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Shy Bladder Syndrome (Paruresis): Getting Help

Allan N. Schwartz, LCSW, Ph.D. Updated: Aug 9th 2008

 There are an increasing number of people sending E. Mails in response to the posting about the problem known as "Shy Bladder Syndrome." The medical term for this condition is Paruresis. People afflicted with this condition struggle with the fear of urination in public bathrooms or even the bathrooms in the homes of friends and relatives. The fear that is suffered is a tortuous self consciousness that there bathroom activities will be over heard by others. For some reason, this stirs up a terrible amount of anxiety such that their bodies tighten and, no matter how urgently they need to urinate and now matter how painful the situation, they are unable to urinate. As a result, they do everything possible to avoid using public rest rooms. In the worst case scenarios, some of these suffers limit their lives by not travelling abroad and taking jobs within walking distance to home.

Perhaps worst of all those with Paruresis begin to engage in very negative self thinking. They begin to condemn themselves as "sick, weird, hopeless and irrational." None of these things are true.

Studies show that those men and women with Paruresis remember feeling this anxiety about urination before the age of twelve. For many, the fear of public bathrooms began in elementary school. However, there are plenty of others who remember it beginning when out in public with parents and being taken to public rest rooms. Thereafter, the situation only got worse.

People sending E. Mails about Paruresis are asking how they can get help with this condition. Following are some suggestions.

What to do about Paruresis:

1. Cognitive Behavioral Psychotherapy (CBT) is an excellent way to begin dealing with this disorder. I suggest that those who choose this route see a Clinical Psychologist who ie trained and expert in the use of CBT.

2. In addition to CBT that same psychologist should have expertise in Systematic Desensitization and gradual Exposure Therapy whereby the individual is gradually helped to become less fearful about public bathrooms and the fear of being heard while urinating.

3. There are a variety of self help techniques that can be used. However, for those who have struggled with Paruresis for many years I would still emphasize professional help. Here are some self help techniques:

a. Males with this condition can use closed stalls instead of urinals found in public men's rooms. The closed stall can add a sense of security while in the rest room.

b. If in the home of a friend, family or your home while guests are in the house, it can be helpful to turn on the tap while urinating. The noise of running water can hide any noises and can provide a sense of security.

c. In many public places such as airports, theaters, etc, there are usually many rest rooms. The advantage of this is to look for one that is empty and, therefore, more comfortable.

d. In a more indirect way, the use of meditation, deep breathing and deep muscle relaxation, are methods that help all of us reduce our general level of anxiety and tension.

What I want to stress, once again, is that these self help techniques are far from perfect. They may help some of you some of the time. Professional intervention is still the best approach and the one I am recommending.

For more information, here is an excellent web site with useful links to other information:

Allan N. Schwartz, PhD


Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

Reader Comments
Discuss this issue below or in our forums.

observed drug test - Kris Boyette - Oct 3rd 2014

Hi my name is kris and im a Iraq and Afgan vet. I never had this problem until i came home from overseas. I do not have a problem using public restrooms but i do when someone is starring at me. Im a Ironworker and  we work at power plants which calls for a observed drug screen. My experience was awful! First the guy was rude and rushing me and i couldnt do a drop of urine if my life depending on it. Finally he told me to come back next week. Should i get a letter from my Va doctor before i go back? I never been in trouble with the law and these people was acting like i had something to hide. What should i do? Thanks

paruresis - - Jun 29th 2010

i am a healthy male age 33 i am being offered a good job but they require pre employment phisical . i have paruresis , from what i can guess, i have always had this problem,on some occasions i have to even go outside in the woods to urinate , sometimes it is very painful to hold, if i am in public, i have not been to the doctor, i dont know if they have meds they can give me or am i just crazy? any way does someone know the laws in wv reguarding paruresis, do i need to go see the doc to get this documented, before i try for the job, what do i do. any info would be sooooooooooo helpful,my email is     thanks

Medical Exam - Allan N. Schwart, PhD - Sep 10th 2009

You are asking an excellent question: What can you do about having a physical exam in which you must give a urine sample and cannot?

My suggestion to people with this common problem is to drink a lot of water prior to the exam. If the exam is in the early morning try to wait to urinate until you get to he Doctor's office. Most MD personnel are willing to take urine samples the minute you walk into the office, if you ask them.

In other words, its a matter of preparation in anticipation of the visit.

One of our readers with this problem suggested to everyone that they wear ear phones and listen to music on the IPods while going to the bathroom. Others run the toilet, the sink in the bathroom and, in other words, anything that helps.

Dr. Schwartz

physical exams - Arline B Bonner - Sep 10th 2009

what do you do when you have to give a urine specimen in the doctor's office and can't

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