What Is Paruresis?

Paruresis is a form of social anxiety disorder that leaves sufferers unable to produce urine when other people are around. Left untreated, paruresis can become a debilitating mental disorder, causing people to become housebound. No standard treatment for paruresis exists, but a combination of mood-altering medications and cognitive-behavior therapy appears to help many people regain their ability to use public restrooms.

Paruresis Facts

• Sometimes called "bashful bladder" or "shy bladder," paruresis affects nearly 7 percent of Americans. People of any age or gender can experience paruresis, and sufferers do not have a physical problem that prevents them from passing urine. No definite cause of the condition has been identified, but the American Urological Association notes on its website that some people with paruresis "believe their ailment was triggered by a traumatic incident that happened prior to or during adolescence, including embarrassment by a parent, teasing by classmate or siblings, harassment in public bathrooms or sexual abuse."

Symptoms

• Symptoms associated with social phobia mark paruresis. In addition to avoiding situations where they may have to use a public restroom, patients with paruresis may sweat, shake, become dizzy, have heart palpitations and even faint when faced with the necessity of having to urinate outside their home. Individuals with paruresis may also feel ashamed, become withdrawn and isolated and feel depressed.

Medical Therapy

• Self-catheterization---inserting a tube up the urinary tract and into the bladder---is the only surefire medical treatment for paruresis. No placebo-controlled clinical trials of drug treatments for paruresis have been published. However, a case report in the January 2005 issue of the journal International Clinical Pharmacology describes success with treating one patient with the epilepsy drug gabapentin. Another case report from the January 1990 American Journal of Psychiatry indicates that one in four men with paruresis responded positively to doses of the diuretic atenolol.

Cognitive-Behavioral Therapy

• As with medical treatments, only case reports support the efficacy of cognitive-behavioral therapy for paruresis. Having a woman pair a "safe" word with using the bathroom in her home and then with using bathrooms outside her home worked in a case described in the June 2000 Journal of Behavioral Therapy and Experimental Psychiatry. Similarly, gradual exposure helped another woman overcome her paruresis in a case reported in the August 1998 Psychological Reports. Medications that reduce anxiety, inhibitions, blood pressure and muscle tension may help some patients when used in conjunction with cognitive-behavioral therapy.

Support

• The website of the International Paruresis Association offers resources, online forums and support group information for individuals who suffer from the condition. The site also links to the website of the Shy Bladder Center (shybladder.org), which offers many of the same patient services as the IPA, and the website of the American Restroom Association (americanrestroom.org), a nonprofit organization that bills itself as "America's advocate for the availability of clean, safe, well designed public restrooms."