Image description. Better Health Channel logo End of image description.

Paruresis - shy bladder syndrome

Apersonwithparuresisfindsitdifficultorimpossibletourinate(wee)whenotherpeopleare around.Paruresisisbelievedtobeacommontypeofsocialphobia,rankingsecondonlytothefear ofpublicspeaking.Paruresisisoftenfirstexperiencedatschool. Theconditionaffectsmenandwomenofallraces.Inmildcases,paruresisisanoccasionalevent, likeaformofperformanceanxiety.Forexample,amanatapublicurinalmayfindthatheis unabletourinatewhenflankedbyothermen.Inseverecases,apersonwithparuresiscanonly urinatewhenaloneathome. Theconditionisalsoknownasavoidantparuresis,shybladdersyndrome,psychogenicurinary retentionandpee-phobia. Symptoms Apersonwithparuresistypicallyhasasensitive,shy,conscientiouspersonalityandisfearfulof beingjudgedorcriticisedbyothers.Paruresiscanbemild,moderateorsevere.Signsand symptomsofsevereparuresiscaninclude: Theneedforcompleteprivacywhengoingtothetoilet Fearofotherpeoplehearingtheurinehitthetoiletwater Fearofotherpeoplesmellingtheurine Negativeself-talkwhiletryingtourinate:forexample:Icantdoit.Imnevergoingto pee.Imsuchanidiot. Inabilitytourinateinpublictoiletsoratotherpeopleshomes Inabilitytourinateathomewhenguestsarepresent Inabilitytourinateathomeifsomeoneiswaitingoutsidethetoilet Feelinganxiousaboutneedingtogotothetoilet Restrictingdrinkstoreducetheneedforurination Avoidingtravelandsocialevents.

Ima ge des crip

Similarities to agoraphobia Severeparuresiscanaffectapersonslifeinasimilarwaytoagoraphobia,whichisanxietyabout beinginplacesorsituationsfromwhichescapeseemsdifficult(typically,fearofcrowdsorbeing outsidethehome). Ifapersoncanonlysuccessfullyurinatewhenhomealone,theymayavoidleavingthehouse.This canreducequalityoflifeandcurtailjobopportunities. The cause is psychological Paruresisisnotaphysicalconditionbecausenothingiswrongwiththepersonsurinarytract.The urinarysphinctermustberelaxedinorderforurinetoflowfromthebladderdowntheurethra. Anxietyabouturinatingoverstimulatesthepersonsnervoussystemandclampsthesphincter shut.Failuretourinateheightensthepersonsanxiety,particularlyifthebladderisuncomfortably full. Forsomepeople,anembarrassingincidentstartsthesocialphobia:forexample,theinabilityto urinateintoacupinfrontofadoctorornurse.Worryingabouttheembarrassingincidentmakes thepersonfeelanxiousabouturinatinginthepresenceofothers. Diagnosis methods Variousphysiologicalconditionscanhamperurination.Prostatitis,forexample,canmakeurination difficultforaffectedmen.Thedoctorwillusuallyperformaseriesofteststomakesurethat nothingisphysicallywrongwithyoururinarytract.

Paruresis-shybladdersyndrome

Page1of3

Generally,thediagnosisisparuresisifyoucanurinatesuccessfullywhenaloneathome.The doctormaysuggesttheshort-termuseofdrugssuchastranquillisersorantidepressants. However,thesedrugswillonlyreduceanxiety,notcurethecondition.Inseverecases,thedoctor maysuggestthatyoulearnself-catheterisation.Acatheterisaslendertubeinsertedupthe urethraandintothebladdertodrainurine. Treatment options Youmayliketoconsiderjoiningaparuresissupportgroup.Inseverecases,itmaybehelpfulto seeapsychologist.Treatmentmayinclude: Relaxation techniquestolearnarangeofstrategiestohelpreduceanxiety. Psychotherapyatypeofcounsellingthathelpsyoudealwiththehereandnow,and teachesproblemsolving. Cognitive behaviour therapychangingthewayyouthinkandbehave. Graduated exposure therapyastep-by-stepprogramthatinvolvesdeliberatelytrying tourinateinincreasinglymoredifficultplaces.Abouteightpeopleoutofevery10with paruresisarehelpedbygraduatedexposuretherapy.

Graduated exposure therapy explained Beguidedbyyourpsychologist,butifitsfeltthatgraduatedexposuretherapywillbehelpfulfor you,yourtherapistwillusuallyaskyouto: Makearankedlistofurinationlocationsfromeasiesttomostdifficult.Forexample,most peoplewithparuresisfinditeasiesttourinateathomealone.Thehardestlocationis usuallyacrowdedandnoisypublictoilet.Theideaistostartwiththeeasiestlocationsand workyourwayupindegreestothemostdifficult. Haveapeepartnertosupportyou.Thiscouldbeafamilymemberortrustedfriend. Askyourpeepartnertostandasclosetoyourhometoiletasyoufeelcomfortablewhile youaretryingtourinate.Urinateforafewsecondsthenstopforafewminutes. Haveyourpeepartnerstandalittleclosertothetoilet.Gobackintothetoiletandurinate againforafewseconds,thenstop. Keeppractising,withyourpeepartnergettingcloserandclosertothetoilet.Thismaytake severalsessionsoveraperiodoftime. Trytomakeasmuchnoiseaspossiblewhileurinating.Deliberatelysplashyoururineinto thetoiletwater.Dothiswithyourpeepartnernearby. Pickaquietpublicrestroom(onceyouarecomfortablewithurinatingathome)andthen, withyourpeepartnerstandingoutsidethetoiletdoor,practisethesamewayyoudidat home. Useyourpeepartnerandworkyourwayuptherankedscaleofdifficultlocationsuntilyou cansuccessfullyurinateinacrowdedandnoisypublictoilet. Graduatedexposuretherapyismoresuccessfulifitispractisedoften,perhapsthreeor fourtimesperweek. Drinkplentyofwaterbeforeyourpracticesessiontomakesurethatyourbladderisfull. Avoidanynegativeself-talkwhiletryingtourinate.Rememberthatparuresisisacommon socialphobia.Youarenotabnormalortheonlyone. Takeitslowly,stepbystep.Dontpressureyourself.Youshouldseeconsiderable improvementafterabout12sessionsorso.

Where to get help Yourdoctor OCD&AnxietyHelplineTel.(03)98869377 AnxietyDisordersAssociationofVictoriaInc.Tel.(03)98538089 GeorgeSupportGroupLeaderMelbourne,ParuresisAssociationofAustralia.Email contact:antipodes7@yahoo.com.au

Things to remember

Apersonwithparuresisfindsitdifficultorimpossibletourinatewhenotherpeopleare around. Paruresisisbelievedtobeoneofthemostcommontypesofsocialphobia. Treatmentincludesgraduatedexposuretherapy,whichinvolvesdeliberatelytryingto urinateinincreasinglymoredifficultplaces.

Paruresis-shybladdersyndrome

Page2of3

This page has been produced in consultation with, and approved by:

MentalHealthFoundationofAustralia

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

Paruresis-shybladdersyndrome

Page3of3