It can be difficult or impossible for someone with paruresis (shy bladder syndrome) to urinate (pee) in public. Only the fear of public speaking is thought to rank higher among common social phobias, including paruresis. Paruresis is often first experienced at school.

The condition affects men and women of all races. In mild cases, paruresis is an occasional event, like a form of performance anxiety. For example, a man at a public urinal may find that he is unable to urinate when flanked by other men. In severe cases, a person with paruresis can only urinate when alone at home.

The condition is also known as ‘avoidant paruresis’, ‘psychogenic urinary retention’ and ‘pee-phobia’.

Symptoms of paruresis

A person with paruresis typically has a sensitive, shy, conscientious personality and is fearful of being judged or criticised by others. Paruresis can be mild, moderate or severe.

Signs and symptoms of severe paruresis can include:

The need for complete privacy when going to the toilet

Fear of other people hearing the urine hit the toilet water

Fear of other people smelling the urine

negative self-talk while trying to urinate, for example: ‘I can’t do it. I’m never going to pee. I’m such an idiot.’

Inability to urinate in public toilets or at other people’s homes

Inability to urinate at home when guests are present

Inability to urinate at home if someone is waiting outside the toilet

Feeling anxious about needing to go to the toilet

Restricting drinks to reduce the need for urination

Avoiding travel and social events

Cause is psychological

Paruresis is not a physical condition because nothing is wrong with the person’s urinary tract. The urinary sphincter must be relaxed for urine to flow from the bladder down the urethra. Anxiety about urinating overstimulates the person’s nervous system and ‘clamps’ the sphincter shut. Failure to urinate heightens the person’s anxiety, particularly if the bladder is uncomfortably full.

For some people, an embarrassing incident starts the social phobia – for example, the inability to urinate into a cup in front of a doctor or nurse. Worrying about the embarrassing incident makes the person feel anxious about urinating in the presence of others.

Treatment options

You may like to consider joining a paruresis support group. In severe cases, it may be helpful to see a psychologist. Treatment may include:

Relaxation techniques – to learn a range of strategies to help reduce anxiety.

Psychotherapy – a type of counselling that helps you deal with the here and now, and teaches problem solving.

Cognitive behavioural therapy – changing the way you think and behave.

Graduated exposure therapy – a step-by-step program that involves deliberately trying to urinate in increasingly more difficult places. About 8 people out of every 10 with paruresis are helped by graduated exposure therapy.