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Bashful Bladder Syndrome / Paruresis

This page uploaded 31 July 2009
By Bashful Tony

More colloquially known as "pee shyness", "4 wall syndrome" and "bathroom stage fright". All these descriptions describe a common, yet often not talked about condition. They all basically describe a condition whereby a man or woman finds it difficult or is even unable to urinate in a public restroom. The term used in the medical field is "paruresis". Furthermore, paruresis is not restricted to public toilets. It can also occur in a person's home when there are visitors or even family members whom are close by or waiting to use the toilet. Certainly from time to time, everybody experiences some urinary difficulties caused by medical reasons, medications, infections, disease and injury. When referring to bashful bladder syndrome we describe more, a physiological condition triggered by a psychological event. As American psychologist and co-author of the first official book dedicated to this condition, titled "Shy Bladder Syndrome" , George Zgourides describes:   
"after an initial unpleasant experience, the individual anticipates difficulty urinating whenever entering a lavatory. Forcible attempts to control the process fail, and associated anxiety with performance reduces the individual's chances of voiding while in a public facility. The paruretic must then adjust to the disorder by voiding as much as possible when at home, restricting the intake of fluids, locating vacant public rest rooms, running the tap, and refusing extended social invitations."
What does paruresis have in common with social anxiety disorders?<  
A person whom is experiencing paruresis may feel alone, therefore employing a pattern of avoidance and isolation. The intensity of the person's symptoms can vary from mild to severe. For instance a paruretic may have a mild case, whereby he/she generally has some coping strategies when in a public environment like using a stall, and therefore experiences limited anticipatory anxiety, and is able to carry out daily activities in a fairly "normal" fashion. The more severe paruretic may experience panic attacks when in a social environment at just the thought of having to pee. They may become introverted and ashamed, because they can't use a public toilet as freely as others may and develop a feeling that they are not normal. They may decline invitations to go out to pubs and nightclubs, or even avoid gaining employment in a building where there is always heavy traffic in the bathroom.  
It is worth noting here that the research available, of which there is very little, indicates that men appear to be more affected than women by this. The reason may be that women often have the convenience of stalls, whereas men often have to face up to wall urinals whereby the whole process of urination is exposed to the scrutiny of others. Some men find this intrusive and an invasion of personal space and privacy, which as a consequence only makes peeing more difficult. Which is exactly where the vicious cycle of anxiety and avoidance begins and often continues to amplify. Did this person see that I couldn't go? Are they going to make fun of me here in front of everybody else? I mustn't be man enough if everybody else can do it with ease..are examples of negative, gloomy thoughts that can seize the mind and reduce a persons self worth.  
It is also worth noting that studies indicate that up to 7% of the American population, that being around 17 million people suffer with this disorder. It is suspected that these figures are actually quite conservative due to the limited research conducted thus far, as some studies cite an incidence between 15 and 20% of populations.  
As for my personal story it goes something like this. As far as I can remember I didn't have a problem peeing around the other boys in primary school. In fact I remember having competitions with other boys whose stream could go the furthest distance. My first negative experience using a urinal occurred in the first year of high school. Here I was, a short, wimpy year seven attempting to relieve myself at a wall urinal when a bunch of year twelve's walked in and began to harass me. They called me derogatory names and even manhandled me which caused me to completely frieze up. The urge to go had faded as the urge to flee this very uncomfortable situation grew. I remember feeling very hurt and empty and afraid after this experience. I felt that such a personal thing as relieving oneself had been terrorised by a group of indecent thugs. From that point onwards, compounded by all the insecurities teenagers have to face anyway, a wall urinal became out of the question. I resorted to using stalls exclusively, and wall urinals only when I was sure I was alone. I developed a pattern of avoidance, which saw me through the whole of high school. I guess I just accepted that this was how it was going to be from now on. Trying to pee next to someone else caused too much anxiety and became near impossible.  
I began to seriously re-examine my bathroom behaviour at the beginning of University when I was first introduced to the idea of drinking large quantities of beer. Pubs, nightclubs, parties and alcohol where the go, and I didn't want to miss out. Of-course the thought of having to use a public lavatory always made me shudder, but I made do. I developed excellent avoidance techniques but always wondered what my social life would be like without the cloud of anxiety and fear that surrounded most social events. I guess it had at times a more profound impact than I ever wanted to consciously perceive. Would I have been more social, more keen to attend those birthdays at pubs and clubs, would I have attended more footy matches with friends, had I not been experiencing paruresis?? These questions, along with my desire to embrace the world as fully as possible prompted me to do much research and find a path to recovery.  
My story is probably what you would call a stock standard paruresis story. Although one must be careful not to put to narrow a perspective on what brings on paruresis, or what kind of person experiences it. It affects all kinds of people, from all walks of life, independent of age, ethnicity, religion or financial status. How it comes about, and when it begins to become a life hindrance is again varied, as with many other social anxiety disorders. It can also co-exist with other anxiety disorders, a common one being agoraphobia.  
Now for the good news. Recovery is possible! Through some innovative developments in cognitive behaviour techniques, and exposure therapy one can greatly reduce, or even eliminate the effects paruresis can have on ones life. Desensitisation appears to be the key to recovery. Seeing a good psychologist whom specialises in the area can also be of immense benefit. A fantastic website to get all there is to know about paruresis: . It has been developed by the international paruresis association in the US. From this site you can also purchase the book "Shy bladder Syndrome".  
As I am currently trying to band together sufferers to conduct workshops, I am also happy to be contacted to answer any queries. My details are available from the Anxiety Disorders Association Of Victoria.
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