Imagine this guys: you’ve just come out of a tortuous meeting; you have a desperate need to pee. You make a quick exit and head to the restroom. Your worst nightmare awaits you. A line of men at the urinals, all the cubicles are in use and more guys follow you in. It’s your turn. You feel like crying your bladder is so full as you step up to the free urinal. You know it’s no good even trying. You know the feeling all too well. Your bladder is on “lock down”. This urinary difficulty is known by many euphemisms: shy bladder syndrome, paruresis, pee-shy to name but a few.
Shy bladder syndrome is one of many terms used to describe a condition which causes the individual concerned to be unable to initiate or maintain a flow of urine in the actual or perceived presence of others. This, also known as ‘paruresis’ (pa-yur-ee-sis) was first mentioned in scientific literature way back in 1954, after a survey of nearly 1500 college students revealed 14.4% of them had experienced urinary difficulty at one time or another.
So who does shy bladder affect? Despite accurate reports being almost impossible to verify, shy bladder syndrome is reported to affect in the region of 7% of the US male population (approximately 10-11 million men). It appears to be strongly biased towards men, although there are women affected also. The male bias lends itself strongly to the fact that often men are supposed to ‘not really care or want any privacy’ or they ‘should be able to pee anywhere and in front of anyone’.
The exact cause of shy bladder syndrome remains elusive and no doubt will be different for each individual. However, paruretics all tend to report a ‘triggering event’ usually in childhood and usually associated with an inability to urinate with other people around or perhaps whilst being rushed. This association with not being able to pee and negative consequences of being teased by peers or perhaps being scorned by parents can have devastating effects. Many guys experience an occasional ‘locking up’ of the bladder. However, the difference between those who do and who do not go on to develop a chronic problem seems to revolve around how much the event impacts on the individual. In other words, some guys are more naturally “worry-ers” who will ‘mull’ the experience over and over. The effect becomes amplified in the mind which then starts to take on a life of its own. A repetitive pattern develops.
This pattern rapidly becomes a vicious cycle whereby the individual becomes so anxious about the fact that “it might happen again”, that he/she often begins to avoid using public restrooms altogether. Avoidance then becomes a huge part of the person’s life. The effect on normal daily activities in severe cases can be debilitating. If severe enough the individual may be physically unable to empty their bladder anywhere but their own toilet at home, regardless of how desperate they are to pee. (Try to imagine that for a second). Sufferers of this invisible affliction remain at the mercy of their own bodies.
Shy bladder syndrome is a learned psychological experience. The exact causes often remain locked in the subconscious of the individual. If a person has no problems urinating on their own and/or in a “safe environment” often at home with a locking door; but often experiences difficulty in the presence of others, then they can be fairly certain they have shy bladder syndrome. The good news is this is a psychological problem that can be unlearned and changed. Experiential studies have shown that the most effective long term treatment for shy bladder syndrome is CBT (cognitive behavioural therapy) and graduated exposure to the feared situation – a crowded male toilet.
Shy bladder syndrome or paruresis, causes urinary difficulty and great anguish for sufferers; affecting their lives each and every day. Despite, the medical community having been aware of this syndrome for almost 60 years, little is still known about it. This is in part still due to a lack of public and health awareness of the condition. This lack of awareness is mainly due to the extreme embarrassment and personal isolation the individual feels. As a consequence, most people with shy bladder syndrome become very secretive, withdrawing from normal social activities and very often completely re-adapting their lifestyles to accommodate a truly debilitating affliction.