Paruresis

performance anxiety

pee-shy

Paruresis [pahr-yew-ree-sis] is a type of phobia in which the sufferer is unable to urinate in the (real or imaginary) presence of others, such as in a public restroom. It most commonly affects males, though there are female sufferers too. The analogous condition that affects bowel movement is called parcopresis.

Many people have brief, isolated episodes of urinary difficulty in situations where other people are in close proximity. Paruresis is also known by many colloquial terms, including bashful bladder, bashful kidneys, mental cloggery, stage fright, pee fright, urophobia, pee-shyness, the slow dribbles, creeping pee-pee, public piss syndrome, shy bladder syndrome, air-blockage, and psychogenic urinary retention.

Paruresis, however, goes well beyond simple shyness, embarrassment, fear of exposure, or fear of being judged for not being able to urinate. Other people may find that they are unable to urinate while in moving vehicles, or are fixated on the sounds of their urination in quiet restrooms or residential settings. In severe cases, a person with paruresis can urinate only when alone at home or through the process of catheterization.

Although most sufferers report that they developed the condition in their teenage years, it can strike at any age. Also, because of the differing levels of severity from one person to another, some people’s first experience of the problem is when, for the first time, they ‘lock up’ attempting to produce a sample for a drug test. Many women are unaware that they, too, are subject to paruresis; articles about women and urination emphasize other female urinary dysfunctions, such as urinary incontinence or frequent urination. Some people cope by deliberately holding in their urine, by refraining from drinking liquids, or locating unoccupied or single-occupancy public bathrooms.

Severe cases of this disorder can have highly restricting effects on a person’s life. In moderate to severe cases, overcoming paruresis can be extremely difficult without the help of a psychologist, therapist or support groups. Severe sufferers may not be willing to travel far from their home or be able to form intimate relationships. Others cannot urinate even in their own home if someone else can be heard to be there.

Some drugs can cause difficulty in urination; MDMA, amphetamines and opiates such as heroin, hydrocodone, or synthetic opioids such as methadone in particular. Partly this is a physical side effect of these substances, but it is often seemingly a psychological symptom, directly related with shyness, like paruresis. Many users have found running water or other sound to ‘cover up’ the sound of their urination is necessary, but once urine flow is finally started it will usually flow normally until completion.

Monroe Weil, Ph.D., a psychologist, has described a method he developed for treating paruresis by the use of breath holding combined with in vivo desensitization. Medication is also an option, SSRI drugs like Prozac, Zoloft, Paxil, etc. can be beneficial, and benzodiazepines such as Xanax, Valium, or Klonopin can be used before the drug test or while in public to relax the muscles and bring the anxiety level down enough to where you can produce a sample.

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