Shy Bladder Syndrome

by Bob Walsh

Hypnosis for paruresis – or shy bladder syndrome – is one of the most effective ways to overcome this kind of social anxiety. Until know, medical experts are not clear what causes it –

Many people think that “you will pee if it gets bad enough”, but that’s simply not how it works for people with paruresis.

Quiet a few people have lost their jobs because of a bashful bladder – simply because they weren’t able to perform a mandatory drug test, during which an observer is present. The employers then probably assumed that the reason why these people weren’t giving a urinary sample was because it would prove that they take drugs – even though the real reason was a very special form of a social anxiety disorder.

Many elite athletes have the same problem, in fact there’s a term for that too: Psychogenic urine retention during doping controls (PURD). As Anne-Marie Elbe noted in a 2011 paper “60% of these athletes have experienced psychogenic urine retention during doping controls, with only 39% of them showing symptoms of paruresis”.

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A surprisingly large amount of people are affected by it. The International Paruresis Association estimates that about 17 million people in the USA alone can be diagnosed with shy bladder syndrome. Yet, very few people talk about it, or even know about it.

As Brett J. Deacon and co-authors recently pointed out in an article of Cognitive Behaviour Therapy:

Paruresis, characterized by the difficulty or inability to urinate in a variety of social contexts, is a scientifically under-studied phenomenon

Often people develop all kinds of avoidance behaviors, most commonly just drinking less so that have to urinate less. However, constant dehydration can lead to urinary tract infections and kidney diseases.

For men sometimes factors that can play a role are penis size anxiety, but for the majority of cases it’s not about that.

Physiology of Paruresis

While the inability to urinate almost always has psychological causes, it is nonetheless helpful to look at the “mechanics” that are involved. We have what are called urethal sphincter muscles that prevent us from peeing. The normal state of this muscle is to be constricted, rather than relaxed. If we want it to relax, our brain has to give these muscles the signal first in order to allow us to urinate. Normally, we have conscious control over this process – but for people with shy bladder syndrome, it’s different. At some times they do have conscious control about it too, but in many cases, relaxing their urethal sphincter is something they can not deliberately do.

Some situations that can cause this are: the presence of others. For example, the most common form of paruresis is being unable to urinate in a public bathroom. However, there are many different kinds. Some people are unable to urinate when people are in a room nearby and simply could hear them urinate. Some people are unable to urinate simply when they think of other people – so imagined people can prevent them from peeing. Others are unable to urinate anywhere except in their own home – even the private bathroom in a friends house won’t help.

How To Cure Paruresis

Since paruresis is not a physiological defect, but a psychological malfunctioning, medication doesn’t help. Sometimes abapentin, atenolol and psychotropic drugs are used to temporarily try to relief symptoms, but the problem is that these substances can actually make your urinary retention problem worse.  However, one doesn’t need to spend countless hours in psychotherapy or psychoanalysis either. Hypnosis for paruresis is one of the most effective ways to cure it.

One of the reasons is probably that hypnosis allows you to directly communicate with the subconscious mind. You probably are aware of the fact that children often have no conscious control over when they pee, and sometimes even adults pee accidentally if they are extremely scared and frightened. That’s because in the end, it is our subconscious mind that controls the urethal sphincter muscles. Hypnosis allows you to regain conscious control over the musculature that is involved in peeing, so that you are able to relax the muscles – and release your bladder – when you want, no matter how many people are around you.

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Sources:

  • Anne-Marie Elbe, Marius M. Schlegel, Ralf Brand, Psychogenic urine retention during doping controls: Consequences for elite athletes, Performance Enhancement & Health, Available online 26 January 2012, ISSN 2211-2669, 10.1016/j.peh.2012.01.001.
  • Development and Validation of the Shy Bladder ScaleBrett J. Deacon, James J. Lickel, Jonathan S. Abramowitz, Patrick B. McGrathCognitive Behaviour Therapy, DOI:10.1080/16506073.2012.658852
  • Malouff JM, Lanyon RI. Avoidant paruresis: An exploratory study. Behav Modif. 1985;9(2):225-34.
  • Vythilingum B, Stein DJ, Soifer S. Is “shy bladder syndrome” a subtype of social anxiety disorder? A survey of people with paruresis. Depress Anxiety. 2002;16(2):84-87.
  • Kaufman KR. Monotherapy treatment of paruresis with gabapentin. Int Clin Psychopharmacol. 2005;20(1):53-5.
  • Hammelstein P, Pietrowsky R, Merbach M, Brähler E. Psychogenic urinary retention (“paruresis”): diagnosis and epidemiology in a representative male sample. Psychother Psychosom. 2005;74(5):308-14.
  • Hammelstein P, Soifer S. Is “shy bladder syndrome” (paruresis) correctly classified as social phobia? J Anxiety Disord. 2006;20(3):296-311.

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