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.

What can women do to help themselves?

Relax!

The first thing to do is relax! Being tense will only make it harder for you to urinate. Breathe slowly and deeply. Relax your abdomen; Breathe in through your nose, hold your breath for four seconds, and then breathe out slowly through your mouth. Relax your stomach muscles so that you reduce the pressure on your bladder.

Focus

Non-sufferers will focus on the cubicle that they are headed for. Sufferers will focus on the people in the bathroom. Discipline yourself to put ‘blinkers’ on and focus only on where you are heading. Deliberately ignore anyone else in the bathroom.

Hesitancy

Remember that hesitancy is normal - hesitancy is the delay between being ready to urinate and the flow actually starting. Everyone has a different hesitancy length. Time yourself at home so that you know what is normal for you. Most people, even those who do not suffer from paruresis, will find their hesitancy time increases when they are unknown places, so if you find yourself suffering from slightly longer hesitancy, remember it’s normal!

Positive thoughts!

Control your negative thoughts to reduce anxiety. If one appears, clear it from your mind. Recognize the thought is negative and tell yourself the thought is not based in reality. Think of a positive thought to replace it and repeat it to yourself - “I can always try again later”, or “There are more interesting and important things on my mind right now”. The important thing is to think of something positive so that no more negative thoughts can arise.

Wait it out

If you still cannot go, wait it out. If other people are in the bathroom, wait for them to leave. Contrary to what you may think, no one will notice or care what you are doing. It’s your personal space and you are entitled to it.

Talk about it

Try talking to someone that you trust - maybe a partner or a friend. You are suffering from a social anxiety so let them know so that they can support you. Emphasize how much this affects your life and let them know you would appreciate it if they covered for you if you take a long time in the bathroom, or if they thought about where and how long you go out for. Log onto our forum and talk to other sufferers.

Other ways to help yourself.

Desensitization

Desensitization is the process where you desensitize yourself to the environment. Experience normal conditions. Most sufferers do not know what passes for routine behaviour because they are so anxious when they do go into public bathrooms. Start by entering the bathroom and just washing your hands or checking your make-up. Do this a few times over a period of time. You will soon see that no-one is focused on you! Soon, this will become boring. Now, start to use the toilet. If you are unable to go within about two minutes, leave, otherwise you will start to enforce the anxiety.

There are workshops designed especially for women which can help with the desensitization process.

Catheters

Self catheterization is where a sterilized plastic tube is inserted into the urethral opening to allow the release of urine. This can be a difficult process for women. It is not a cure for the problem but may help until the underlying causes of the affliction are cured.

Catheters come in a variety of sizes, styles and materials. It is important to find one which suits you so that you can feel happy using one. Because of the variety, it is a good idea to go to a health care practitioner to ensure you find the catheter which is best suited to you.

There are a few different methods for inserting a catheter. The method which is most used is to sit or stand over the toilet bowl and identify the opening of the urethra by feel. The catheter is then inserted and the urine is drained. If you have problems inserting the catheter, there are products on the market which can help identify the opening. Again, visiting a health care practitioner is advisable so that they can show you a range of methods which you can try.

Women are more susceptible to infections of the urinary tract such as cystitis than men. If you do decide to use a catheter, it is advisable to drink plenty of fluids (especially water) and to urinate frequently. This, of course, is a catch-22 for a paruretic! Antibiotics can be prescribed as a preventative measure, and can also be prescribed if you do get a urinary tract infection.

What else can I try?

You could try a urinary pouch. This is a plastic bag which attaches to the inner thigh which has a valve at the bottom to release the urine. If you wear a skirt or loose fitting trousers, it will be totally hidden.

There are also assistive items which can be used, although they are recommended more for outdoor use (such as camping). They are ‘funnels’ which enable a woman to urinate through the flies of their trousers whilst standing up.

Your local GP may also be able to prescribe you something to help to reduce your anxiety levels - common prescriptions are SSRIs such as Prozac or Paxil.

Why is paruresis more common in men than women?

There is no underlying reason why men are more likely to suffer than women, however there may be a few reasons why men appear to suffer more than women.

Some women may suffer in silence believing it is an inconvenience that they just have to put up with.

Media attention has primarily been focused on men with paruresis so women may not be aware that they can suffer from the condition too.

Some women may not wish to participate in mixed discussion groups.

Women tend to be more inhibited when it comes to talking about the condition. Many forums are male-orientated and women may be put off by the lack of other women to talk to. They may also be reluctant to talk about personal problems with strangers.

What else can I do?

Read! Although, as mentioned above, most literature is aimed at men, you will learn a lot about the condition and you will find there are many sufferers out there. Come and register on our forum (remember, you do not have to use your real name, or give it out to anyone, so no one else will know who you really are) and talk about techniques which work for you, and what you are doing to help yourself!

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