Paruresis is the inability to use public restrooms despite the absence of a medical cause. Known by many other names such as urophobia, shy kidney, shy bladder, and bashful bladder syndrome (BBS), paruresis is found in both women and men of all ages and when severe and untreated can lead to medical complications. Paruresis is considered to be a social phobia, and if severe and limiting is generally diagnosed as social anxiety disorder (SAD).
It is unlikely that there is one cause underlying paruresis. Some people with this problem may have experienced childhood bullying or had parents that were overly critical. Others may have experienced a traumatic episode in which they were unable to urinate when required to do so -- for example when asked to provide a urine sample. In general, people with paruresis fear negative evaluation by others. If you suffer with a medical condition that prevents you from being able to urinate, you would not be classified as having paruresis.
Paruresis can cause difficulty with travel, social obligations, and professional commitments. Many people with paruresis will develop coping strategies such as drinking less, urinating frequently while at home or before leaving the house, and running the tap or flushing so that others cannot hear. Usually fears are centered around public restrooms, but may extend to the homes of friends or relatives or even your own home if visitors are nearby.
The impact of paruresis can range from mild to severe. Those with mild problems are unable to urinate in certain circumstances but capable in others. Those with more severe problems are only able to urinate at home. Paruresis is generally a progressive problem, with fear increasing and generalizing over time to more and more locations.
There are a number of common triggers which may make it more difficult for people with this social phobia to use a public restroom. If you suffer with paruresis, you probably find it more difficult to use a restroom if it is very busy, if the stalls lack proper partitions for privacy, or if you are feeling particularly anxious, fearful, or pressed for time. People with paruresis may imagine that there is someone waiting and listening while they urinate.
A variety of treatments are available for paruresis including cognitive therapy, exposure therapy and anti-anxiety medications. Although exposure therapy can be very effective, it is important to consider whether paruresis is the only symptom, or one of a collection of social fears. If you suffer with a number of social fears, it is also important to receive treatment that addresses problems with self-esteem, self-confidence and beliefs about your abilities. In addition, before you begin any psychological treatment for paruresis, physical causes should be ruled out by a medical professional.
International Paruresis Association (IPA). About Avoidant Paruresis. 4 August 2008.