Most people would prefer to use the restroom in the comfort of their homes, but for some people, privacy is more than just a preference — it’s a requirement. Roughly 7 percent of the general population, or 21 million Americans, suffer from paruresis, better known as shy bladder syndrome — a type of social anxiety disorder that can negatively affect their quality of life, relationships and even bladder health.
Causes and Symptoms
“Someone with a shy bladder has difficulty urinating in certain places,” explained Dr. Arthur Mourtzinos, a urologist at Lahey Health practices in Burlington and Peabody, Massachusetts. “That could mean any public place, when someone is in the restroom with them, or even in the homes of family and friends. It’s a very common problem, usually stemming from fear — fear of embarrassment, fear of infection, fear of social isolation.”
Because people with paruresis wait too long to void their bladders, they are prone to urinary tract infections and often develop bladder leakage. However, the problem usually has a greater affect on quality of life than bladder health, says Dr. Mourtzinos.
“People (with shy bladders) often isolate themselves,” he said. “They avoid going out or being in social settings. They isolate themselves at work, where they will wear dark clothes to hide any leakage of urine. They won’t exercise, so they begin to live a more unhealthy lifestyle. I have also heard of people being fired because they couldn’t take a drug test at work.”
Managing Shy Bladder Syndrome
Paruresis is a treatable condition. Here’s where to start.
1. Know you’re not alone. As with any social or performance-related anxiety, paruresis can be self-perpetuating. Embarrassment makes it hard to urinate, which causes more embarrassment and anxiety, which in turn makes it even harder to go. Dr. Mourtzinos reassures his patients that these experiences are very normal.
“This isn’t a problem that affects one or two people,” he said. “It’s a very common problem, and part of coping with it is understanding that you’re not alone. That’s one of the most important messages I try to convey to patients with this condition.”
2. Try baby steps. Dr. Mourtzinos encourages his patients to face their fears, but to start slowly and in low-pressure environments.
“For instance, one of the most common problems is that people can’t urinate at work,” he said. “You could try to urinate when people are out to lunch. Start with that and get more comfortable gradually.”
3. Talk to your doctor. There are treatment options, such as anxiety medication, self-catheterization and behavioral therapy. Dr. Mourtzinos recommends that patients start the conversation with their primary care doctors.
“Typically, patients who have these symptoms also have some other anxiety issues that can be addressed medically or potentially with therapy,” he said. “Primary care can screen out other associated symptoms, discuss medical options and provide referrals for behavioral therapy or urology if necessary.”
Don’t have a primary care doctor? Find a Lahey Health physician near you.