Provocative Wave for Men

Pee Shy

by Joe Kerr

Imagine that you're at a baseball game. You've had one too many Cokes with your hot dogs and nachos, but when you head for the restroom, you freeze up. Your full bladder demands immediate attention, but when you try to empty it, nothing happens.

"Pee Shy"

Paruresis, the medical term for "shy bladder syndrome," is a social anxiety disorder in which a person is unable to urinate in a public restroom. For those who suffer from this condition, daily life can be a struggle. Imagine being away from home for hours or even days and not being able to relieve yourself. Besides the tremendous discomfort of "holding it in" for hours at a time, ignoring the signals from a full bladder can also lead to possible bladder inelasticity (loss of tone over time) and, in women, urinary tract infections. According to a 1997 Harvard University study, approximately 17 million Americans suffer from this phobia. It affects about one to two million Americans so significantly that it impairs their lives and forces them to seek treatment, says Steve Soifer, M.S.W., Ph.D., associate professor of social work at the University of Maryland at Baltimore. Soifer, who is also president of the International Paruresis Association, a nonprofit organization located in Baltimore, Maryland, explains that in people who suffer from paruresis, the body senses the public restroom as an unsafe place. Adrenaline starts pumping as it would in a "fight or flight" situation. The result is that the part of the body that controls urination (the parasympathetic nervous system) is temporarily inhibited or suppressed. Scott, a 25-year old marketing exec from San Diego, is a member of the pee-shy brigade. "It can be really embarrassing," he explains, "I've been out at dance clubs with friends where I had to leave because I couldn't pee in the noisy, crowded restroom. It's not as if I can just tell them the truth: Hey, I have to go find a more private place to pee."

What's the Cause?

The exact cause of paruresis varies, but approximately fifty percent of paruretics can cite an incident, usually one that took place when they were much younger, in which someone made a negative remark or hurried them in the restroom. For example, a parent may have said, "Hurry up and go now, or you'll have to hold it in until we get to Grandma's house." For someone with a predisposition to paruresis, this type of offhand remark can trigger the condition. The other half of paruretics can't remember a specific incident, but nevertheless developed the phobia. Some shy bladders are more social than others. The severity of symptoms is measured on a scale from one to ten. Someone at level one may have experienced only one incidence of paruresis, whereas someone at level ten has such severe symptoms that they may be agoraphobic and unable to leave their home for fear of having to use a public restroom. Most paruretics fall somewhere in the middle of the spectrum. Among individuals seeking help from the International Paruresis Association, men outnumber women by a nine-to-one ratio. Women's restrooms, featuring several enclosed stalls rather than a row of urinals, tend to offer more privacy than men's rooms. This design feature may explain the IPA's numbers by suggesting that women seem to be able to cope better with public urination.

Dealing With It

Whether you're an employee of a large company, a college student living in a dorm, or simply a concert-goer who needs to take a leak at intermission, public restrooms are a fact of modern life. The best way to deal with paruresis is to gradually become desensitized to public restrooms. As Soifer points out, "Each person has an idiosyncratic hierarchy from what's easy to what's difficult." To get over being "pee shy," begin by constructing a list of places in which it is easy or difficult for you to relieve yourself. A sample list might look like this: "Easy: at home. Moderately difficult: at work, at a friend's house. Very difficult: restaurants, the gym, movie theaters."

Once, you've made your list, the goal is to gradually desensitize yourself to each setting. Start with the easiest place. Go there when there's low traffic (in the "off peak" hours). Next, try the same setting a high traffic time. Improve your tolerance by gradually working your way up to the point that you can go even when a restroom is crowded. You may want to get a friend to tag along to help make the place feel safer for you and to provide a friendly face. Eventually, you will build up a comfort level and be able to pee under any circumstances.

You Are Not Alone

If you're pee shy, remember you're not the only one. The problem is more common than people think. Chances are someone you know also suffers from this phobia.