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.

History

Although literature suggests paruresis has been around for a long time, the term was first named by a paper by Willaim and Degenart in 1954. The paper was entitled “Paruresis: a survey of disorder of micturition” and was published in the Journal of Psychology. The paper surveyed 1,419 college students and discovered that 14.4% of them had experienced paruresis - either continuously or incidentally. Interestingly, there is no data available about paruresis before this time - a good example being World War 2. The conditions and the lack of privacy in training and fighting would have been intolerable for paruretics however there are no accounts of men dodging the draft due to this condition, going AWOL or obtaining psychiatric discharges.

What are the major problems for people with this problem?

The NHS and government are beginning to recognize this problem - the NHS on-line encyclopedia of conditions and disorders now lists this condition. Paruresis is also catered for in the rules for mandatory testing for drugs in UK prisons. UK incapacity benefit trials also recognize this condition. It is now also reportedly a valid reason for jury service excusal. With workplace drug testing becoming more common, this can also prove to be an obstacle. However in the UK, employees have the right not to be unfairly dismissed if the company does not recognize and cater for this condition.

Severe cases of this disorder can be highly restrictive on the sufferer’s life - severe sufferers may not be willing to travel far from their home, or able to go out for meals and days out such as camping or outdoor concerts. Some people are unable to urinate in their own home if someone else is there. Strategies which may be employed by sufferers include:
- Drinking less fluid. This is dangerous as it can lead to dehydration
- Avoidance of large or busy public toilets and only emptying out when ’safe’
- Trying to find less-busy or single cubicle toilets
- In the case of men, finding a stall instead of a urinal
- Running a tap or flushing the toilet to mask the sound of urination

If a user is unable to urinate and the bladder is held at a very full level for a long period of time, it can lead to internal infections and severe stomach pains.

The strategies outlined above only address the symptoms and do nothing towards curing the problem. Treatments which aim to cure the problem, or alleviate the symptoms include:
- Cognitive behaviour therapy: with the help of a therapist, recognizing the patterns and replacing the reaction of ’seizing up’ with a more helpful action.
- Biofeedback: a complementary therapy which monitors bodily processes such as heart rate and skin temperature to provide access to the sufferer about their physiological information so that they can gain control over physical processes which are normally considered ‘automatic’.
- Use of a catheter: although more of a ‘work around’ than a cure, it helps to alleviate the symptoms
- Drug treatment: in some cases, medication is necessary especially when depression or serious anxiety problems are present. Some medication can help the sufferer to relax more hence alleviate some of the symptoms.
- Gradual exposure therapy: reducing the level of privacy slowly to help the sufferer feel more comfortable. This therapy is normally employed at workshops so that sufferers can work together.

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