It is difficult and sometimes impossible for people suffering from paruresis to urinate in public toilet facilities. Almost 3 percent of all men are affected, but they rarely consult a specialist because the problem is taboo. This is unfortunate in that there are effective methods to combat paruresis.


What is paruresis?

Paruresis is a psychological micturition disorder. Urination is colloquially referred to as “urination”. Affected people have inhibitions about emptying their bladder in public toilets. They either need a certain amount of time to get there or they have to forego relief and leave the toilet again. See foodanddrinkjournal for Common Bile Duct Cyst Dictionary Definitions.

The inhibition is evoked in particular by the presence of other men. Different gradations and degrees of severity can be observed in what is also called shy bladder. Some of the affected men prefer to go to a cubicle rather than a urinal because they are hidden from the possible view of other toilet users.

Some can relax better while sitting. In severe cases, these measures no longer help and urination is only possible at home. The result is a massive reduction in quality of life.


The cause lies in a formative situation that those affected experienced – mostly during puberty – and in which they felt fear, shame and stress. They felt like they were being watched while urinating or were laughed at because they couldn’t urinate right away.

This experience can contribute to the development of so-called “anticipation anxiety”: the fear of “failing” again the next time you visit a public toilet facility. This sets in motion a cycle that can hardly be corrected. In addition, it happens that psychological stress without a triggering experience can cause the problem.

Unable to relax and bladder emptying is blocked. The inner and outer sphincters close the urethra in men and usually ensure that the bladder does not empty against the will. When going to the toilet, however, nervousness and stress can prevent the sphincter muscles from relaxing and thus preventing the bladder from emptying.

Symptoms, Ailments & Signs

About a third of all men occasionally experience the problem of not being able to urinate, but those who suffer from paruresis suffer more than once: in situations in which they absolutely have to urinate (before boarding a long flight, during a bus ride), it is particularly difficult for them.

The severe physical discomfort is accompanied by mental irritation. To make matters worse, other people cannot understand the problem and smile at it. Those affected feel misunderstood and have the feeling that something is wrong with them. This increases the tension.

Those people who have a penchant for perfectionism and self-observation often suffer from paruresis. They also attach great importance to what other people think of them, but this quickly makes them feel like they are being watched. And the feeling of being watched plays a crucial role with the shy bubble.

Diagnosis & course of disease

In order to make a diagnosis, it is first necessary for a specialist to rule out possible physical causes (enlarged prostate, narrowing of the urethra). Various psychotropic drugs can also be responsible for urinary retention.

The taboo surrounding the disease usually also characterizes its course: those affected try to hide it from others, come to terms with it and integrate it into their lives. They show a pronounced avoidance behavior that makes their work, their free time and their relationships more difficult. Difficulties often lead to social withdrawal and depression.


Paruresis in various forms is actually not that rare and is usually not a serious illness. It is also not the effects of urinary behavior in public toilets that lead to complications. Because the urinary behavior of the shy bladder only affects public toilets, where the person concerned feels watched by others. At home, emptying the bladder works without any problems.

The problem with paruresis, however, can be the effect on the psychological development of those affected. Paruresis usually develops during puberty, when male adolescents attach particular importance to the body and male behavior. Paruresis can be triggered by trauma. Or it is the fear of not being able to pee standing up in front of others, which is considered male behavior, and therefore of being mocked.

The male youth affected by paruresis avoids using public toilets because of this fear, because he thinks that the others judge him as unmanly or even abnormal. This often develops into a dangerous inferiority complex that can overshadow your entire life. In severe cases, the affected person is completely socially isolated just to be able to go to the toilet at home. If left untreated, the long-term consequences can be depression or even the risk of suicide.

When should you go to the doctor?

People who are very afraid of using public toilets should discuss this problem with a psychologist or psychotherapist. If paruresis is present, treatment is generally recommended, because the phobia can have a negative impact on the quality of life, for example if the person concerned is unable to go to the toilet on an airplane or bus. A doctor’s visit is necessary if the avoidance behavior leads to noticeable limitations in everyday life.

Anyone who is looking for a job near their own home because of their phobia or avoids long journeys may have paruresis that requires treatment. People who suffer from the fears described should first consult their family doctor. He can make an initial suspected diagnosis and, if necessary, consult a specialist. The suffering is processed within the framework of behavioral or talk therapy and can thus be treated effectively. In the case of severe phobias, inpatient treatment in a specialist center for anxiety disorders is necessary.

Treatment & Therapy

Avoidance behavior is a clear sign of the disease and this is where treatment comes in. As part of behavioral therapy, those affected face the stressful and frightening situations under the guidance of an expert.

Attempts are made to gradually increase the degree of difficulty: At the beginning there is a visit to an empty public toilet and urination while sitting in a cubicle, the end of a successful therapy consists of urinating at the urinal in a busy public toilet. The goal is to eliminate the fear of failure and to mature the awareness that it doesn’t matter what other toilet visitors (possibly) think.

Another remedy that is often used to accompany behavioral therapy is relaxation exercises, which can also be carried out at home. These include progressive muscle relaxation according to Edmund Jacobson or pelvic floor training according to Arnold H. Kegel.

These help to train and specifically use the contraction and relaxation of the sphincter muscles involved in emptying the bladder. The chances of success of a treatment are very good and should encourage those affected to overcome their shame and confide in a specialist.

Outlook & Forecast

In principle, paruresis can be cured. For a good prognosis, the mental disorder should be treated in the initial phase. The more severe the symptoms are and the longer the illness has existed, the longer the recovery process usually takes. Without therapy, those affected rarely recover. Rather, an increase in the feeling of anxiety is to be expected and other mental disorders can develop. The prognosis is worse in these cases because the development of anxiety or phobic behaviors can spread to other areas.

The symptoms are only alleviated if the person concerned cooperates. Otherwise doctors and therapists can only achieve limited success. An improvement in the health situation is achieved by initiating changes through behavioral training and cognitive work. In most cases, it is not necessary to investigate the cause. Rather, the focus of treatment is on learning how to urinate in public facilities. At the same time, the general feeling of anxiety and the resulting physical discomfort are gradually reduced.

For a successful prognosis, a quick start of therapy and the willingness to alleviate the symptoms require sufficient patience. Improvements are often seen after a few weeks or months. However, some patients require years to achieve freedom from symptoms.


Since in most cases a traumatic event has triggered the paruresis, prevention is difficult. The widespread belief that a man is only a “real” man if he empties his bladder standing up increases the level of suffering. Stereotypes like these lead to uncertainty and danger to unstable people who are concerned about the opinions of their fellow human beings. The best prevention is to develop more self-confidence and not to take seriously the opinions that are circulating about what a “real” man should be able to do.


In most cases, those affected with paruresis have very few or only limited measures or options for aftercare. Therefore, the person affected by this disease should consult a doctor very early on, so that complications or other symptoms do not occur later on. The sooner a doctor is consulted, the better the further course of the disease.

A doctor should therefore be consulted as soon as the first signs and symptoms appear. Paruresis can be alleviated by various therapies and relaxation exercises. However, a complete cure cannot always be achieved, so that those affected have to continue to avoid public toilets throughout their lives.

In many cases, the support and help of one’s own family is very important to alleviate the symptoms. Further follow-up measures are therefore not available to those affected by paruresis. However, the disease has no particular impact on the health of those affected, so that paruresis does not reduce the life expectancy of those affected. The person concerned can also try to urinate in public toilets to counteract the feeling of shame.

You can do that yourself

A parureris always requires behavioral therapy. Together with a therapist, those affected have to learn how to use public toilets without feeling the typical fears. This is achieved through step-by-step approach. For example, the patients first visit an empty public toilet before finally going to a more frequented toilet and slowly getting used to urinating there. The aim of this therapy is to eliminate any fear of failure.

Relaxation exercises can be used to accompany the therapy. These can be carried out under the supervision of a therapist or alone at home. Proven methods include progressive muscle relaxation or pelvic floor training. Both methods make it easier to empty the bladder and make those affected calmer and more relaxed overall.

If therapy is not possible, for example because the patient is suffering from severe paruresis, which may even be the result of severe trauma, public toilets must be avoided. The most important measure is prevention. Before long journeys by public transport, you should ensure that you do not have an urge to urinate during the journey. When in doubt, those affected must wear adult diapers or take steps to avoid lengthy journeys without access to a private toilet altogether.