Paruresis – also known as “shy bladder syndrome” – a common but unrecognized condition is the difficulty or inability to pass urine in a public toilet, or when other people are nearby. The situation could make you smile if it were not likely to turn everyday life into a real ordeal. Psychologically, this urinary blockage is similar to a social phobia. Solutions make it possible to get out of it, in particular behavioral and cognitive therapies.

Definition

Paruresis (“shy bladder syndrome” or psychogenic urinary retention), is defined by difficulty in urinating up to total incapacity when one can be seen or heard by others, when one anticipates this eventuality, and more generally in various situations experienced as stress, especially when one is pressed for time.

Causes

Affected people do not present any organic disorder that would explain their inability to urinate. An anxiety disorder related to a social phobia is the cause of their urinary blockage.

Underlying psychological causes are often found, in particular childhood traumas experienced at school (toilets that do not close, mockery, intimidation, etc.) or in the family home (poorly lived toilet training).

Diagnostic

The diagnosis is based on the experience described by the affected people, after elimination of any physiological causes.

Each experience differs, but there are certain common traits that allow the diagnosis to be confirmed:

• It is not an occasional discomfort that would push to hold back from time to time, but a constant urinary blockage under the same conditions, often existing for many, many years at the time of diagnosis.  
• There is no urinary blockage when the conditions of privacy are perceived as good: when they are alone at home, affected individuals use the toilet without any problem.
• The triggers for urinary blockage and the appropriate comfort conditions for it not to occur are identifiable.

In some mild forms, urinary blockage manifests itself mainly in public places when the conditions of privacy are degraded (queue at the urinals, insufficient isolation, etc.), while severely affected people will be totally unable to pee even in the open. tightly closed toilets at friends’ homes, restaurants, trains, etc.

The people concerned

The taboo surrounding paruresis and the few studies available make it difficult to estimate the number of people affected, but its frequency would be rather high. According to the IPA (International paruresis association), an international organization created in the United States to develop the fight against paruresis, this disorder affects up to 7% of the populations studied, or even more; 21 million Americans and 220 million people around the world would be affected. 

People who are anxious, shy, introverted, very self-aware, strongly apprehending critical looks are the most affected.

Men are more represented in studies, but this could be linked to a greater difficulty for women to talk about it.

Risk factors

A personal or family history of other symptoms of social anxiety is often reported. More generally, multiple factors of a biological, psychological, social or environmental nature are likely to intervene in the genesis of this disorder.

Urinary difficulties

Urinary difficulties appear most often in childhood or adolescence, and tend to get worse over time.

In the early days, paruresis is expressed only in specific circumstances. A classic case is that of an anguished teenager in the toilets of his school establishment, his anxiety causing physical symptoms such as profuse sweating or palpitations and preventing him from urinating.

On the psychological level, this anxiety is accompanied by an irrational fear of being judged negatively.

These symptoms are aggravated by certain triggers, such as noise, smell, knowing that other people are waiting …

Over time, the situations likely to trigger the phobia multiply and the urinary blockage worsens. As in other social phobias, people with paruresis express their anxiety in anticipation, at the mere thought of having to use the toilet without being able to do so.

Avoidance behaviors

Caught in a spiral, people with shy bladders implement strategies to avoid being confronted with it. They look for isolated places, invent schemes to find themselves alone, avoid drinking during the day… Their phobia affects their personal and social life: to avoid being exposed to them, they increasingly restrict outings and trips.

In the absence of large-scale clinical studies, treatments are not currently standardized. However, individual case studies as well as testimonials and surveys show the benefits of medical treatment adapted to social phobias, which range from improvement in symptoms to total recovery, which is more difficult to obtain in severe cases. .

Psychological care

Behavioral and cognitive therapies often seem to be effective. They are mainly based on exhibition techniques, with a progressive scenario. Evidence suggests that the use of NLP (neuro-linguistic programming) or EMDR (Eye Movement Desentitization and Reprocessing) can bring improvements in some cases.

Psychotherapy and participation in support groups can also be helpful.

These different approaches can be combined for better efficiency.

pharmaceuticals

Different classes of drugs have been tried in the treatment of paruresis. In addition to psychological management, antidepressants and anxiolytics can help reduce symptoms but should be used with caution given their side effects.

Medicines used in urology have been tried, but their effectiveness has not been demonstrated.

Urinary self-catheterization

Some urologists suggest that people with paruresis learn to use a catheter to discreetly empty their bladder. This is not a treatment, but a help that can lead to a more fulfilling social life. 

Complementary approaches

• Hypnosis has been shown to be effective in some people.
• The “hold breathing” technique, which consists of holding your breath in a specific way, helps some people to pass urine. However, mastering it seems difficult to acquire.
• Different herbal remedies have been tried but have not shown their interest.

Prevention involves early treatment, before the paruresis sets in over time and gets worse. Do not hesitate to consult as soon as you become aware of your disorder, even if the discomfort caused is relatively moderate.

A child who complains of difficulty using the toilets at his school must be listened to. It is sometimes possible to act with the head of the establishment to obtain improvements in comfort and privacy.