What is shy bladder?

Shy bladder, also known as paruresis, is a condition where a person is afraid to use the bathroom when others are nearby. As a result, they experience significant anxiety when they have to use the restroom in public places.

Those with shy bladder may attempt to avoid traveling, socializing with others, and even working in an office. They may also have difficulty urinating on demand for random drug tests for school, work, or athletics.

An estimated 20 million people in the United States are affected by shy bladder. From toddlers to the elderly, the condition can occur at any age.

Shy bladder is highly treatable.

What are the symptoms of shy bladder?

Those with shy bladder have a fear of urinating in a public restroom or around others, even at home. They may try to “make” themselves use the restroom, but find that they can’t. Often, people with shy bladder will try to change their behaviors to avoid having to use a public restroom. Examples include:

  • avoiding social situations, travel, or work opportunities due to fears of having to urinate in public
  • drinking less fluids to avoid having to urinate as much
  • experiencing feelings of anxiety at the thought of or when trying to use a public restroom, such as fast heart rate, sweating, shaking, and even fainting
  • always looking for restrooms that are empty or only have one toilet
  • going home over lunch breaks or other breaks to urinate and then returning to an activity
  • trying to use the restroom frequently at home so they won’t have to in public

If your experience these symptoms on a regular basis or have greatly changed your social habits due to shy bladder, you should see a doctor.

What are the causes of shy bladder?

Doctors classify shy bladder as a social phobia. While anxiety and sometimes fear may be the emotions associated with shy bladder, doctors can usually link the causes to a number of factors. These include:

  • environmental factors, such as a history of being teased, harassed, or embarrassed by others in relation to using the restroom
  • genetic predisposition to anxiety
  • physiological factors, including a history of medical conditions that may affect the ability to urinate

Although doctors consider shy bladder a social phobia, it’s not a mental illness. However, it does indicate a mental health condition that deserves support and treatment.

What are the treatments for shy bladder?

Treatments for shy bladder usually involve a combination of professional mental health support and sometimes medications. Your doctor should evaluate you to ensure you don’t have an underlying medical disorder that is affecting your ability to urinate. If you receive a shy bladder diagnosis, you should be treated with an individualized plan for your unique symptoms and causes.

Medications prescribed

Your doctor may prescribe medications for shy bladder that treat the bladder or any underlying anxiety. However, medications aren’t always the answer and haven’t been proven to be especially effective for those with shy bladder.

Examples of medicines prescribed to treat shy bladder include:

  • anxiety-relieving medications, such as benzodiazepines like alprazolam (Xanax) or diazepam (Valium)
  • antidepressants, such as fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft)
  • alpha-adrenergic blockers that relax the muscle of your bladder to make it easier to use the restroom, such as tamsulosin (Flomax)
  • medications used to reduce urinary retention, such as bethanechol (Urecholine)

Medications to avoid

In addition to treatments to reduce shy bladder, your doctor may also review your medications to determine if you’re taking medicines that may make it more difficult to urinate. Examples of these include:

Anticholinergics, such as:

Noradrenergic medications that increase the amount of norepinephrine in the body, such as:

Doctors prescribe many of these medications as antidepressants.

Mental health support

Mental health support for shy bladder can include cognitive behavioral therapy, or CBT. This type of therapy involves working with a therapist to identify the ways shy bladder has changed your behaviors and thoughts and to slowly expose you to situations where you can relieve your fears. This approach can take anywhere from 6 to 10 treatment sessions. An estimated 85 out of 100 people can control their shy bladder with CBT. Participation in online or in-person support groups can also help.

What are the complications for shy bladder?

Shy bladder can have both social and physical complications. If you hold your urine for too long, you’re at increased risk for a urinary tract infection as well as a weakening of the pelvic floor muscles used to urinate. You may also have kidney stones, salivary gland stones, and gallstones due to limiting your fluid intake.

The anxiety associated with shy bladder can lead you to dramatically change your behaviors to avoid going out in public. This can affect your relationships with friends and family and impede your ability to work.

What is the outlook for shy bladder?

Shy bladder is a treatable condition. If you have shy bladder, you can reduce your anxiety and successfully urinate in public. However, the medical and mental health support required to get you to this goal may take time, which can be anywhere from months to years.