Paruresis Advice

Catheters are small rubber or plastic tubes that can be inserted through the urethra and into the bladder. Both men and women can use catheters. Catheters are a method of emptying the bladder and should work every time. Paruretics who use catheters are use ‘clean intermittent catheterization’ (CIC). This is a fancy way of saying the catheters are used only when needed, and on an intermittent basis. It also means that the catheters do not have to be sterile, however they do have to be totally clean. There is a small risk of infection, particularly in women, however the risk is minor and keeping the catheter as clean as possible will reduce this risk.

It is recommended that you tell people that you trust about your paruresis. It means that they may be able to help you in social situations - perhaps covering for when you take a long time in the bathroom, or will be more willing to go to a particular pub or restaurant where you feel more comfortable. It also usually comes as a relief for sufferers when they tell someone. It normally isn’t easy, but most people will tell you that it was worth it.

Introduction

Paruresis - often known as ’shy bladder’ or ‘bashful bladder’ - is a social anxiety disorder that can affect both men and women. The sufferer is unable to urinate in the presence of others - for example in a public toilet such as at work or in restaurants, or in toilets in other people’s houses. A person with this disorder is known as a paruretic.

Although lots of people experience ’stage fright’ where they have difficulty urinating in undesirable or uncomfortable situations, this is different to paruresis. Paruresis is far more serious and may cause physical problems. Although the problem is a psychological problem, the physical effects of it are unable to be controlled by the sufferer.

Micturition is the medical name for the process of voiding the bladder. The bladder is voided by a contraction of the detrusor, the muscle which surrounds it, coupled with the relaxation of the two sphincters of the urethra.

A simple explanation is that we can imaging that it is based on a reflex between strain sensors in the wall of the bladder and flow sensors in the urethra and the detrusor. The strain of having a full bladder triggers it to contract. The flow sensors detect when there is a flow of urine and feeds back to the bladder sensors to ensure the bladder stays contracted whilst there is urine still flowing. For adults, this reflex is a conscious reflex which is controlled by the brain. However, the co-ordination of the micturition and continence are subconsciously controlled and are integrated into other bodily processes.

The triggers for paruresis will be unique to each person. Although it may seem it has appeared out of nowhere, there is usually an underlying cause. For most, it will be triggered by one or more negative events associated with urination. Common events are being interrupted whilst urinating or being in an unpleasant environment. One event may not trigger then syndrome off - there may be a close succession of events which lead to the syndrome.

Women generally only have the option of stalls whereas men will normally have the added option of urinals. For a woman who is unable to urinate in a stall, there is only really one fall back option - self-catheterization.

Female bathrooms are usually treated differently to men’s. That old adage that women go to the bathroom in pairs holds true - women’s bathrooms tend to be more of a social area than men’s, with women talking between the stalls, doing their make-up and hair in the mirrors, taking in small children (who can be disruptive) and changing babies nappies. For these reasons, women’s bathrooms tend to have longer queues. Both the queues and the social aspect of the bathrooms mean extra difficulties for female paruretics because they dislike being rushed and dislike other people being around meaning these types of situations can cause extra anxiety.

The main elements in the process or urination are the sphincters, the bladder and the urethra. The bladder is enclosed in a muscle called the detrusor which is divided into two parts - the dome around the bladder and an area around the bladder neck (the internal sphincter). This is normally subconsciously controlled. Lower down, an external sphincter surrounds the urethra. This sphincter is normally consciously controlled.

As your bladder fills, the dome around the bladder relaxes and both of the sphincters contract. As you urinate, both the sphincters relax and the dome around the bladder contracts so that the urine is forced out with minimal resistance.

This article shows you some basic things that you can do to help improve your paruresis. They may not fully cure your condition, however if you follow some of the suggestions here, you may find that you condition improves. It is important to try and follow the guidelines every time you go to the bathroom - progress will take time and the more you practice these suggestions, the more natural they will become.

Relax!

Being tense makes it more difficult to urinate. Ensure that you breathe slowly and deeply, fully relaxing your abdomen. Deep slow breathing will calm you down and help you to relax. Breathe in slowly through your nose and hold for four seconds before breathing out slowing through your mouth.

This guide requires a second person to help and support you during the treatment. It is important to choose someone who understands your problem, who has a lot of patience and who will be able to give you the support that you need over an extended period of time. There are also self-help workshops held around the country which practice exposure therapy and you may want to attend one of these first before trying this exercise on your own.