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How to Deal With a Shy Bladder That Makes Peeing Way Too Hard

Self logo Self 2/8/2018 Korin Miller
a woman sitting on a table © Annie Engel/Getty Images

Basically everyone would rather pee in the comfort of their own home instead of in a public stall. But for people with paruresis, also called shy bladder syndrome, peeing in public can truly be impossible. Trying to squeeze out a drop—or even think about attempting to—can result in symptoms like sweating, trembling, and nausea. That’s because paruresis isn’t just a niche medical condition. It’s actually a type of social phobia that can make life much harder than it should be.

If you struggled to pee once while your boss happened to be in the restroom at the same time, you don’t have paruresis, Kimberly Cooper, M.D., a urologist at NewYork-Presbyterian/Columbia University Medical Center, tells SELF. It’s normal to feel a little uncomfortable in that situation. But if you find that you consistently can’t go when other people are around, that’s a sign you could have this condition.

Even though paruresis may seem like a physical problem, it has a psychological cause.

In fact, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) defines paruresis as a manifestation of social anxiety disorder (also known as social phobia). People with social anxiety disorder experience marked fear or anxiety in situations where others may judge them, and as a result, they often try to avoid those situations altogether, according to the National Institute of Mental Health. If you have paruresis, that may mean holding off on peeing for hours because you can’t stomach the thought of going in a public restroom. (Or worse, a porta potty.)

Paruresis can be embarrassing on its own, but holding your urine in for too long can also have physical and social effects.

If you’re stuck in public and you have to pee but can’t, you’ll experience a backup of urine in your urinary tract system. “It can become very painful if you’re not able to get it out,” Dr. Cooper says.

Urine sitting in your bladder for too long can give bacteria more time to grow, increasing your chances of a urinary tract infection. The backup of urine could even cause swelling in your kidneys in a condition known as hydronephrosis. That can lead to pain in your back or side, a frequent need to urinate, pain when you pee (when you’re able to go, of course), bloody urine, nausea, vomiting, weakness, and fever, according to the Cleveland Clinic. If left untreated, it can even cause kidney damage.

Paruresis can also create complications most people wouldn’t even think of, like not being able to do a urine test on demand, which could delay medical care. Some people may even have job troubles if they can’t urinate when needed for a drug test, the International Paruresis Association points out.

Luckily, there are a few things doctors can do to help if you have paruresis.

For some people, obscuring the sound of pee by running water or flushing the toilet can make it easier to go in public, Dr. Cooper says, but that doesn’t really treat the root issue.

Cognitive behavioral therapy (CBT) may address the social anxiety at play and help people become more comfortable peeing when others are around, David Kaufman, M.D., director of Central Park Urology, a division of Maiden Lane Medical, tells SELF.

CBT aims to replace a person’s negative thought patterns and behaviors with healthier ones. For someone with paruresis, CBT may include gradually stepping up exposure to other people and noises when they try to pee, with the goal of eventually making them feel OK peeing in a crowded bathroom, Dr. Kaufman says.

If your therapist decides this route makes sense for you, they’ll help figure out the exact right procession of exposures. Maybe you’ll start by confiding in a friend and peeing at home with them outside the door, for example, and work your way up from there.

There are also support groups you can find through the International Paruresis Association, where you may be able to connect with other people who have the same issue. That might be an easier way to find a “pee partner” to practice with if you don’t want to do so with friends or family members.

Your therapist may also decide it makes sense to take anti-anxiety medication to treat the phobia underlying your paruresis, as well.

If you’re dealing with a complete inability to pee in public—or a lot of anxiety about it, even if you can actually go—talk to a urologist about next steps. They may want to run tests or do an exam first to make sure there’s not a physical reason you have anxiety about peeing, Dr. Cooper says, like pain from an undiagnosed UTI that makes you want to avoid urination. If it’s a mental issue and your urologist can’t help, ask them to refer you to a therapist, ideally one who specializes in phobias like paruresis, who can.

Slideshow: 20 questions you're too afraid to ask your doctor (but should) (Courtesy: Mom.me) 



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