As many as 1 to 2 million Americans can't urinate at all if there is someone else in the restroom. These people, mostly men, suffer from an anxiety disorder known as "avoidance paruresis" (sometimes called shy bladder, bashful bladder, or bladder shyness). By some estimates, 15 million more "low level paruretics" have some difficulty urinating when there is someone else at the next urinal or in the next stall.
Anxiety often causes muscle tension and makes it difficult to relax muscles. In order to pee you need to relax a set of sphincter muscles. When you were toilet trained you learned to keep these muscle in a tense state unless you wanted to urinate. The self-conscious feelings elicited in some people when others are present seem to interfere with the ability to relax the sphincters.
For this larger group of people the problem is a mild inconvenience. For men, heading to a stall rather than a urinal is all that is needed. Persons with the more severe form of paruresis find that it gets in the way in their lives. Some paruretics carry "cath kits" so that they can catheterize themselves when needed. Others seek psychotherapy or hypnosis to help them solve the problem.
In vivo desensitization is one behavioral treatment that is often used. It involves using a "pee buddy" who is present when you need to urinate. This person may start out in the next room with the door open. As it becomes easier to start a flow of urine then the person gradually positions themselves closer and closer. Relaxation techniques are often used in conjunction with this approach.
What should you do if you have this problem? Try to keep it in perspective. Most people have a mild problem that is only an inconvenience. Men should try using a stall rather than a urinal. Flushing may help you start your urine stream. A reader responded on the forum to suggest that doing math problems in your head can help - possibly by distracting you from the situation. Consider psychotherapy or hypnosis, or see a urologist if the problem is so severe that you want to consider radical options such as self-catheterization.
Last updated 12/15/05