Problems peeing with others present

Dear Reader,

Instead of the soothing sounds of the wind and rivers, bathrooms echoing of footsteps and piping sounds constitute the modern place of pee and poo. Feeling anxious about urinating and defecating in the presence of others is known as "bashful bladder" syndrome or "shy" bladder syndrome (a.k.a., paruresis). Your "pipes just seal[ing] themselves up" when you're feeling uncomfortable in certain social situations, like a public bathroom, happens to many people — you're far from alone. Fortunately, a number of treatment options are available (alone, or under the guidance of a health care provider/counselor) to decrease and eventually eliminate the anxiety you feel when nature calls.

Paruresis, a social anxiety disorder, may cause the sphincter muscles in the urethra (or anus) to tighten when you're feeling anxious about urinating or defecating in public, making it difficult to pee or "take a dump" while others are present. Keep in mind that difficulty peeing may sometimes be indicative of a serious health problem. However, since anxiety is to blame in most cases, addressing this anxiety with a counseling professional may be helpful.

Cognitive Behavioral Therapy (CBT), conducted by trained counseling professionals, has been shown to be effective in turning bashful bladders into the life of the party (so to speak…). It involves gradually exposing yourself to a situation that you fear and gradually becoming "desensitized" to that feared situation. Although CBT may take some time, it may be an effective treatment option for some people.

In addition, you may want to try your own relaxation techniques. While standing or sitting in the bathroom, close your eyes, take a few deep breaths, and think to yourself, "I am warm" when you inhale, and "I am calm" when you exhale. You may also want to put mind over matter and pretend you hear a faucet running, a river flowing, or maybe even visualize Niagara Falls. Flushing the toilet may help get the stream going. Another method to keep your mind calm or distracted while in the bathroom is listening to music with headphones. Pick your favorite song or sounds of nature and close your eyes for a quick escape from other distracting bathroom patrons. You may also want to check out Stress, anxiety, and learning to cope and Meditation for general relaxation tips.

Joining a support group and taking prescription medication (in conjunction with CBT and/or support group) may also be other options. Depending on individual circumstances, a health care provider (urologist) may suggest self-catheterization, a process in which a tube is placed in the urethra to remove urine. If treatment seems too long-term, however, you may want to consider some "quick fixes" in the meantime:

• If possible, seek the comfort and privacy of a stall instead of a urinal
• Find a private bathroom somewhere on campus that you may use
• Stifle any sounds that embarrass you by putting toilet paper inside the toilet bowl before urinating or "taking a dump" or flush the toilet while urinating

List adapted from Can You Pee In Public? from About.com

If this issue is affecting your life and/or ability to pee or "take a dump," you may want to consider talking to a health care provider or counselor to discuss possible treatment options. If you're a student at Columbia you can make an appointment with a health care provider from Primary Care Services by calling x4-2284 or by logging in to Open Communicator. You can also make an appointment with a counseling professional from Counseling and Psychological Services. If you are not at Columbia, you may want to seek the services that are available at your school, or visit the International Paruresis Association website for more information.

Next time nature calls, you can calmly stand (or sit) and deliver!