Bashful bladder syndrome, also known as avoidant paruresis, is a relatively common condition in which a man steps up to a public urinal and nothing happens. (Reprinted from Healing without Medication.)Urination may be impossible even though the bladder is uncomfortably full. Bashful bladder syndrome varies in severity. In mild cases, men need to use a stall rather than a urinal. In more severe cases, a man may only be able to urinate when the restroom is completely empty. In the most severe cases, urination is completely impossible away from home. Travel becomes impossible, and sufferers have bought homes near their places of employment so they can go home whenever they need to urinate. For reasons that have not been explained, more than 90 percent of men who have bashful bladders are first-born children.
In about 15 percent of men over 40, bashful bladder is a complication of prostate enlargement. For almost all men under 40 and the majority of men over 40, however, bashful bladder is a treatable anxiety disorder. A combination of practice and stress reduction can make bashful bladder bearable. Although antianxiety treatments help, the best way to overcome bashful bladder syndrome is practice. First, drink 2 or 3 glasses of water. Then, in the privacy of your home, practice starting and stopping your urine stream. This exercise strengthens the sphincter muscles that control urination and increases your conscious control of urination. (If you are unable to start and stop your stream of urine at will after several private practice sessions, you may have an anatomical problem that could be medically corrected. See a urologist.)
After you have practiced stopping and starting urination at home, enlist the help of a friend or therapist. Locate a public building, such as a medical center, with numerous restrooms. Drink several glasses of water, and then go to the building. With your associate watching the door of a restroom designed for multiple users, practice stopping and starting your urine stream and then fully relieving your bladder. After several practice sessions, tell your helper to wait a few minutes and then come in to the restroom. If you experience severe anxiety when your helper enters, ask him to leave and then finish urinating. At your next session, your helper should come in at a time of his own choosing. After three or four successful sessions with the help of a confederate during which you have been able to allow him to stand at the stall next to you while you relieve yourself, you should try urinating in a public restroom at a public event, such as a football game or a concert.
What else helps?
∆ Some therapists use biofeedback to teach pelvic floor retraining, conscious control over the muscles controlling the bladder. Before you begin a biofeedback program, however, you should have a medical examination to make sure there is no anatomical obstruction blocking your bladder.
∆ Natural health expert Artem Agafonov reports that in Eastern Europe bashful bladder syndrome is treated by exercising (not urinating) in public while wearing a minimum of clothing. Men who are able to appear in public with minimal attention to modesty tend to “forget” to have a bashful bladder.
∆ Physicians frequently prescribe antidepressants such as Paxil or Zoloft to treat bashful bladder. While they may facilitate urination, they can interfere with orgasm. The less frequently prescribed blood pressure medication atenolol also relaxes the bladder but interferes with sexual intercourse.
∆ If you have not yet overcome the condition, travel with bashful bladder syndrome is not impossible. The International Paruresis Association maintains a partial list of gas stations and restaurants that offer private restrooms with locked doors. Nationwide, Exxon stations usually offer private, locked bathrooms.
∆ Young men with bashful bladder syndrome are frequently misdiagnosed as having prostate infections. Consider taking steps to treat bashful bladder if difficulty in urination persists even when there are no signs of infection.