And is there treatment for paruresis?
Many people can have difficulty going when in a bathroom if other people are nearby. This is not uncommon. However paruresis, also known as shy bladder syndrome, is when shyness, embarrassment, or fear of being judged for not being able to urinate develops into a phobia or irrational fear.
There can be a spectrum of what is ok or not ok. One guy is ok when there are empty spaces and there are large dividers between the urinals, but if there are no dividers or someone is right next to him than he can’t go. Or a guy can go if they use a closed stall and don’t consider this as a problem. At the other extreme a person can only go when they are at home and no one else is in the house, or if they use a catheter. I have known people that resorted to using a catheter during a long airplane trip, as there was no other way that they could take a 14-hour flight without intense discomfort and pain.
Why do people develop paruresis?
Why does someone have this? Good question! Certainly there is sensitivity, and a heightened awareness of one’s surroundings. Keep in mind that virtually no one can go when their body has shifted into the fight or flight mode. This is part of the biological design of mammals. When we are running away from a tiger the last thing we are going to do is stop and take a leak, we are just going to keep running like mad. Or we may freeze and every non-vital function is going to be put on hold as long as we are gripped by fear. This includes digestion, rational thought processes, and also the sphincters that are related to urination are going to close up. And for a person with paruresis, absolutely nothing they think or will to happen in that moment will loosen those sphincters! Not until the fear passes and they can relax again.
I find the main issues about shy bladder to one or a combination of the following:
- Visual, being seen going to the bathroom. If there is a stall without large gaps in the structure, or a urinal with large divisions between the basins, they are usually ok to go in public.
- Auditory, this is more about being heard than seen. Often the standard pubic washroom design makes going impossible. In Japan, they play music in bathrooms, or the toilets make noise to mask the sounds of going to the bathroom.
- Proximity, this is about how close the other person is. It can be ok if they are five urinals away, but not two. Or if they are eight stalls away or across the hallway, but not right next to you. It can also be that they are only able to go if there is no one inside the same building or house.
- Delay, this is about how long it takes to start going. If it seems that someone else is listening or can hear and is therefore judging the person about how long it is taking them to go to the bathroom, this can start anxiety. Once the anxiety is triggered it can be impossible to start.
- Knowing that someone is waiting can also be an issue. Even if that person is outside of the washroom, just knowing they are waiting is the issue.
- Some people have a germ phobia, so this is more about the uncleanliness of a public washroom rather than paruresis.
Stigma and shame
Unfortunately being teased or laughed at for this particular phobia is common. And usually people either think that they are the only person on the planet who has this thing, and that everyone else can go easily whenever they need to. Some will think, “Am I crazy. I don’t understand this.” Or they are too ashamed to ask for help and to reach out to friends or professional support. The result is that people with paruresis are often very isolated and don’t seek help. Then the phobia can easily become the center of their life.
My own story with paruresis
Part of the path to cure is knowing what we are feeling anxious or fearful about. For me it was the amount of time, I couldn’t just sit down on a toilet seat and start to go. I finally realized my main issue was the delay. I felt embarrassed about how long it was taking me, especially with people waiting to use the bathroom. I was convinced other people were keeping track and that they could notice my hesitation. That combined with my usual anxiety, and my issues I found through homeopathy of vulnerability, safety and performance, and I started to take longer and longer to be able to go. And eventually I completely blocked.
So in less than six months after moving to a large city, where bathrooms are always filled with people, I went from being a bit shy about going in front of others to only being able to go if I was alone at home with the door closed. It happened so fast, and led to a closing in of my life. I became very isolated in many ways and I also felt ashamed and at fault for what had happened. I was so completely unaware that other people also have this problem at first. I mean really, who can’t go to the bathroom! We all need to go, every day, several times a day, and no one talks seriously about not being able to go, they just laugh at the idea.
Social life and isolation
You can see how much this might affect a person’s life in terms of relationships, friendships, socializing, work, and career. There is a preoccupation with what you drink, especially before you leave the house, with where you are, and what options are available for using a bathroom. Every day is taken up with these kinds of thoughts. You change your habits and social behavior in order to compensate. It is no longer easy to plan on going to a friend’s house, a party, or the theatre. The longer it goes on, the more the person can forget how it was before they were phobic and not realize how much the phobia is affecting their life and their choices. After time a person is a person controlled by his or her own fear and shame rather than being able to be spontaneous and social.
What I did to get better?
Since it happened so fast I realized I could not live like that, being unable to go out without extreme anxiety and discomfort. I stubbornly reached out for anything that might help me. Once I found the definition for paruresis online and realized that this was a thing that could happen to people, around 7% of the population, I could at least say to myself that this was a real thing. At that time there was not much online about it. I found the International Paruresis Association in the United States and this encouraged me to start and lead a support group in my city.
I wrote emails to people with shy bladder, I read books, I did the graduated exposure therapy practice in the malls, I went to Baltimore for a workshop for women, I saw a cognitive behavioral therapist, I helped host workshops in my city, whatever I could do I was going to do it to get better. And it helped; I went from a nine to around a five or four in a couple of years. The biggest piece was understanding the cycle of anxiety and how to stop it, and that no matter what I do, I will tend to have a delay before I can go. So if I could sit in the delay and avoid the anxiety, all was well.
Homeopathy and phobias
I started studying homeopathy and got my degrees, and through that process my facilitators and instructors treated me. After several core remedies and exploring the symbols related to safety, vulnerability and performance, I was much less triggered and anxious in general. One day I noticed that I was no longer phobic about going to the bathroom anymore. This is not to say that who I am completely changed, sometimes there are situations where I don’t want to go or can’t go. So, as I was before the phobia, I am still a bit shy. However, I don’t feel anxious or uncomfortable anymore.
Needless to say my work life, social life and relationships have all changed immensely for the better. My day is never overshadowed by worry and concern for what may happen, or where I will be, or what I might have to say to avoid discomfort or embarrassment. With homeopathy my perceptions changed in many aspects and now that I don’t feel worried or ashamed and my shyness never escalates back into a phobic condition. I feel I have gone from a 5 down to a 1. And as I mentioned above, lots of people are shy about using bathrooms, they just aren’t phobic about it.
How homeopathy is different?
Homeopathy is based on the principles of individualization, minimum dose and like cures like, and it uses a truly holistic approach. The aim of homeopathy is not to treat phobia, or shy bladder, or any disease diagnosis, but to explore the root source of symptoms and individual susceptibilities. Homeopaths don’t separate the mind and the body into various parts and systems that are treated independently of each other. They see that all aspects of any person are dynamically interconnected and directly influence each other. Liver, nervous system, anger, ego, soul, any symptoms the person focuses on are considered during a homeopathic session.
It is always great to start early as well. As a child I was terrified of the dark, timid, shy, and in my early teens developed epilepsy. These can all be treated in children simply with homeopathy. I had to wait until my 30s to find homeopathy and this after having years of living with anxiety, depression, and the shy bladder phobia for a short time. For an adult, symptoms usually get more complex, we have compensated, suppressed, denied our experiences, been further traumatized, and gotten further and further away from our true self. And by this I mean the inner self that is not our personality, or ego, or our social mask. This is one of the best parts of homeopathy, it brings us back in touch with this inner self, and it reminds us of who we really are, of what our purpose is. After all, this is the key question all spiritual paths eventually ask of us, “Who Am I.”
What is the expected process?
The most common response to a well individuated remedy is a nearly immediate reduction of anxiety. We can start to feel whole, the root of the anxiety is addressed and we are able to start the healing process. Healing is not that different than being able to go to the bathroom, we can’t heal when we never relax and we are anxious all the time! The rest of the process may take time, depending on each individual person, there is no way to know in advance. However, as the response to a core remedy is global, the results can be wide reaching and often unexpected! And no matter how challenging the process, it is certainly worth the investment if we can regain our life and joy of living.
Listen to my interview about paruresis and phobias with NotBroken Radio, April 17, 2017.