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Paruresis: The Fear That Makes It Hard to Pee In Public Toilets

When a person tries to urinate, he or she needs some privacy. / Photo by: Memory Stockphoto via Shutterstock

 

Everyone needs a little privacy when they need to urinate. For some rare cases, others want to have complete privacy when urinating, which prevents them from using public toilets or bathrooms. They may even exert much effort such as not drinking any fluids in order for them to avoid doing it. This describes the condition called Paruresis.

It is estimated that seven percent of Americans,which means around 21 million of them, suffer from the said condition. A study also reveals that it is more prevalent in men than in women, amounting to 90% of males comprising the ones who are affected by paruresis.

 

Paruresis Definition

Paruresis a psychological phobia that a person has a fear of using the public toilet without any reason. / Photo by: FUN FUN PHOTO via Shutterstock

 

Paruresis is defined by Arlin Cuncic, a psychological test publisher, as being afraid of public toilets without any medical cause. It is also known by the names Shy Bladder Syndrome, Bashful Bladder Syndrome, Urophobia, Shy Kidney and Pee Phobia. It is categorized as a social phobia, where a person fears that others may judge them while using public toilets. When this fear of being criticized by others in their usage of public toilets begins to restrict major areas of their life, they may also be diagnosed with Social Anxiety Disorder.

According to Shybladdersyndrome.org, this is characterized as the inability to urinate in public even when the individual desires to do so. Since the individual feels uncomfortable when using public toilets, they usually hold it in no matter how strong the urge to urinate is, until they get home or find a more isolated place to do it.

Medical Daily states that those who suffer Paruresis, called parretics, may also resort to catheterization besides home urination.

 

Causes

 

The main cause of Paruresis is identified to be psychological. The Better Health Channel explains that for urine to flow smoothly down the urethra, the urinary sphincter should be relaxed. However, since the anxiety from the thought urinating triggers the nervous system too much, this causes their urinary sphincter to lock up.

The fear of using public toilets may range from mild to severe and may also rely on the context of the situation. Men have been found to suffer from this because of the closeness of the next person in the bank of urinals. As for women, it may be due to not being able to decide whether they will use a stall or urinal.

Verywell Mind adds that Paruresis may also be caused by the bullying a person has gone through in their childhood or their harsh parents. This may also be caused by having an experienced where they were required to urinate but were unable to. For instance, they may have been unable to give a urine sample to the doctor when they were requested to.

Various other reasons may also prompt a person to develop Paruresis. They may fear that if they use a cubicle, somebody else may be waiting too long for them to come out. It may also be caused by the public restroom or toilet being too full of people or busy. When they attempt to use a public toilet, they may feel some kind of time pressure, become anxious and also feel apprehensive. They may also feel that a certain bathroom does not have proper dividers that could provide them privacy. Finally, they may also get the sensation that people might overhear them urinating.

 

Symptoms

Typically, a paruretic is someone who has a timid personality. They are described as being overly-conscious, shy and are afraid that someone may criticize them as they attempt to use a public restroom. The signs that an individual is affected by Paruresis are:

1. Requiring total privacy when having to use the toilet.

2. Being fearful that other people may be listening on them as their urine hits the toilet water.

3. Being afraid of others might smell their urine.

4. Negative self-talk while they try to urinate.

5. Being unable to use other people’s home toilets or public bathrooms.

6. When there are visitors in their house, they are unable to urinate.

7. Not being able to urinate if someone else is waiting for them to finish.

8. Feeling anxious when they actually have to go to the toilet.

9. Avoiding drinks to lessen the need to go to the toilet.

10. Refraining from travelling or having to attend social events.

 

Treatment

Cognitive behavioral therapy is a type of therapy that helps the patient alter or change behaviors. / Photo by: BlurryMe via Shutterstock

 

Paruretics are advised to seek the assistance of a psychologist, hypnotherapist or look for Paruresis support groups to be part of. Treatment options for the condition includes many kinds of therapies and the use of relaxation techniques. Mental health experts strongly recommend Graduated Exposure Therapy, as it has been proven to be the most effective.

Therapy

The therapies that a paruretic may try are:

Psychotherapy

When a paruretic decides to undergo this therapy, the clinician helps them by educating them on how to manage their condition and how to solve the problems related to it.

Cognitive Behavioral Therapy (CBT)

In this kind of therapy, the therapist helps the patient alter their manner of thinking and change their behavior.

Graduated Exposure Therapy

This therapy is described as a step-by-step program that includes helping the paruretic to purposely urinate in increasingly difficult places. It is noted to have cured eight out of ten patients.

 

Self-help

Relaxation Techniques

Learning different strategies that may help lessen their anxiety when it comes to urinating in public places may also aid the patient in coping with Paruresis.

 

Systematic Desensitization

This treatment method depends upon the context of what may have caused the individual to develop Paruresis.

For instance, if they fear the quietness of public bathrooms, they may try exposing themselves to toilets that are crowded, and use the noise by the crowd to distract them. It is suggested that the patient drinks one quart of water before attempting to do this.

Later on, they may  lessen the distance or the space they need in the public toilet and the number of people present. Eventually, they may become more at ease in using public bathroom stalls and will not be shocked or paralyzed by them.

 

Paruresis Should be Taken Seriously

Steven Soifer, author of The Shy Bladder Syndrome, declares, “Shy bladder is a real disorder, not something to snickered about or laughed at.”

Patients who suffer from Paruresis may often feel great distress or embarrassment about their condition. The notion that people may have negative impressions about them while they attempt to urinate in a public place causes them to avoid using public toilets altogether. There was a case reported where a paruretic had to hold in their urine for 14 hours, which is not healthy for their urinary tract.

Carl Robbins, director of training for Anxiety and Stress Disorders Institute of Maryland, clarifies, “What people worry about is being in a bathroom near other people and not being able to urinate, and that others will notice and form judgments about them.” He goes to explain that Paruresis patients are often perceived by other people as weird, defective, and if they are male, not masculine. However, Robbins assures the paruretics that since it is a psychological problem, they can get past it as long as they are able to break the cycle of fear.

Paruresis is a phobia and type of social anxiety that requires attention and understanding. Although it is regarded as a social deficiency, as stated by Robbins, it can be overcome if the patient addresses their fear and in the process, come out of the cycle of dreading the use of public toilets.

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