Dear Alice,

I'm currently a Freshman at a large University in on-campus housing. Being a dorm, everyone shares a bathroom which has several urinals along one wall. My problem is that I can't urinate when other people are in the room. I have found this to be true in other restrooms as well. It seems that my pipes just seal themselves up. Unfortunately, I even have difficulties "taking a dump." It's bad enough that I have trouble even going down to the bathroom when I have to go. I purposely take a long drink at the drinking fountain outside of the bathroom to try to give time to clear out. Unfortunately, it’s happened more than once that I stand there just beginning and someone comes in. I just stand there like a moron and then flush pretending that I actually did something. Any ideas? Thanks in advance!

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 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 to hopefully decrease and potentially eliminate the anxiety you feel when nature calls.

Those who suffer from paruresis, a social anxiety disorder, cause the sphincter muscles in the urethra to tighten when you're feeling anxious about urinating in public, making it difficult to pee while others are present. However, the specific mechanism that causes this is still unclear. Keep in mind that difficulty peeing may sometimes be indicative of a serious health problem. As such, a health care provider will likely screen for any underlying medical issues that might be contributing to your condition. S/he may also make a referral to a mental health professional as anxiety may play a large part in this condition.  

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

Joining a support group and taking prescription medication to address anxiety or other related issues (in conjunction with CBT and/or a support group) may also be other options (though there isn’t a consensus on the effectiveness of various drug therapies for this condition). Depending on individual circumstances, a health care provider (urologist) may suggest biofeedback treatment to relax the pelvic floor or self-catheterization, a process in which a tube is placed in the urethra to remove urine.

If this issue is affecting your life and/or ability to pee or "take a dump," consider talking to a health care provider or mental health professional to discuss possible treatment options. You may want to seek the services that are available at your school, or visit the Urology Care Foundation and the International Paruresis Association websites for more information.


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