Your Shy Bladder Syndrome FAQs Answered

Shy bladder syndrome and paruresis are the same thing. Some people also call it “stage fright”.

There is no pill which will definitely and quickly cure you of paruresis. Some antidepressant medication may help by generally reducing your anxiety, but it’s not a certainty – it helps some people, but not others. 

We find it more useful to think of a road to recovery rather than a sudden cure. Most people find Cognitive Behavioural Therapy very helpful. Most people also find it very helpful to talk to someone about their paruresis, particularly other people who experience it themselves. Most people find it very helpful to learn the physical causes of their paruresis. People who come along to our workshops can do all of these during the course of a weekend. You’re unlikely to be totally cured in a weekend, but you will have the tools to go forward with more confidence. Learn to know your enemy and you’re halfway to reducing its power over you.     

This description is a simplified version of the mechanism. One part of the nervous system looks after voluntary actions (e.g. raising your arm) and a second part that looks after actions you do not consciously control (e.g. breathing when you are asleep or the body’s preparation for fleeing danger).

The bladder is surrounded by muscle fibre called the detrusor. The tube that empties the bladder is called the urethra and it exits the bladder via the internal sphincter (think of a tap). The detrusor and the internal sphincter are not under your voluntary control, but under “unconscious” control.

The urethra then goes through the external sphincter, which IS under your voluntary control.

What happens is that the bladder fills up and at a certain point sends a signal to say “time to empty”. The unconscious mechanism triggers the detrusor muscle to squeeze the bladder in order to force out the urine – think of compressing a small balloon in your hands. At the same time the internal sphincter opens. The only thing stopping you from wetting your pants is your voluntary control of the external sphincter which you keep closed. When conditions are right, you consciously “let go” which opens the external sphincter and you pee.

With paruresis, the environment you are in causes your brain to go into an alert state i.e. it thinks there is a danger somewhere. The brain’s action is to trigger the “freeze” response whereby the unconscious mechanism relaxes the detrusor muscle, and closes the internal sphincter. Hence even if you voluntarily want to pee, the unconscious is saying “wait, there’s something wrong”. So it does not help to be made to drink more and more in an attempt to force you to pee. The unconscious has shut the internal sphincter and the detrusor is not squeezing the bladder and so nothing will happen.

This is in contrast to a person who doesn’t have paruresis who, say, is trying to avoid giving a sample. In that case the detrusor is squeezing, the internal sphincter is open, and it is only the conscious desire to not pee that is keeping the external sphincter closed. Being forced to drink more and more increases the pressure of the urine against the external sphincter and eventually the person will be unable to hold it back.

The UKPT are very cautious about hypnosis as a treatment for paruresis for 2 reasons: We get people on our workshops who have tried hypnosis at some cost to no avail, and in some cases it has been a difficult experience.

One of our honorary advisors, a chartered psychologist, who was also a registered psychotherapist and a hypnotherapist, told us that in his opinion, hypnosis was not the treatment for this condition. Another clinical psychologist who works with us says the same. In cases of very mild paruresis where someone is comfortable with using urinals but from time to time locks up, hypnosis may be of help in showing them how to relax. But other than that, we do not feel it is of help. For more information about Hypnosis and paruresis please visit https://www.ukpt.org.uk/living-with-paruresis/hypnotherapy

The UKPT is interested in any evidence of the effectiveness of hypnotherapy. We would be looking for evidence such as personal case studies given by participants at our workshops.

Catheters are small plastic tubes that can be inserted up the length of the urethra, through the sphincters and into the bladder, in both men and women, enabling the bladder to be emptied. Some people with Paruresis self-catheterise with medically available catheters for immediate relief in situations when they know they are otherwise likely to experience difficulty. So far, it’s the only sure fire way of peeing we know. The UKPT is committed to supporting severe cases (i.e. those who struggle at home) to get to grips with this technique, so that they can get their life back and, just as importantly, be enabled to attend a UKPT workshop.

If you reach the conclusion that you want to have the option to self-catheterise, visit your GP practice and ask to be shown how to do it. Your GP can also prescribe catheters. You should take along UKPT literature, or download information from this website Urology Care Foundation to help you.

A ring of muscle that when tightened closes a tube e.g. the internal sphincter closes the urethra at the point where it leaves the bladder. When the muscle is relaxed, the tube is opened. The anal sphincter closes the anus.

UKPT does not provide professional treatment. Instead we use a self-help approach in workshops where the leaders are not medically or psychologically qualified but are recovering from the condition themselves. We are passing on what we have learnt about overcoming paruresis and providing support along the way in the hope that it will be helpful to others. Feedback so far is that this approach is very helpful. However it is not the aim of the UKPT to be a replacement for professional therapy which might be the best option for some individuals if it is available.  

The condition was first researched and defined by Williams and Degenhardt in their paper "Paruresis: a Survey of a Disorder of Micturition" published in the Journal of General Psychology, 1954, 51, 19-29. https://journals.sagepub.com/doi/10.1177/0033294187060003-233.1

It can, although by its nature this is usually less of a problem. For more information visit www.shybowel.com

There are two aspects to consider:

1. Coping while at work
2. Therapy

Have a confidential discussion with him/her about what conditions at work make it difficult or impossible to pee. Then you can consider how the company can help. The usual negative triggers are: proximity of other people, silence, others knowing they have gone to the toilet, and/or time pressure. These negative triggers vary from person to person, so give them the chance to explain what they are for them. One possible way forward is to allow them to use a private toilet, well away from any office. You may have an accessible toilet: let them use that. It is important for them to be able to go to the toilet without any comment being made by anyone before or after. It may help you to think of it as extreme self-consciousness on their part and to manage the relationship on that basis.

There is usually a lot of shame and embarrassment attached to the condition. And there may be accusations from other members of staff about preferential treatment. Agree with the individual to use a statement that is as close to the truth as possible without giving away that it is paruresis. Maybe they could say they are “having problems with their water works”. If an older man, one can hint at prostate issues; with a mother, childbirth related issues. 

The recommended therapy is that used for any anxiety-based condition i.e. Cognitive Behaviour Therapy (CBT). We as a charity have been running CBT based weekend workshops since 2003; over 70 workshops, over 700 participants, both men and women.

Finally, direct them to our website where they will find a wealth of information about living with paruresis. This will also give them the opportunity to book onto a CBT based workshop.

A urologist is a specialist in the field of medicine that focuses on the urinary tract and urinary organs.

If you visit your GP to discuss your paruresis they may well decide to refer you to a urologist to make sure there is no physical medical issue causing your peeing problem.