Some people, particularly men suffer from being unable to urinate in from of other people, or in a public place. This is called urination shyness, but it can also be referred to as paruresis. This can be an embarrassing problem to talk to a medical professional about, and many men avoid it rather than be embarrassed. However, in addition to the embarrassment it can be a particularly uncomfortable problem. Imagine this: You are at the big game with your buddies. You are eating salty peanuts, popcorn, hotdogs, etc. and washing it all down with that extra large coke or beer. You really need to go, so you make your way through the crowded stadium, and into the bathroom. You get ready to go, and can't. Now, not only have you inconvenienced everyone by making them move so you can get through the stand, but you also are totally uncomfortable the rest of the game because you still have not emptied your bladder.

Paruresis is a major problem for some people, and goes by many names. Paruresis is also known as shy or bashful bladder, pee shyness, urination shyness, and many other names. However, basically it is the inability or difficulty to urinate in the presence of other people, when under time pressure, or on vehicles such as trains or airplanes. It is a problem that can affect men and women both, but because typically it is caused by urinating in front of others, it is more common in men who urinate in a more public setting than women do. People who suffer from Paruresis generally have no problem with urinating in their bathrooms at home, when under normal conditions. However, if you apply any sort of pressure to their urinating, it becomes increasingly difficult for them.

Research has shown that because urinating at home is not problematic, the problem urination shyness is not a physical problem, rather a social phobia, or social anxiety disorder. Having this disorder is not uncommon, in fact, some research has shown that 17 million Americans, 3.25 million Canadians, and 51 million Europeans suffer from this particular social anxiety disorder. Again, this is mostly exclusive to males.

People who suffer from urination shyness have varying degrees of severity. Some struggle under only certain pressures, while others find it impossible to urinate if they are not at home alone. So, whether you struggle with time restraints, or with public restrooms, or with other specific conditions, whether your problem is mild or severe, you probably want to do something about it. Being in uncomfortable situations where you need to urinate and can't is not very happy, and can actually be very socially disabling; when your friends go out for the night and you can't or won't go because of the fear that you might need to urinate and can't, makes it hard to do much, whether it is dinner with friends, or drinks, or sporting events. This means that not only are you missing out, but there are often serious psychological consequences as well. Many people who have urination shyness, also suffer from depression, and anxiety because of it. Let's face it, when you have a social disorder, your job choices and career decisions, social calendar, and more are going to be affected. This is especially true of jobs where there are mandatory drug testing done by the supervised collection of a urine sample. If you can't pee in public, this makes getting a job of this nature next to impossible. As you can see, this would be very problematic.

Causes and symptoms

If you suffer from urination shyness you probably want to know what the causes are more than anyone else. Generally those who suffer from paruresis find that there are three triggers that influence them when in public restrooms. In most cases, if you can remove these three triggers, you can urinate. If you can't, you need to try for another toilet. The first trigger is that of having strangers in the restroom. Often times friends and family won't elicit the same response. So, if you can enter a public restroom and get started before any strangers come in, you should be good. The second trigger is often proximity. If the bathroom is crowded and the restroom does not have good partitions or dividers between stalls or urinals, it can be very uncomfortable for someone who suffers from urination shyness to get started. The need for privacy is a physical and psychological need for a paruretic. The third trigger is a psychological one. If the person who needs to urinate is feeling anxiety, anger, fear, etc. it can interfere with their ability to urinate.

Diagnosis

In order to diagnose this, a doctor does not perform any tests, really, they just listen to what the sufferer says happens to them. If any or all of the triggers mentioned above exist, the doctor will likely diagnose paruresis. Most people simply self diagnose urination shyness. If they struggle to go to the bathroom in a public restroom, or find themselves waiting for the bathroom to clear out before they will go, and especially if the three mentioned triggers affect them, they likely suffer from urination shyness.

Treatment

So, now that you understand the causes, and how it is diagnosed, let's look at what you can do to treat it. Generally treatment is of a psychological. The treatment option that is most often used for this problem is that of cognitive-behavioral therapy. With this therapy type, the goal is to help the sufferer recognize and reorganize the "abnormal" emotional schemes arising from the anxiety generating elements that trigger this problem. Some people approach this method of treatment in the self help way, others join support groups, others use the help of a psychologist or psychiatrist.

Other therapy or treatment options include:

Drug treatments. These are usually done with medications that are used to treat benign prostate hyperplasia (BPH). This is a medication used for an enlargement of the prostate gland. Common medications used are terazosin (Hytrin), tamsulosin (Flomax), and alfuzosin (Uroxatral). These drug treatments are often debated as to whether or not they are useful, because it is considered a social anxiety, many doctors do not feel drugs have much effect.

Most doctors do not recommend trying to pee in public during times that you really have to go. Some people think that if they have to go bad enough they will be able to overcome their anxiety and just go. However, in most cases they still can't, and possibly get bladder infections or other complications as a result of holding their urine too long, while their bladder is too full.

The fact is that the best treatment options are going to vary from person to person. For some a medication will do wonders because psychologically they think they have something that solves their problem. For others it takes intensive psychotherapy. It can take years to overcome this problem, and since most people that suffer from this condition never seek help or treatment, in some cases it is never solved. In fact, a lot of people never even discuss the problem with anyone, which makes it hard to take care of the problem. Evidence has shown that if someone with this problem does seek help their likelihood of overcoming it increases significantly. If someone seeks help, they will have an easier time overcoming their anxiety. It can still take several months, or even years to get over something like a social anxiety about public excretion, but taking a few years to get over it is better than always suffering from it.

While it is great to want to prevent urination shyness, there is nothing that can be done to prevent this problem from developing. Paruresis is a problem that does not usually manifest until around puberty.  So, if you want to do something to help prevent this from being a problem with your children, consider teaching them from a young age to use public restrooms. The more used to it they become before the social disorder has a chance to manifest, the less likely it is to be a problem.

Urination shyness can be very difficult in social situation, but most difficult in situations where the shy person has no other choice. People in prison, for example, may have to get over their urination shyness at an accelerated rate in order to live. If you suffer from urination shyness it is a good idea to try some self therapy, try to eliminate some of the things that trigger your anxiety, and most importantly if the situation does not start to improve, talk to someone about it, whether it is a doctor or a psychiatrist. Wanting help is often the best way to overcome this sort of problem. It is a healthy first step to being able to pee in public.