Andrew Siegel MD 1/16/16
The image above is of Charley Morgan, my Springer spaniel, who is standing in a bed of cherry blossoms. She has the very opposite of shy bladder syndrome, urinating involuntarily whenever people visit!
The following are quotes from patients of mine who suffer with shy bladder syndrome, the difficulty or inability to urinate in a public venue or in the presence of others:
“ I can’t urinate in front of other people.”
“No way could I ever use a urinal.”
“No beer for me at the sports arena.”
“I would die before I ever attempted to urinate into one of those trough urinals they have at some stadiums and gyms.”
“I need a private stall when in a public restroom.”
In medical speak, the condition “shy bladder syndrome” is known as “paruresis,” although I prefer the term “bashful bladder.” There are an estimated 20 million or so Americans suffering with this social phobia in which even the thought of having to urinate in public causes great distress, making the physical act of urinating impossible. However, those with bashful bladder have no such issues when in a private venue. In its most extreme form, a person with this phobia can only urinate at home when no other family members are present.
This problem occurs in both women and men and often manifests itself in adolescent years. It is a classic example of the mind-body connection in action. Anxiety brought on by the thought of having to pee in public causes the release of adrenaline and other stress chemicals, which cause a host of general effects such as rapid pulse, shallow breathing, but also specific effects including the clenching of the muscles in the urethra (and male prostate gland). The inability to relax these sphincter muscles make the act of urinating difficult, if not impossible. It is little different than stage fright or the inability to speak in a public setting.
There are a variety of coping measures that people with shy bladder syndrome use, including restricting fluid and caffeine intake, deliberately holding in their urine and avoiding travel and other circumstances that would require the use of public restrooms.
Solutions to Bashful Bladder
The seemingly simple act of urination is actually a very complex event. Effective urination requires a contraction of the bladder muscle with coordinated relaxation of the sphincter muscles that pinch the urethra closed. In order to improve bashful bladder, efforts need to be directed at general relaxation/anxiety management as well as at relaxing the urethra and sphincter muscles.
- Relaxation techniques include deep breathing with exhalation to maximally relax the voluntary sphincter when in a public restroom; other methods include meditation and any of the many means of achieving a relaxed state including yoga, massage, tai chi, aromatherapy, hypnosis, etc.
- Pelvic floor physical therapy to help relax tense pelvic muscles that can contribute to the problem, since they contribute in a major way to the voluntary sphincter muscle.
- Cognitive behavioral therapy, which aims to retrain the mind to replace dysfunctional thoughts, perceptions and behavior with more realistic or helpful ones in order to modify fear of emptying one’s bladder in public.
- Medications: Alpha blockers, “anti-adrenaline” agents used to relax the muscles of the urethra and prostate (Flomax, Rapaflo, Uroxatral, etc.); Anti-anxiety medications can be helpful as well at times.
Bottom Line: Bashful bladder is a not uncommon social phobia that can severely impact one’s quality of life. The good news is that this is a manageable problem. For more information visit paruresis.org.
Wishing you the best of health,
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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.
Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.