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Public bathroom stage fright is a real and burdensome condition

Dominika Osmolska Psy.D.'s picture

Need to go? Caught at the rest stop in the middle of the desert? Or the fancy restaurant on a date night, for that matter? Most of us don’t think twice when the urge comes on strongly enough, but some 20 million Americans actually can’t go. They have public restroom stage fright, and it can make their lives briefly nightmarish.

People with a "shy bladder," a real condition also known as paruresis, are fearful of urinating when other people are nearby.

The condition is a form of social anxiety disorder: people afflicted with the problem worry about being scrutinized, evaluated, and judged unfavorably while exposing their bodies – or contents thereof – to public perception. While the problem may be exacerbated for men, who are often expected to stand next to each other at urinals and whose masculine endowment may come under unwanted scrutiny, women and children are just as likely to suffer from the condition. Peeing, after all, reverberates as it splashes and hits the porcelain bowl.

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The tremendous amount of shame and embarrassment that sufferers feel because they can't urinate like everyone else can result in extreme situations, such as holding pee for 14 hours at a time or severely restricting fluid intake, both of which can have deleterious effects on the body. Both can lead to urinary tract infections and even kidney problems.

While it is not exactly clear what can set the condition off, about 50% of patients report some sort of childhood trauma associated with the bathroom, such as being bullied or parental pressure. It is doubtless more common, as well, among individuals who are prone to other forms of social anxiety, especially those with “avoidant” personality types. People with an avoidant personality profile have a tendency to focus on their own shortcomings. They form relationships with other people only if they believe they will not be rejected.

Paruresis is also probably inevitable in a culture which burdens the natural process of bodily excretions with connotations of shame. Urine and excrement are synonymous with “dirt,” and I am not talking about soil, either. Changing a lot of diapers or being a caregiver to a disabled or dying patient sheds a very different light on these processes, highlighting, in fact, their great usefulness and even their life-giving properties.

Eighty to 90 percent of sufferers can get considerably better through cognitive-behavioral therapy, which gradually exposes people to their feared situation in small steps, says Steven Soifer, associate professor at the University of Maryland School of Social Work in Baltimore, and author of "The Shy Bladder Syndrome."

Soifer is CEO of the International Paruresis Association, a nonprofit educational organization he founded 15 years ago. The Association's website has online bulletin boards, treatment information, and lists of workshops, support groups, and therapists familiar with shy bladder.



As a female former shy bladder sufferer, of many years I can well relate to the debilitating effects this condition can have on one's life. In fact, I didn't really have much of a life before I recovered, avoiding many social situations that required me to share a bathrooms with others (think ski cabins, sleepovers, college dormitories, work environments, etc). Through a lot of practice of exposure exercises and changing my thinking about bathrooms and the women I might encounter in them, I have fully recovered. I have documented my journey in a guidebook I wrote, "Bathrooms Make Me Nervous". I hope those of you who suffer will find some hope and inspiration by reading it.
i enjoy your article. great job.
The problem is the physical inability to relieve oneself. Any other little fears I have are nothing compared to paruesis because there are not physical implications attached. I consider myself relatively free of anxiety when I enter a restroom, but there is just a tiny amount of anxiety that removes the urgency to go, and in the end this is what it's all about. A central problem I have noticed is that shame and embarassment come into play and become one of the many factors that cause paruresis to snowball. This condition needs more awareness and recognition for the debilitating problem it can easily become.