Most people have felt the need to urinate on more than one occasion in contexts and situations far from their home.
In a bar or restaurant, in a shopping center, in a hospital, at work, during a trip… in all these places we have a sink where we can urinate more or less comfortably, and we generally go to them without any major problem other than the fact to locate it or that it is not already occupied.
However, some people are unable to use a public bathroomnot being able to urinate in the presence of other people or in places where there is a risk that other people may know that you are doing it. These people suffer from paruresis, also called shy bladder syndrome..
We understand paruresis or shy bladder syndrome to be a psychological disorder characterized by the impossibility or high difficulty of using public toiletsnot being able to excrete urine in that situation.
Paruresis has sometimes been conceptualized as a type of social phobia because the inability to urinate is caused by the observation of other people or the idea of being easily observed. As in social phobia, this situation, in which they can be judged and evaluated by others, generates a high level of anxiety and can represent a real alteration in the person’s life leading to the avoidance of certain stimuli and situations. Some strategies used by those affected by paruresis are not drinking liquids outside the home or retaining them until they get home, although the severity of the condition can vary greatly depending on the case.
Thus, shy bladder syndrome can cause anything from a slight delay in the urination process in milder cases to total avoidance, with the affected person not wanting to leave the vicinity of their home and even isolating themselves and avoiding contact with partners and relatives so that they cannot hear them urinating, in the most serious cases.
Possible causes
Although paruresis is a phenomenon that is not well known, The research carried out highlights that the causes of this syndrome are predominantly of psychogenic origin.. That is, the reason why this disorder occurs is acquired and mental.
Experts who have studied shy bladder syndrome or paruresis indicate that there are multiple factors that can produce or maintain this type of problem.
One of the main causes is the presence of childhood trauma linked to a situation that occurred in public bathrooms. For example, it has been detected that in a large number of cases individuals with paruresis suffered bullying in their childhood, being harassed, judged and mistreated. For this and other reasons (for example, having a very critical family), subjects tend to have a high level of insecurity, in some cases presenting an inferiority complex that is triggered in an exposure situation, with these people using the bathroom in presence of others.
It has also been observed that people with paruresis have a high sensitivity to criticismfearing being seen as inadequate and also tend to have a low level of assertiveness. Doubts and fears about one’s own anatomy and characteristics of one’s own genitals are also observed with great frequency, with these subjects fearing that they will be laughed at or valued.
Although the documented cases reflect that it appears more frequently in men, there are also a large number of women with this disorder.
The data from some studies carried out reflect that there is a certain differentiation in the type of aversion that occurs in men and women. Specifically, it seems The female sex is more disturbed by the idea of hearing or being heard by other people around them.while in men it is the idea of being seen urinating by other people.
This has a logical explanation if we think about how public bathrooms are structured, with the male urinals placed in a group, so that the urination of other men is visible, while in the case of women the cubicles are usually separated by a wall or screen, generally not being able to be seen by others but they can be heard.
Treatment for shy bladder
If you have difficulty urinating, the first thing you should do is go to a doctor to assess the possibility of a medical problem that could be causing the problem. Once the medical etiology has been ruled out, and once the case has been analyzed, the diagnosis of paruresis is made.
Cognitive behavioral treatment has shown a good level of effectiveness in shy bladder syndrome, treating, on the one hand, cognitive problems such as the belief that one is going to be evaluated and tolerance to criticism, as well as the patient’s behavior.
Taking into account that it has been considered a subtype of phobia, The psychological treatment of choice at the behavioral level would be gradual exposure to the feared stimulus.. This graduation will take into account that over time the patient will have to urinate in bathrooms that are increasingly difficult for them.
For example, exposure may begin in the patient’s home, first completely alone and then having another person wait behind the door. Once the anxiety has decreased or if there has not been anxiety to this degree, you move to other bathrooms, for example in the houses of family or friends, and later you will urinate in public bathrooms that are not very crowded (such as those of a library or a cinema) until you reach very crowded places such as the bathrooms of a nightclub or during a celebration. It is important that the exposure occurs in a very scheduled manner, moving to the next level only once the anxiety has decreased by at least half.
These treatments are very effectivealthough it must be taken into account that what is being treated is the current problem, that is, the symptoms that the patient has today. It would also be very useful to incorporate other types of treatments that would allow working on the reason for the appearance of paruresis and the sensations that they cause at a deep level, in order to prevent this and other problems.
