It is important that you check the dosages on all the following remedies as products from different manufacturers may contain different amounts of the active substances, and concentrations in different batches may also vary (even if they come from the same manufacturer).

St. John’s Wort
St. John’s Wort is sometimes known as hypercium. It has been used for centuries to treat anxiety and it is commonly used throughout the World. The flowers and leaves of the plant are used to make the remedy – they contain a substance called hypericin and it is this substance which is believed to help alleviate anxiety.

There have been recent reports that St. John’s Wort may adversely affect your kidneys and/or liver so check with your doctor before taking it.

Kava-Kava
Kava-Kava is made from the pepper plant ‘piper methysticum’ which is found in Polynesia, Melanesia and Micronesia. It is made from the root, ground down to a powder. Kava-Kava is most commonly used to aid relaxation and produce a contentment and occasionally a mild euphoria.

Please note that Kava-Kava is banned in the UK because of possible toxic effects on the liver.

Saw Palmetto
Saw Palmetto, otherwise known as Serenoa repens, is often used as a treatment in benign prostatic hyperplasia (BPH). It also known as Sabal serrulatum, Sabal serulata, Sabalis serulata, Sabalis serulatae, Serenoa serrulata and Serenoa serrulatae.

Saw Palmetto has been used for over 100 years to treat swollen prostates. For this reason, it may be beneficial to men who are suffering from paruresis.

Using a catheter should be painless, quick and easy. Depending on the diameter of the catheter and the amount of urine in the bladder, it may take up to two minutes for all the urine to be passed. You will know when your bladder is empty as no more urine will flow.

Catheters are small therefore can be carried in a handbag, pocket or luggage with no problems. Many people will carry lubrication jelly and handwipes with the catheter in a small cosmetics-type bag. Most people like to lubricate the catheter with lubrication jelly – note that Vaseline should never be used. There are some catheters that do not need lubrication – which brand to use is personal choice.

Catheters comes in a variety of styles, materials and sizes. You may need to try a few catheters out to find what is most suitable for you. Common catheter materials are silicone, plastic, rubber, PVC or Teflon. Some catheters also have tapered tips to help with insertion. Some also have a slight bend near the tip and are know as Coude catheters – men often prefer to use these.

You should always get fully trained in how to use a catheter before using them as you can damage yourself if it is incorrectly inserted. Your local doctor or nurse should be able to help teach you how to use one correctly.

Catheters are widely available. You should be able to get them at pharmacists, on-line, mail-order or medical supply stores. No prescription should be necessary. Both reusable and disposable catheters can be used. Reusable ones just need to be washed with water and a little soap.

It is better to lead them in gently than drop the issue on them. You might want to start with something such as:
“I have a phobia which is really messing my life up. It is an illogical fear. So far, I’ve been too embarrassed to tell anyone. I have a social phobia rather like stage fright – like when you are unable to speak when other people around. For me, when people are around, I lose the ability to pee. I want to go but I’m unable to. It often makes my life a misery. It is a recognised condition called ‘paruresis’ and lots of people have it, but it’s not something which many people talk about.”

This dialogue will lead them gently into the problem and give them something they may be able to relate to before you tell them the problem outright. It also lets them know that paruresis is a real condition which is recognised by organisations such as the NHS. They may even offer you to try and help you get over the condition.

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.

The external muscle can be controlled consciously. However even muscles consciously controlled can seize up, particularly when we are anxious or stressed. If you could get this sphincter back under control, you may be able to learn to urinate more freely.

One method we can use is to focus on the muscle. Ensure that you are in a quiet place where you feel relaxed and comfortable.
Contract the sphincter muscle as strongly as you can so that you are aware of it’s position.
Relax the muscle.
Now to try and relax the sphincter more. Focus on the muscle and focus on relaxing. You should find that you are able to relax the muscle more than you expected to.
Repeat this exercise a few times a day and try to get the muscle as much under control as you can.
After a few days, try to imagine a situation where you do not feel comfortable. Now try to relax your sphincter muscle.

When you try this technique in a real situation, if the flow does not start, try to push a little bit with the muscles of the abdomen. If your sphincter is totally relaxed, the flow of urine should start. If you still have problems, relax, and continue to practice the exercise a little while longer before employing it in a ‘real life’ situation again.

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.

Lean slightly backwards until your thigh muscles are not tensed. Bend your knees slightly. Let your shoulders relax. Scrunch them up to your ears and then drop them down again.

Anxious people often tighten their abdomen which puts pressure on the bladder. Try to relax your stomach muscles.

Understand your hesitancy

Hesitancy is the delay between being ready to go and the flow actually beginning. Hesitancy is normal and everyone has a different hesitancy length – from milliseconds to up to 15 seconds. When you are in a relaxed environment, time yourself to find what your normal hesitancy is. Most people, even those who do not suffer from paruresis, find that their hesitancy increases in unknown places. Some may even not be able to go at all, however they do not see this as a problem. So, you will also find that your hesitancy length will increase whenever you are not home – it is entirely normal!

Stop the negative thoughts

Try to control your negative thoughts. The moment a negative thought pops up, try to clear it from your mind. Relax, and breathe slowly. Recognize the thought as negative and say to yourself it is not based in reality. Now try to think of a positive thought – ‘I can always try again later’, or perhaps ‘I have more interesting things on my mind right now’. The important thing is to focus on something other than the negative thoughts so no more can arise.

Remember, whatever you may think, no one else is judging you. They are not interested in you – they have other things on their mind!

Wait it out!

If other people are in the bathroom with you and you are unable to go, wait it out. They will eventually leave. Contrary to what you may think, no-one will notice or care. In fact, the busier the place, the easier it is to wait it out. Most men avoid standing next to each other at urinals unless there is no choice. In this situation, many will choose to use a cubicle anyway. It’s your personal space and you are entitled to do so! If someone does look up at your as you walk by, they are not thinking about you! It is an automatic reaction to see what has gone past and is in no way a judging look.

Tell people

Tell someone you trust – it is a social anxiety and they will be able to support you through it. Ensure that you emphasize that it affects your life and your peace of mind. Let them know that just them knowing about it takes the pressure off you. You can also let them know that they can help you by taking your needs into account – about when and where to go out and how long to stay out, and to cover for you if you take a long time.

When you go out, desensitize yourself to the environment. Experience normal conditions. Most sufferers don’t know what passes for routine behaviour in public toilets because they are so fearful when they do go, they do not notice. Go into the public toilets – maybe to just wash your hands. You will soon realise that no-one cares. Soon, it will become boring and you will be desensitized. Now you can start to use the toilet. If you find yourself becoming anxious, leave the toilet as you do not want to reinforce the anxiety.

Nerve Stimulation (for men only)

Some men have a nerve which, when stimulated, can cause them to urinate substantially. It is located in the bit of the penis sking which anchors the shaft sking to the underneath tip of the penis. If you are uncircumcised, you will need to retract the foreskin. Just a slight touch can cause an urge. Tickling the base of the spine just above the coccyx can also help both men and women.

Focus

Non-sufferers will focus on the cubicle or urinal they are headed for when they enter the toilet. Sufferers will tend to focus on the people in the toilet and everything which is around them. Discipline yourself to focus on where you are going to and deliberately ignore anyone else who may be in the toilet with you.

Try again later

If you are unable to go after 2 minutes, leave and try again later, otherwise you will reinforce the negative anxiety.

Before you begin, it is advisable to seek out a doctor’s advice first to ensure that your symptoms are not caused by something physical. As a general rule, you have paruresis if you are able to go at home easily but you find it difficult to go or are unable to go in social situations.

Exposure Therapy involves several sessions. Each session will involve several attempts at urinating. This means that a substantial amount of urine is needed. Because of this you must try to drink a lot of fluid (preferably water) before the session. Most people will only be able to succeed using this therapy if their need to urinate is high at the time of the session – it is a good idea to try and ensure that the urgency is fairly high, but not extreme.

It is also important to try and have a back-up plan. The most common of these is the use of a catheter. Ensure that you are comfortable using a catheter before you start the exposure therapy sessions.

In your first session, you will need an isolated bathroom where you feel comfortable. Ask your buddy to wait away from the bathroom but on the same floor – somewhere where they will not be able to hear you urinate. Once your buddy is in place, try to urinate. If you are able to star the flow, continue the flow for 3 seconds and then stop. Take a break for 5 minutes. Now, try again. If you are a paruretic who does not like the noise of urination, try to make your urine flow as loud as possible to desensitize yourself to the sounds. Do not use any background noises such as a running tap as you go. If you are unable to urinate after 2 minutes, take a break for 3 minutes and then try again. If you are still unable to urinate, have your buddy move further away – maybe a different floor or even outside the house. Remember it is also important to relax – check out our relaxation techniques with hints and tips on how to do this.

When you have successfully urinated a couple of times, move your buddy closer. Typical ‘steps’ are:
- Just outside the bathroom door with the door locked
- Just outside the bathroom door with the door unlocked
- With the bathroom door slightly ajar
- With the bathroom door wide open
- Standing just inside the bathroom
- Standing directly behind you.

If you do not have a buddy to practice with, or you have reached the ‘top step’ with your buddy, try setting yourself a series of steps such as:
- Trying to go when people are outside the bathroom
- Trying when there is one person in the bathroom
- Trying when there are multiple people in the bathroom
- Trying when someone is in the stall next to you.

With each step, after you have successfully urinated a couple of times, move up to the next step. The ideal which you are aiming for is being able to urinate freely in a public bathroom with a lot of people in the bathroom with you.

If you find one step is giving you a lot of bother, try breaking the step down into smaller steps. Just a couple of centimetres can make the difference and will help to boost your confidence.

For the best results, it is advisable to practice several times a week for up to an hour. Longer sessions are generally more helpful than shorter ones. You may need to keep drinking fluids throughout the session to ensure that you have enough urine. Be prepared for some inconsistency in your progress – it’s entirely normal! Most people will experience ups and downs with how close they can let their buddy get to them in each session and it is nothing to concern yourself about.

This therapy normally takes around 12 sessions, although each person will be different – some people will require more sessions, some less. It is important to go at your own pace. Although this treatment has helped many people overcome their paruresis there is no guarantee it will cure yours. Check out the other pages on our site to see if there are other techniques that can help you.

On extremely rare occasions, you may find that you are unable to urinate even after your buddy has gone home and you are on your own. If this happens it is imperative that you seek medical treatment immediately otherwise you risk damaging your health.

If you feel that you have tried all the self help available, seek advice from your doctor who may be able to advise you on other techniques to try, or may be able to prescribe you medication to help lessen your anxiety.