Is your bladder a little shy?
Being unable to pee in public toilets can be a huge problem.
Just imagine, being unable to pee anywhere, whatever the reason is, when you need to go really badly. Sounds like a nightmare.
People struggling with Paruresis feel like that every day.
Stay with us as we explain what Paruresis is, what causes it and what’s the most effective treatment option.
Let’s dive in!
- 1 What is Paruresis (Shy Bladder Syndrome)?
- 2 What are Your Treatment Options?
- 3 A Simple Trick – Hold Your Breath for 40 Seconds
- 4 Conclusion
What is Paruresis (Shy Bladder Syndrome)?
Shy (bashful) bladder syndrome, or as it is officially called – paruresis, might sound cute but it is as far from that as possible. This condition is defined as one’s inability to urinate in a public restroom or anywhere else where other people can hear.
Seven percent of the American population, which is roughly around 21 million people, struggle with this syndrome every day.
It might not seem serious to you, but it is a bigger problem than you can imagine. People spend most of their time outside of their home and places where they feel comfortable. We find ourselves in situations where we have to use public restrooms, bathrooms at our workplace, or in someone else’s house on a daily basis.
Now imagine having to pee, really badly and at the same time being physically restricted to do that.
In paruresis, the presence of other people causes a person’s sphincter muscle, which controls the urine flow from your bladder, to lock up. Once this happens, your body simply can’t release the pee.
As if it wasn’t big enough of a problem that this happens outside your home, it can happen even in your own bathroom if other people are nearby.
List of paruresis symptoms
Many people feel uncomfortable peeing outside their apartment, but that doesn’t mean they necessarily have shy bladder syndrome.
Here’s the list of symptoms that are characteristic for paruresis, which will help you recognize if you are dealing with this problem:
- The irrational need for absolute privacy when going to the toilet;
- Fear of other people hearing you urinate, as your pee hits the toilet water and smelling the urine;
- Inability to urinate in public restrooms or at the office and other people’s homes;
- Inability to urinate at own home when other people are present or waiting outside the bathroom;
- Negative self-talk while trying to pee;
- Anxiety related to the need for urination;
- Limiting the number of drinks to reduce the need to go to the toilet;
- Avoiding social events and traveling.
As you can see, if you decide to neglect this issue, it can severely affect your personal, professional and social life. Long hours away from home might become unfeasible. Avoiding parties, different events, and dates or choosing your job accordingly is not a solution.
What’s the cause?
Fortunately, it is not your urinary tract that’s causing the problem. It’s your head.
Shyness and nervousness regarding peeing in the presence of others are considered to be a social anxiety disorder.
We still cannot say precisely how it happens as the human brain and psychology is still a mysterious field even after centuries of studying.
Your case of paruresis might have started in early childhood when your parents criticized your performance during potty training. Perhaps, there was a bully in school who abused you or made fun of you in the bathroom. Or you failed to pee on cue at the doctor’s office when they wanted to take your urine sample, and you felt embarrassed. Maybe you were a victim of sexual abuse that happened in a restroom.
After the inability to pee appears for the first time, you worry that it’ll happen again. This is called performance anxiety.
Unfortunately, you trap yourself in a circle of worrying and failure. The more you push yourself to pee, the more your muscles refuse to cooperate. The anxiety causes your nervous system to produce adrenaline, which consequently makes your sphincter clench.
Make the distinction
Before considering the right treatment for your paruresis, you should know that various physiological conditions can also affect your ability to urinate. If you are a male, prostatitis might be a cause.
Make sure to consult your doctor who will determine whether there’s something physically wrong with your urinary system. Once the medical professional confirms that you are physically healthy, you can search for the treatment option that will suit you best.
What are Your Treatment Options?
Even though paruresis might seem undefeatable to you in the beginning, various treatment options can help. Your doctor will assess the severity of your case and make a recommendation.
Here are the most common forms of treatment for shy bladder syndrome:
- Relaxation techniques – It is based on adopting a range of strategies that will help you reduce your anxiety and relax your sphincter.
- Psychotherapy – As we mentioned, paruresis can be a consequence of a deeper trauma that needs to be resolved and can degrade the quality of your life. Counseling will help you learn how to cope with both the causes and consequences of your problem. You should also consider joining a paruresis support group.
- Cognitive-behavioral therapy (CBT) – It will change the way you think and behave through different techniques with graduated exposure having the central role. This step-by-step program trains you to deliberately urinate in increasingly more difficult places.
- Medications, such as tranquilizers or antidepressants – Your doctor might recommend short-term use of certain drugs. However, they can go as far as reducing your anxiety, but not curing the condition.
- Self-catheterization – In the most severe cases, doctors suggest that patient learns how to perform self-catheterization. This means you would insert a catheter (slender tube) up your urethra and into the bladder. The goal is to drain urine. Usually, the urologist will be the one who will teach you how to do that.
As you can see, there are different measures you can take to solve your shy bladder syndrome.
You just have to pick the right one for yourself.
Graduated exposure technique
Graduated exposure technique is most commonly used to treat paruresis. Fortunately, eight out of ten patients report that this helps their problem.
Significant improvement is expected after only 8-12 sessions with a trained cognitive-behavioral therapist.
You should always be guided by your psychologist or psychotherapist, but we will list out the steps of graduated exposure therapy, to help you understand what you will be asked to do.
Here it goes:
- First, you will make a ranked list of different urination locations. You should sort them from the easiest one to the most difficult. Most patients will say that the easiest location is their home, when they are alone, while the hardest is a crowded public toilet. Your therapist will invite you to start with the easiest locations and progress your way up to the most difficult, one step at a time.
- Find a “pee partner” who will support you. This would ideally be a family member or a friend, someone you trust.
- Instruct your pee partner to stand as close to your home bathroom, as you feel comfortable while you are trying to pee. Urinate for a few seconds. Stop and wait for a few minutes.
- In the next step, your pee partner should move a little closer to the toilet. Your task is to go back in and repeat the process. Urinate for a few seconds, then stop.
- Repeat this step over and over, with your pee partner getting a little closer to the toilet each time. This might take some time and several sessions.
- While you are peeing, make as much noise as possible. Deliberately aim your pee stream directly into the toilet water. Your pee partner should be nearby.
- Once you master urinating at home, pick a quiet public restroom. Tell your pee partner to stand outside the toilet door, and repeat the whole routine, the same way you did at home.
- Use your partner to work your way up the scale of pee locations, until you can pee in a crowded, noisy public restroom.
- You have to make sure your bladder is full before each practice session. Don’t forget to drink plenty of water.
- Practice graduated exposure three or four times a week to increase its effectiveness.
- Avoid negative self-talk as you are trying to urinate.
- Go slowly. Step by step. Make sure not to push yourself.
A Simple Trick – Hold Your Breath for 40 Seconds
There’s another technique that we didn’t mention among the most commonly used treatments – the breath-hold technique.
It is rather simple, and due to its simplicity, many people question its efficiency.
Practically, all you have to do is learn how to hold your breath for forty seconds. If you can do this, you ’ll be able to urinate anywhere in no time. However, similarly like with the graduated exposure, there are some steps that you have to take before it starts to work.
If you stay consistent, practice and put in some effort, you can see the results in one to two weeks. If you combine it with The Paruresis Treatment System developed by Rich Presta and Dr. Cheryl Lane, Doctor of Clinical Psychology, you will get a systematic approach that will save you from your troubles, won’t make you take drugs or spend thousands of dollars on expensive psychotherapy that might or might not work.
Why Does the Breath-Holding Technique Work?
This fantastic yet straightforward technique works by building up carbon dioxide levels in your blood from breath-holding. Increased carbon dioxide levels lead to muscle relaxation.
It might sound dangerous, but it is not. How many times in your life have you held your breath underwater, especially during your childhood? Countless! Nothing bad happened, as you were the one who had the complete control over your breathing. Same way, nothing bad can happen now.
Let’s learn how to use this technique together. Depending on the severity of your paruresis, progress could take between one and two weeks.
Without any further ado, here come the detailed instructions:
Step 1 – Visit your doctor
Just like before applying any other kind of treatment, you should consult with your doctor before you start the breath-holding technique. If you have any underlying medical condition and the shy bladder is just a symptom, this won’t be helpful.
Your overall physical health has to be good enough to undertake the paruresis cure training program.
Step 2 – Learn how to hold your breath
Once you get permission from a medical professional, you can move on to the next step.
You are probably not able to hold your breath for 40 straight seconds right now, so, you’ll have to practice. It is a skill to be learned, like riding a bike.
Your motivation might vary because this step will take the longest. However, this is the essential part of the process. You have to get to the point where you can comfortably hold your breath for forty seconds, without feeling as if you are going to pass out.
Start your training, lying down on your back in bed, just to be safe. Once you feel comfortable and confident enough, you can proceed to practice while sitting in a chair.
Just like with any other skill, the more you practice, the better you’ll be. The best thing about it is that once you make some progress, you can exercise wherever you want, in your office chair, on a bus, while watching your favorite tv show, your possibilities are infinite. No one will know that you are holding breath!
You can even make it into a game, a sort of competition with yourself or others.
When you master the breath-holding while sitting, proceed to practice while standing up.
Start with holding your breath for only 5 seconds at a time. Then, you can increase the time to 10 seconds. Then go for 15, 20, and so on, until you can hold your breath for 40 seconds straight. This will take you a few days.
You are ready to move on to the next step, once you can hold your breath for forty seconds while standing, without struggling or feeling uncomfortable.
Step 3 – Keep practicing with 40 seconds
Practice every day, as often as you can. For a start, hold your breath while your bladder is empty.
After a few days or weeks, depending on your learning tempo, you’ll be able to hold your breath without any problem. Keep practicing until you reach 40 seconds of breath-holding at about 20% of your lung capacity.
Notice how your body relaxes while you are holding breath. Keep practicing while walking around.
Step 4 – Breath-holding while peeing
Now, you can combine breath-holding with urinating. The time duration of this step will depend on how severe your paruresis is.
If you believe you can do it, you can start using the breath-holding technique in public restrooms right away. However, if your bladder is still too shy and you are too anxious, practice at home and in front of someone you love and trust.
Make sure to drink plenty of fluid and wait until you have to go to the toilet badly.
Take one, normal breath while you are waiting to pee. Then exhale slowly until you reach the point where you have 20% of air left in your lungs.
Hold your breath as you practiced. After a while, you will notice that your muscles are relaxing around your sphincter and bladder. At this point, the flow should start. Most commonly, you will begin to pee before reaching forty seconds of breath-holding.
However, continue to hold your breath for a few seconds longer, until you can feel the flow is steady.
If the stream stops midway, don’t worry, you can breathe in again and repeat the process.
Step 5 – Keep challenging yourself
Keep practicing in increasingly more difficult situations. Creating a ranked list of tricky urination locations might help here as well.
If you are a man, you can start with public stalls first and then move to the urinals once you feel comfortable enough.
Pee in public every day, whether you have the “audience” or not. Use the technique, and the flow will start on its own.
You can also switch to holding your breath as you are entering the bathroom. By the time you get to the toilet seat or urinal, you will be ready to go.
As you can see, the breath-holding technique is the simplest and most effective solution.
However, it will only help you get rid of the sphincter freeze and won't really solve your anxiety problems.
This is why it is crucial to combine it with The Paruresis Treatment System.
You will save yourself a fortune if you go for this treatment option rather than any other one and you’ll get the fastest results.
Pee in a public toilet, no matter who’s listening.