Harvard Men's Health Watch

On call: Shy bladder syndrome

On call

Shy bladder syndrome

Q. I hope you can help me understand a troubling and embarrassing problem. I often find it difficult, sometimes even impossible, to pass my urine in a public men's room. I'm 41 years old, and I'm very healthy. I have no problem urinating at home, and I rarely get up at night. But last week I couldn't even urinate at a friend's house, and I had to go home early just to use the bathroom. What can you suggest?

A. Although your problem doesn't get much attention, it's far from rare. In fact, it's earned a medical name, paruresis, and a popular translation, the "shy bladder syndrome."

Paruresis is not a urologic problem but a psychological one. It's a variation on a common theme of social phobia disorders. Social phobias can take many forms. Perhaps the most obvious is performance anxiety or stage fright. Others can include fear of being seen eating or extreme shyness in personal encounters. In your case, the "performance" that triggers anxiety is urination. People with paruresis tense up when they think someone may see them urinating, hear them urinating, or even know they're urinating, particularly when there is a line at the bathroom door. Anxiety tenses up the sphincter muscles at the bladder neck, and when these muscles won't relax, urination is a no-go.

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