensive of critical looks or with a feeling of inferiority are the most affected.
Men would be more affected than women, notably because of the design of restrooms and urinals, which "expose" men to the presence of others.
Symptoms of Paruresis
Blockages in the washroom
Urinary difficulties most often appear in childhood or adolescence, and tend to worsen over time.
At first, paruresis is only expressed in specific circumstances. A classic case is that of the teenager who is anxious in the school bathroom because he or she has to hurry before the bell rings or is pressured from others who are waiting.
Psychologically, this anxiety is accompanied by an irrational fear of being judged negatively and over time a feeling of inferiority can evolve ("why can't I do it when others can?!").
When we have paruresis, we become hyper conscious of others, we tell ourselves that they are listening to us and probably laugh at us because we can't do it. This feeling of shame accumulates with the rest and blocks us even more...too bad it will be for another time.
Over time, the situations that can trigger the phobia multiply and the urinary blockages worsen. Several elements can trigger the freezes such as noise, smell, the looks of others, a door opening, the fact of being heard or the fact of knowing that other people are waiting...
It is from this moment on that we develop techniques on the spot to try to unblock these damned muscles that control our bladder.
Development of "I don't have a choice, I have to make it" techniques
After a while, we tell ourselves that we need to find techniques to get out of it because sometimes we can't escape from where we are.
Some of the most common techniques include:
- Staring at a point on the wall to "clear your head."
- Using headphones and music to "isolate" yourself,
- Closing your eyes,
- Drinking alcohol to loosen yourself up (and don't give a damn to other people),
- Use "super spy" faculties, i.e. always have an eye on the entrance of the toilets to observe who enters and leaves and choose the right moment to try your luck.
Unfortunately, these techniques do not work very well or are not always applicable. We then develop avoidance techniques.
The technique of "staring at the wall to clear the mind" and hoping bladder will open is a classic for people with shy bladder.
Development of Avoidance Techniques
We then begin a downward spiral. The paruresis gradually takes over our behavior. We set up strategies to avoid certain situations. For example :
- Avoid drinking too much to avoid having to urinate later,
- Find pretexts to isolate yourself (take a shower, go very far during a hike...),
- Refuse invitations when you know that the conditions will not be friendly (festivals, concerts, bars, friends with toilets too close to the living room...),
- We delay going to the bathroom with others (friends etc...) so that we can go alone a few minutes later,
- We invent behaviors and ready-made excuses to "justify" ourselves. If we see that there are too many people when we return from the toilets, we will pretend to wash the hands to temporize.
Fear of talking about it, rumination and isolation
Every time we suffer a failure, we start to ruminate on ourselves. If we are in a social context, our mind becomes more and more preoccupied with it and in the end we don't enjoy the moment 100%, in short, we miss moments of life.
The worst part of it all...is the fear of talking about it to others.
Saying that you are afraid of spiders or closed places, everyone understands. But not being able to pee?! The simple fact of imagining talking about it to someone is anxiety-provoking.
One does not dare to speak about it to his close relations (parents, partner...) or even his doctor ("he risks to laugh at me!").
Alcohol can, in some cases, loosen us and help us override the stress. It's the same principle as with dating, you're less shy after a few drinks. Unfortunately, for people with shy bladders, it is clear that this is not a viable long-term solution.
For some, this creates unbearable situations that can be dramatic (loss of job, depression, divorce, social isolation...)
Personally, it took me 16 years of paruresis before I dared to talk about it to someone, it was to my wife, and we had been together for 5 years. I didn't even know it had a name, and I thought I was the only one in the world with this problem.
What can be done to overcome shy bladder?
Unfortunately, as with all phobias, there is no miracle method. When it comes to solutions, there are two types of approaches, short and long term.
Solutions to overcome shy bladder (long term)
- Cognitive Behavioral Therapies (CBT) such as EFT, EMDR, NLP etc...
- Gradual exposure with one or more partners to get used to the presence of others.
Palliative solutions against paruresis (short term)
- Medications such as antidepressants and anxiolytic to reduce anxiety and blockages. But like with any medication, this is not sustainable in the long term due to their side effects.
- Use of a catheter to drain the bladder discreetly. This is not a treatment, but an aid that can allow for a more fulfilling social life (flying, for example).
- Breath holding, in a very specific way, helps some people to urinate. However, it is difficult to master and requires practice.
"Hi, I'm Guillaume. I had paruresis for 17 years, and I decided to talk about this topic because it's still a taboo, and it's not normal because it's something that a lot of people are suffering from, and I've decided to talk about it openly.
So in this video, firstly I will talk about what is paruresis? What are the causes and does it concern you really? Because there are different troubles related to not being able to pee. In the second part, I will talk about the behaviors we develop and the kind of techniques we set up when we have a shy bladder syndrome. I will also talk about whether you should talk or not about it to others close to you, and finally, I will talk to you about how you can overcome paruresis for good.
So, what is paruresis, also known as shy bladder syndrome? Basically, it is the fact of not being able to pee in public places when we know that we can be seen, heard, or that we are in a hurry, like we have to do it in a certain time. So basically, what happens is when you live with paruresis, it's like you just go to the bathroom, you go in front of the urinal or whatever, and well basically...nothing. Nothing wants to come out. Sometimes you can feel it's coming, and then bam, there is an external trigger such as someone entering the restroom, a noise, I mean, you know, it can be different triggers for different people, but basically, the most common one is the presence of someone else. And so, you feel it starts to come, it starts to come, and then there's this trigger, and bam, it's like a block. Your bladder is totally blocked, and you can stay for 5 minutes in front of the urinal, and nothing will come out. So even if you don't have yourself shy bladder syndrome, you can understand that it's very, very, very embarrassing because peeing is something we have to do every day, and we cannot hold it forever because it's extremely painful when the bladder is overfilled, and it can be dangerous over time.
So where does paruresis come from basically? First of all, we have to know that it's classified as a social phobia, meaning that it's an irrational fear. So it is something that is happening in our head, and like most phobias, it comes from some kind of traumas or some beliefs we have built in ourselves, like programs we are running. Once this program is installed, basically, it blocks us from peeing. In general, it appears in our teenage years, most of the case around 15-17 years old, something like that. Most of the time, we don't know where it comes from; we can have an idea sometimes, but most of the time, it appears like that. One day before, we had no problem, and then just one day, bam, it comes without notice. So yeah, it's basically a mental construction and something that is happening in our head.
So there are several kinds of paruresis, basically. Everyone being affected by this thing has a different level, but we can distinguish basically two categories. The heavy form, the severe form, which basically means that people cannot pee at all if there's someone in very close vicinity. It makes it impossible to take long flights, trains, even being at home when the family is around, at work if there are colleagues around, stuff like that. It makes life very, very complicated, and most of the time, people have to adjust their lifestyle around the shy bladder syndrome.
The other kind is mild paruresis, and in that case, we still block, but in certain conditions, we can do it. For example, if we can have an enclosed cubicle, where the door acts as a protection barrier, then it can allow us to pee, not always but it can ease up a bit in some situations compared to people who have a very severe case of paruresis.
So how many people are really touched by this phobia? According to Steven Soifer, the author of the book "The Secret Social Phobia," around 4 to 7% of the population is concerned by this phobia, although it's very difficult to have an exact figure because it's not something people talk about really. Also, an interesting point is that 90% of the people who seek help are actually men. So it looks like it's affecting more men than women, although women are also concerned by this thing, but it seems there's a tendency towards men being more touched by this thing.
So what are the kind of behaviors and tricks we set up when we are affected by the shy bladder syndrome? Well, the first one we develop is to be aware of where the toilet is and who is going in and who is going out. So in a way, we become what I call a "super spy" because we always have an eye on this door, even though we are with friends or whatever, we unconsciously start to have an eye on our friends and one eye on the restroom door just to know when is the best moment we can jump in and try to have the best chance possible to be able to pee without anyone or the least people possible in the bathroom.
Another thing we do once we get there and we are in front of the urinal, for example, and that's a basic technique, but we know the problem is in our mind that is thinking too much. So to try to make the void up there, we start by fixing a point on the wall and then praying, basically. We try to fix a point, make a void here, and pray that the bladder opens up. Most of the time, it doesn't, and so yeah, there are other techniques. Another behavior we develop is we start drinking, especially in bars or restaurants and stuff like this because, as everybody knows, alcohol loosens us up, makes us think less, makes us more relaxed. Because the brain basically is half asleep when we are in front of the toilet, it is thinking less, and then he can finally leave the bladder do its job. So alcohol might help, but it's not obviously something we can recommend because alcohol is not good for us, and it's not something we can always have under our hand or whatever. So it can be useful when we are in our 20s, but when we reach our 30s
or 40s, it's not something that is advisable.
In the more global behavior, we can start to refuse social events. For example, going to a concert, going to a very crowded bar or very crowded mall or something like that, something where we know we will have trouble in advance. We know we will have trouble, so we might refuse and separate ourselves from some social life events. For some people, like I said before, they cannot travel, they cannot see the world, they cannot enjoy some quality moment with their family. So at the beginning, we start to adjust, but for some people or after some time, basically, we adjust our life to live with the paruresis, and that's not good because it can affect our whole life, but also our morale and our state of mind. Those are techniques or behaviors we develop when we have paruresis; there are tons of them. I'm not gonna cite them all, but basically, you can easily understand that the more we have this thing, the more we develop tricks and tips to cope with the phobia.
So another thing that is hard to explain unless you have had this thing is the fear to talk about it to others. It's extremely difficult to talk about it to others because most of the time when we have paruresis, we think we are the only one in the world because well, nobody is talking about it around us. It's extremely difficult to tell someone, 'Man, I can't pee!' Especially when you are a man, and you know we live in a society where 'yeah, man needs to be strong and don't cry' and all this stuff. It's extremely difficult to talk about it even to our close ones like a wife or husband or parents. It's extremely, extremely embarrassing to talk about. And so what we do basically, we start to close ourselves. In general, we start to close ourselves, thinking we are the only one in the world. Every time we go to the loo and we fail, we come back from where we come from, but we have this mental chatter, those ruminations going on, those dark thoughts like: 'Why me?' 'Why can't I pee like everyone?' 'I'm not normal' and blah blah blah. So we are basically living with dark thoughts all the time. I mean each time we fail, well, it doesn't take much to understand that when you live like that for decades, it can really ruin your morale. I mean this thing is serious in some cases, luckily not everyone, but in some cases, it can break up families, it can break up marriages, you can lose your job for that, and in some severe cases, people will go into depression, and the worst of the worst, of course, can lead to suicide. But we can easily understand that it's something extremely embarrassing and something that will basically take you down.
Okay, so what can we do about it? There are two kinds of solutions. There is a short-term solution that is just working on unblocking us temporarily and long-term solutions that are actually treating the root causes of the phobia and that can free us totally. So first of all, the short-term methods can include, for example, drugs like anxiolytic that basically numb our brain and will allow us to pee a bit, almost like alcohol. A second option is the catheter where we put something to drain the urine from our bladder, and this can allow some people to, for example, take a long flight, travel in peace, or go to some event without anybody knowing. It's just that they're emptying their bladder with a mechanical system. And another technique is called the breath hold or breath-holding where it's something you need to practice to master. I will describe it in another video, but basically, the principle is to hold our breath so the CO2 level in the body increases, and CO2, one of its properties is that it dilates muscles and it will dilate the muscles around the bladder and allow the flow of urine to start. So, it's a technique that is not for everyone, not everyone manages to master it, but it's a short-term solution for people who are really struggling.
So in the range of long-term solutions, there are two main things. The first one, the one recommended by Steven Soifer from the book I recommended before, is gradual exposition. So what does it mean? It means to practice with someone to expose ourselves, to pee in front of someone and increasing the difficulty over time. So for example, at the beginning, he can start very far behind the door, then we open the door, he comes closer and closer and closer. Like that, we can get used to the fear basically and overcome it over time. It can take a very, very long time, and it's not easy to put into practice because we have to find a partner to do that, but it's something that is efficient. Other methods that exist are all kinds of techniques that are today well proven to be efficient against phobias like hypnosis, EFT, EMDR, and all kinds of other CBT therapies that can be used to treat the root cause and basically accept our fear and deal with the trauma we had, even though we might not remember them. But really tackling the root cause of the problem and getting free.
So to conclude this video, paruresis or shy bladder is a nightmare. It's really a nightmare to live with this thing, and if you are really motivated to tackle it, to overcome it, then just go below this video where you will find links to useful resources for you to take your first step towards freedom and really to overcoming your shy bladder. I'll see you in another video, take care, bye."