Shy bladder syndrome can be debilitating

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Dear doctors, would you please devote a section to shy bladder syndrome? This embarrassing condition is a significant drawback for many men. In severe cases, it is a life-changing disability. I suspect there are more sick people than you imagine, but shame silences them.

Dear Reader, Shy Bladder Syndrome is a social anxiety disorder that makes it difficult or impossible for an individual to urinate in the presence of someone else. The medical term is paruresis. Taken from ancient Greek, the word has its roots in the words “para,” which indicates something atypical or abnormal, and “uresis,” which refers to the act of emptying the bladder. The term was coined in 1952 by two doctors, who first described the condition in an article they published in the Journal of General Psychology.

Shy bladder syndrome is a common form of social anxiety, and is thought to be second only to fear of public speaking in terms of human apprehensions. The exact number of people it affects is not known, but studies suggest that up to a quarter of the population have experienced it to some degree. It is seen more often in men, which has been attributed to the public nature of male urinals. However, the disease occurs in people of all sexes and all ages, including children and adolescents.

When a person has shy bladder syndrome, they avoid using toilets other than those in their own home. The possibility that someone else might enter the bathroom, or even hear them using the toilet, can trigger the condition.

Voluntary urination involves neurons located in a small region of the brainstem known as Barrington’s nucleus. They send signals via the spinal cord to the urinary sphincter, which is the muscular ring that controls the flow of urine from the bladder. When someone chooses to urinate, these nerve impulses tell the sphincter to relax.

When someone has shy bladder syndrome, something disrupts this message cascade. The result is that the person’s sphincter does not relax and they are unable to urinate. It’s easy to dismiss this as a minor annoyance. But for those living with the disorder, it can range from embarrassing to disruptive and, in some cases, downright dangerous. Not being able to use public restrooms can interfere with activities of daily living, including work, social interactions, relationships, and travel. A routine urinalysis during a medical appointment or for employment purposes becomes an ordeal. People with severe paruresis often limit their alcohol intake to avoid having to go to the bathroom.

Not emptying the bladder when needed can lead to health complications, including urinary tract infections. It can also damage the muscles of the bladder, which ironically can lead to urinary incontinence. The good news is that the condition can be treated. This includes the use of relaxation techniques to reduce anxiety, psychotherapy, anti-anxiety medications, and cognitive behavioral therapy. A systematic program of desensitization known as graded exposure therapy has proven particularly helpful. In order to rule out a medical cause for difficulty urinating, it is important to see a doctor for a definitive diagnosis.

Eve Glazier, MD, MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, MD, is an internist and assistant professor of medicine at UCLA Health. Send questions to [email protected], or write to: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Due to volume of mail , no personal answer can be given.


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