Paruresis

For people who are under Paruresis sufferers, it is difficult and sometimes impossible to urinate in public toilet facilities. Almost 3 percent of all men are affected, but because the problem is taboo, they rarely consult a specialist. This is unfortunate in that there are effective methods of combating paruresis.

What is a paruresis?

Around a third of all men are occasionally faced with the problem of not being able to urinate, but those who suffer from paruresis suffer from multiple problems.
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Paruresis is a psychologically caused micturition disorder. Micturition is colloquially referred to as "urination". Sufferers are reluctant to empty their bladder in public toilets. Either they need a certain amount of time to get that far or they have to forego relief and leave the toilet again.

The inhibition is particularly caused by the presence of other men. With what also shy bubble different degrees and degrees of severity can be observed. Some of the men affected prefer to go to a cubicle and not a urinal, as this is where they are hidden from other toilet visitors.

Some can relax better while sitting. In severe cases, these measures will no longer help and urination is only possible at home. The result is a massive reduction in the quality of life.

causes

The cause lies in a formative situation that those affected - mostly during puberty - experienced and in which they felt fear, shame and stress. They felt they were being watched while urinating or were laughed at because they could not urinate immediately.

This experience can contribute to the development of what is known as “fear of expectation”: there is a fear of “failing” again the next time you visit a public toilet. This sets in motion a cycle that can hardly be corrected. In addition, it happens that mental stress without a triggering experience can cause the problem.

You fail to relax and your bladder emptying is blocked. In men, the internal and external sphincters close the urethra and usually ensure that the bladder does not empty against its will. However, when going to the toilet, nervousness and stress can prevent the sphincter muscles from relaxing and thus preventing the bladder from emptying.

Symptoms, ailments & signs

About a third of all men are occasionally confronted with the problem of not being able to urinate, but those who suffer from paruresis are plagued several times: In situations in which they absolutely have to urinate (before starting a long flight, during a bus ride), it is particularly difficult for them.

Psychological irritation is added to the strong physical complaints. To make matters worse, other people cannot understand the problem and smile at it. Affected people feel misunderstood and have the feeling that something is wrong with them. This increases the tension.

Often those people suffer from paruresis who have a penchant for perfectionism and introspection. They also value what other people think of them, but it quickly makes them feel observed. And the feeling of being watched plays a crucial role in the shy bladder.

Diagnosis & course of disease

To make a diagnosis, it is first necessary for a specialist to rule out possible physical causes (enlarged prostate, narrowing of the urethra). Various psychotropic drugs can also be responsible for urinary retention.

The tabooing of the disease usually also shapes its course: those affected try to hide it from others, come to terms with it and integrate it into their lives. They show a pronounced avoidance behavior that complicates their professional activity, their leisure time and their relationship life. Not infrequently, the difficulties lead to social withdrawal and depression.

Complications

Paruresis in different forms is actually not that rare and usually does not represent a serious illness. It is also not the effects of urinary behavior in public toilets that lead to complications. Because the urinary behavior of the shy bladder only affects public toilets where the person concerned feels observed by others. At home, emptying the bladder works fine.

The problem with paruresis, however, can be the effect on the psychological development of those affected. Paruresis usually develops during puberty, when male adolescents attach particular importance to the body and male behavior. Paruresis can be triggered by trauma. Or it is the fear of not being able to pee while standing in front of the eyes of others, which is seen as male behavior, and therefore of being mocked.

The male adolescent affected by paruresis avoids using public toilets out of this fear, because he thinks that others rate him as unmanly or even abnormal. A dangerous inferiority complex often develops from this, which can overshadow all of life. In severe cases, the person concerned is completely socially isolated, only to be able to go to the bathroom at home. If left untreated, the long-term effects of depression can develop into the risk of suicide.

When should you go to the doctor?

Individuals who are very afraid of using public toilets should discuss this issue with a psychologist or psychotherapist. If paruresis is present, treatment is generally recommended because the phobia can have a negative impact on the quality of life if the person concerned is unable to go to the toilet on the plane or bus, for example. A doctor's visit is necessary if the avoidance behavior leads to noticeable restrictions in everyday life.

Anyone who is looking for a job near their own home due to their phobia or who refrains from longer trips may have paruresis that requires treatment. People who suffer from the fears described should first see their family doctor. They can make an initial suspected diagnosis and, if necessary, call in a specialist. The ailment is dealt with in behavioral or talk therapy and can thus be effectively treated. In the case of severe phobias, inpatient treatment at a specialist center for anxiety disorders is necessary.

Treatment & Therapy

Avoidance behavior is a clear indication of the disease and this is where treatment begins. As part of behavior therapy, those affected face stressful and fearful situations under the guidance of an expert.

The attempt is made to carefully increase the level of difficulty: At the beginning there is a visit to an empty public toilet and urinating while sitting in a cubicle, the end of a successful therapy consists in urinating through the urinal in a busy public toilet. The goal is to eliminate fear of failure and to mature the awareness that it does not matter what other toilet-goers (possibly) think.

Another means - often used to accompany behavioral therapy - are relaxation exercises that can also be performed at home. These include, for example, the progressive muscle relaxation according to Edmund Jacobson or the pelvic floor training according to Arnold H. Kegel.

These help to train and specifically use the tension and relaxation of the sphincter muscles involved in emptying the bladder. The chances of success of a treatment are very good and should encourage those affected to overcome their shame and confide in a professional.

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Outlook & forecast

In principle, paruresis is curable. For a good prognosis, the mental disorder should be treated in the initial phase. The more serious the symptoms are and the longer the illness has been going on, the longer the recovery process normally takes. Without therapy, the person concerned rarely makes a recovery. Rather, an increase in the feeling of fear is to be expected and further psychological disorders can develop. The prognosis in these cases is worsened as the development of fear or phobic behavior can spread to other areas.

The symptoms can only be alleviated if the person concerned cooperates. Otherwise, doctors and therapists can only achieve limited success. An improvement in the health situation is achieved by initiating changes through behavioral training and cognitive work. In most cases it is not necessary to work up the cause. Rather, the focus of treatment is on learning to urinate in public facilities. At the same time, the general feeling of fear and the resulting physical complaints are gradually reduced.

For a successful prognosis, in addition to a quick start of therapy and a willingness to relieve symptoms, sufficient patience is required. Often improvements are achieved after a few weeks or months. However, some patients take years to achieve symptom relief.

prevention

Since in most cases a traumatic event triggered the paruresis, prevention is difficult. The widespread view that a man is only a “real” man if he empties his bladder while standing increases the level of suffering. Stereotypes like this lead to uncertainty and endangerment of unstable people who are concerned about the opinions of their fellow human beings. The best prevention is to develop more self-confidence and not overlook the views that are circulating about what a “real” man should be able to do.

Aftercare

In most cases, those affected have very few or only limited measures or options for follow-up care available to paruresis. Therefore, the person affected should consult a doctor very early on in this disease so that there are no complications or other complaints in the further course. The earlier a doctor is consulted, the better the further course of the disease is usually.

A doctor should therefore be consulted at the first signs and symptoms. Paruresis can be alleviated through various therapies and relaxation exercises. However, a complete cure cannot always be achieved, so that those affected continue to avoid public toilets in their lives.

In many cases, family support and help is very important to alleviate the symptoms. Further follow-up measures are therefore not available to those affected with paruresis. However, the disease has no particular influence on the health of the person affected, so that the paruresis does not reduce the life expectancy of the person affected. The person concerned can also try to urinate in public toilets to counteract the feeling of shame.

You can do that yourself

A parureris always requires behavioral therapy. Those affected have to learn together with a therapist to use public toilets without experiencing the typical fears. This is achieved through gradual introduction. The patients then first visit an empty public toilet, for example, before they finally go to a more frequented toilet, where they gradually become accustomed to urinating. The aim of this therapy is to remove any fear of failure.

Relaxation exercises are available to accompany therapy. These can be performed both under therapeutic supervision and at home alone. Proven methods include progressive muscle relaxation or pelvic floor training.Both methods make it easier to empty the bladder and make those affected calmer and more relaxed overall.

If therapy is not possible, because the patient suffers from severe paruresis, for example, which may even be the result of severe trauma, public toilets must be avoided. The most important measure then is prevention. Before long trips by public transport, it should be ensured that there is no need to urinate during the trip. When in doubt, sufferers must wear adult diapers or take steps to avoid long journeys without access to a private toilet altogether.