Shy Bladder Syndrome (Paruresis): Getting Help

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Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

There are an increasing number of people sending E. Mails in response to the posting about the problem known as "Shy Bladder Syndrome." The medical term for this condition is Paruresis. People afflicted with this condition struggle with the fear of urination in public bathrooms or even the bathrooms in the homes of friends and relatives. The fear that is suffered is a tortuous self consciousness that there bathroom activities will be over heard by others. For some reason, this stirs up a terrible amount of anxiety such that their bodies tighten and, no matter how urgently they need to urinate and now matter how painful the situation, they are unable to urinate. As a result, they do everything possible to avoid using public rest rooms. In the worst case scenarios, some of these suffers limit their lives by not travelling abroad and taking jobs within walking distance to home.

Perhaps worst of all those with Paruresis begin to engage in very negative self thinking. They begin to condemn themselves as "sick, weird, hopeless and irrational." None of these things are true.


Studies show that those men and women with Paruresis remember feeling this anxiety about urination before the age of twelve. For many, the fear of public bathrooms began in elementary school. However, there are plenty of others who remember it beginning when out in public with parents and being taken to public rest rooms. Thereafter, the situation only got worse.

People sending E. Mails about Paruresis are asking how they can get help with this condition. Following are some suggestions.

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What to do about Paruresis:

1. Cognitive Behavioral Psychotherapy (CBT) is an excellent way to begin dealing with this disorder. I suggest that those who choose this route see a Clinical Psychologist who ie trained and expert in the use of CBT.

2. In addition to CBT that same psychologist should have expertise in Systematic Desensitization and gradual Exposure Therapy whereby the individual is gradually helped to become less fearful about public bathrooms and the fear of being heard while urinating.

3. There are a variety of self help techniques that can be used. However, for those who have struggled with Paruresis for many years I would still emphasize professional help. Here are some self help techniques:

a. Males with this condition can use closed stalls instead of urinals found in public men’s rooms. The closed stall can add a sense of security while in the rest room.

b. If in the home of a friend, family or your home while guests are in the house, it can be helpful to turn on the tap while urinating. The noise of running water can hide any noises and can provide a sense of security.

c. In many public places such as airports, theaters, etc, there are usually many rest rooms. The advantage of this is to look for one that is empty and, therefore, more comfortable.

d. In a more indirect way, the use of meditation, deep breathing and deep muscle relaxation, are methods that help all of us reduce our general level of anxiety and tension.

What I want to stress, once again, is that these self help techniques are far from perfect. They may help some of you some of the time. Professional intervention is still the best approach and the one I am recommending.

For more information, here is an excellent web site with useful links to other information:

Allan N. Schwartz, PhD

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