Shy Bladder (Paruresis): Symptoms, Tricks, and Treatment

Shy bladder syndrome or paruresis is a social phobia. Essentially, it is an inability to urinate when others are nearby or when potential scrutiny might occur. 

Some psychiatrists also consider it an anxiety disorder. It can be a minor annoyance. But for others, it can have life-altering consequences and greatly affect a person’s quality of life.  

What is Paruresis?

As a syndrome, shy bladder or paruresis does not have any specific causes or symptoms that define it as a disease.

Instead, it is a collection of symptoms occurring together by several otherwise healthy people. Thus, its definition is a syndrome rather than a disease.

Syndromes are when no specific physical deficiencies are present to define the condition as a disease.

Some examples are; fibromyalgia syndrome, chronic fatigue syndrome. 

While it is not specifically a physical disorder, it can be pretty discomforting and embarrassing to its sufferers. Paruresis is one of the most common types of social phobia.

Symptoms of Paruresis

A person with paruresis may find it difficult or impossible to urinate when other people are present.

Signs and symptoms of paruresis typically include:

  • A need for complete privacy when trying to urinate.
  • Embarrassment at the thought of others hearing the urine stream.
  • Fear of others detecting a urine smell.
  • Inability to urinate in public toilets. 
  • Inability to urinate because someone is waiting outside to use the toilet. 
  • Restricting liquid intake to reduce the need for urination.
  • Avoiding travel or social events. 

In severe cases, many of these symptoms may be present. The sufferer may also tend to alter behavior to accommodate the condition. 

Causes of Shy Bladder Syndrome

There are no specific causes of shy bladder syndrome.

Like other phobias, it may link to an emotional episode during childhood, or it may have no apparent reason. 

Emotions like anxiety and fear often link with it. However, it may not be possible for a professional to connect it to a specific incident or factor.

Some known factors that correlate with it include:

  • A general predisposition to anxiety or panic attacks.
  • Environmental factors, such as a history of being embarrassed by others in relation to using the restroom.
  • Physical characteristics, including a history of medical conditions that may affect the ability to urinate.

While doctors do not consider shy bladder a mental illness, it does indicate a mental health condition that deserves support and treatment.

Shy bladder is much more common in men than women. Specific triggers that cause it are numerous and often unique for each individual. Each case is different and triggered by items that may be very personal to the individual. 

Generally, most triggers are related to a perceived lack of privacy. This is especially true in public restrooms that rarely offer much privacy, especially men′s bathrooms.

For example, most public facilities for women provide individual stalls, but public men′s restrooms often provide only partial privacy walls. 

Even when there is a guarantee of privacy, such as a home setting, individuals within hearing distance may predispose the sufferer to be unable to urinate. Simply hearing other voices close by is, for some, a trigger that will prevent urination. 

There are a few other medical conditions that may cause an inability to urinate. Chief among these are prostate problems for older men, prostatitis, and benign prostate hyperplasia (BPH). Plus prostate cancer, for example, can make urination difficult.

Treatment and Tricks for Overcoming Paruresis

As with many other conditions, paruresis has support groups for sufferers.

Conventional medical practitioners do not have any specialized treatment, but it may be helpful to see a psychologist.

Practitioners that treat the condition often use:

  • Strategies to help reduce anxiety.
  • Cognitive-behavioral therapy to help change thoughts and behavior.
  • Graduated Exposure therapy – a step-by-step program that involves deliberately trying to urinate in increasingly more difficult places. According to current research, graduated exposure therapy is relatively successful, especially with highly motivated patients.


Severe paruresis can affect a person’s life in many ways. For example, a person who can successfully urinate only at home alone may avoid social contact, especially when restroom use may be necessary. This deliberate limiting of social contact can reduce the quality of life. 

Also, urinary retention can be introduced if a person deliberately postpones bladder emptying over extended periods. Such urinary retention can lead to severe kidney disorders.

It is time to seek professional intervention if or when the issue substantially impacts the quality of life. Psychological treatment, especially graduated exposure therapy, can significantly impact and reduce the discomfort and embarrassment of the situation. 

Therapy often seeks out the source of a phobia. For some people, an embarrassing incident starts it. Then, thoughts and reliving the embarrassing incident adds to the anxiety felt about urinating in the presence of others.

While someone struggling with shy bladder syndrome may be unable to urinate in a public restroom when others are nearby, they may be able to urinate successfully in other circumstances.

Others may struggle only when they are in busy places. Thus, for some, this issue is relatively minor, whereas, for others, it is life-altering.

People that need psychological help may not even be able to urinate in a locked cubical in a public toilet.

However, needing complete privacy to urinate is an indicator of severe paruresis and a major disruption to a person′s life, and that person should seek professional intervention.

While there are no approved medical drugs or interventions to treat the condition, talking therapy combined with graduated exposure therapy may help considerably. 

Next Up

stress and anxiety

Next, find out 15 Simple Ways To Relieve Stress And Anxiety.


  1. Hammelstein P, Soifer S. Is “shy bladder syndrome” (paruresis) correctly classified as social phobia? J Anxiety Disord. 2006.
  2. Soifer S, Himle J, Walsh K. Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach. Soc Work Health Care. 2010.

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