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,

When you gotta go, you gotta go — and it’s frustrating when other people or circumstances get in your way! You’re far from alone — many people have experienced difficulty going to the bathroom in the presence of others. Fortunately, a number of options and changes in your routine may hopefully decrease the anxiety you may feel when nature calls. This includes reducing coffee and alcohol intake, practicing peeing in public, graduated exposure therapy, and more.

It may be helpful to think about ways to minimize the effects this has on your daily life. Some tips include:

  • Peeing in private before heading out
  • Avoiding the use of decongestants (which may tighten sphincter muscles)
  • Reducing the amount you eat and drink (including caffeine and alcohol) before being in public
  • Using stalls when available (instead of the urinal)
  • Running a faucet while you go to the bathroom
  • Practicing using the restroom in public on your own

Based on what you’ve described, it’s possible you’re experiencing paruresis, the inability to urinate when others are present (or when you imagine people are present), and parcopresis, the inability to defecate in similar circumstances. Paruresis and parcopresis are thought to be social phobias that stem from social anxiety causing a person’s sphincter muscles in their urethra and anus to tighten as a result. If this issue is affecting your day-to-day life 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 out the services available at your school, or visit the Urology Care Foundation and the International Paruresis Association websites for more information.

Interventions such as graduated exposure therapy, a specific subset of cognitive behavioral therapy (CBT), has been shown to be effective when treating paruresis. A health care provider could help to reduce your fear response over time. For example, you may be asked to try urinating with one friend standing far away from the bathroom, and then work your way up to experiencing circumstances you rate as highly distressing, such as peeing in various public restrooms with many people nearby. Other interventions that focus on relaxation, talk therapy, or biofeedback may also be useful. Certain medications that help to relax the sphincter muscles may also make it easier to go. 

Many people prefer using the bathroom to be a private matter. If making changes to your routine doesn't help in your ability to use the bathroom, then seeking medical advice could be useful, as difficulty peeing and pooping may sometimes be indicative of a serious health concern. As such, a health care provider may screen for any underlying medical issues that might be contributing to your struggles to use the bathroom.

Hope you're able to find some relief!

Alice!

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