Shy Bladder: Causes, Symptoms, and Solutions

May 03, 2022

4 mins

Shy bladder, known medically as paruresis, is a condition that causes anxiety (sometimes debilitating) when urinating around other people.

"Stage fright" as it's known colloquially, may not seem like a big deal, but when severe it can impact one's ability to travel, be in public, and generally live a normal life. Going on a road trip is generally nothing to fret about, but those with extreme shy bladder may find it excruciating since public restrooms tend to be the only option on the road.

Below is a closer look at the causes, symptoms, and treatments available for paruresis, everything you need to know to help you understand this condition and your options.

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What Causes a Shy Bladder?

Shy bladder differs from most other urinary conditions because it has a psychological basis.

Many other urinary conditions like urinary incontinence, urinary retention, and frequent urination can be traced to a specific physical or biological cause. Shy bladder, however, often has more to do with your mental state and psychology than it does with your bladder and its anatomy.

Societal

Social influences play a large role in shaping the person you are. Gender norms, peer pressure, obedience, and taboos are examples of social pressures that shape and influence individuals.

Urination can carry stigmas, and some people are made to feel ashamed or embarrassed over public urination early in life. Everyone urinates, but it's largely not discussed and can make people feel as if they should be ashamed of it.

These circumstances can cause an individual to feel as though urination is something to be done in private. When other people are nearby, they may subconsciously resist, resulting in a shy bladder.

Childhood Trauma

Another potential cause of shy bladder is a traumatic event in childhood. Many people associate childhood trauma with something serious like sexual assault, but the reality is that a seemingly small event could lead to lasting trauma.

Some scenarios that can contribute to trauma surrounding urinating in public could be teasing by others, urinating in front of a medical professional for a urine test, sexual assault, being assaulted in a public bathroom, and more.

The exact trauma that leads to a shy bladder may seem insignificant, but it can have lasting impacts on behavior in the long term.

What Are the Signs of a Shy Bladder?

While you might think that a shy bladder is obvious, you may have a shy bladder without even knowing it.

Individuals may subconsciously avoid using public restrooms and never truly understand that there's a little more to this desire. Below is a closer look at some common, tell-tale signs of paruresis.

Avoiding Drinking Surrounding Events

Since individuals with a shy bladder have anxiety when it comes to urinating in public bathrooms, they may avoid urination entirely by stopping the consumption of fluids before going out.

While this may be effective in relieving their fear of needing to go to the restroom while they're out, it can lead to dehydration and discomfort.

Elect To Stay at Home

A bashful bladder is considered a social phobia, and the risk of potentially needing to go to the restroom while in public may be enough to cause a person to withdraw from social settings.

This is an extreme case of a shy bladder, but it can lead to agoraphobic tendencies where an individual finds it hard to leave their house.

Avoidant paruresis is another form of shy bladder that coincides with the need to stay at home. Avoidant paruresis is a condition where an individual needs to be home alone in order to urinate.

Physical Manifestations

While paruresis is largely considered a psychological social phobia, it can affect your body physically.

The stress and anxiety surrounding going to the restroom in public toilets can lead to panic attacks, increased heart rate, and psychogenic urinary retention. These symptoms can occur alongside other symptoms and can have a severe impact on quality of life.

In addition, holding your urine during outings just to avoid using the bathroom can be painful and uncomfortable, and even result in medical issues if severe or consistent.

What Are the Treatments for a Shy Bladder?

Paruresis is a psychological disorder, and as such many of the treatment options available have to do with therapy and modifying behavior.

If you suspect you may suffer from a shy bladder, you should have a conversation with a healthcare provider such as a psychologist who can help diagnose and treat your condition.

Below is a closer look at some of the treatment options they may offer in relation to a shy bladder. 

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on altering the learned automatic or reactionary thoughts and behaviors that result in a disorder.

When it comes to shy bladder syndrome, CBT often focuses on altering the way you think about using the bathroom in public while also working to change behaviors such as avoidance.

CBT is not an overnight treatment, and it can take a long time for an individual to see progress. Relearning and retraining the automatic responses your body has can take time. Through a combination of graduated exposure therapy and traditional talk therapy, an individual can reach a sense of normalcy and improved quality of life.

Support Groups

As a form of social anxiety disorder, paruresis can take quite a toll on your mental health and physical wellbeing. Many individuals with this medical condition have difficulty opening up about their health condition due to a lack of understanding and embarrassment.

This is where a support group can help tremendously. While a support group won’t cure a shy bladder outright, it can allow those with paruresis to hear other people's stories and feel a less alone, improving the symptoms over time. For sensitive issues, online communities can be helpful.

Benign Prostatic Hyperplasia vs. Paruresis

The term shy bladder is somewhat vague, and many people confuse it with having an enlarged prostate.

An enlarged prostate can lead to a number of symptoms, ranging from impacting sexual performance to affecting your ability to urinate.

With an enlarged prostate, some people find it hard to urinate, and this is distinct from paruresis because it has a physiological basis that may require a urologist more than a psychologist.

In addition to physiological causes, you may directly treat an enlarged prostate with surgery or medications like Cialis® (tadalafil).

Whether you're dealing with Benign Prostatic Hyperplasia, erectile dysfunction, or hair loss, Rex MD may be able to help with highly accessible men’s telehealth services and common men's health medications shipped right to your doorstep. With online consultations, accessing popular and common men's health treatments has never been easier.

The Takeaway

A shy bladder is a psychological condition that's more common than most people realize. According to the International Paruresis Association (IPA), nearly 7% of the general population is affected by this social anxiety disorder.

By understanding some of the common causes, symptoms, and treatments, you can feel less uncertain about paruresis and find the right treatment approach for your situation.

Sources

About Avoidant Paruresis | International Paruresis Association (IPA)

Paruresis Facts | International Paruresis Association (IPA)

Shy Bladder (Paruresis): Causes, Symptoms & Treatment | Cleveland Clinic