Some women and men find it difficult to urinate in the presence of other men. They cannot urinate in a public toilet if anyone else is there. The muscles that control urination tighten up, stopping the flow. This is called ‘parauresis’ (pronounced par-YOU-ree-sis) or ‘bashful bladder syndrome’. According to doctors in the armed forces – who know about servicemen living in open barracks – it is quite common and possibly 1 in 10 men is affected. It can be distressing, because it can limit your activities if you are unable to urinate away from home. And some people worry that others might assume they are gay because they are spending so long at the urinal. One study found that 60% of men with bashful bladder felt ashamed, and most tried to conceal the problem; 25% had not told their partners, 44.4% had not told their families and 58.7% concealed it from their friends (Actas Urológicas Españolas 2007;31:328–337). Hiding the problem can itself be a source of stress, particularly if you are in a close relationship.
What Causes ‘Bashful Bladder’?
There is nothing physically wrong. It does not mean that there is anything amiss with your bladder or urethra. No one knows what causes it, but it seems to be an exaggeration of something that most men experience slightly. Research has shown that when a stranger is nearby, most men take slightly longer to start their urine flow, and pass urine for a shorter length of time.
A doctor writing in the medical journal the Lancet (1999;354:P78) has a suggestion about the cause of bashful bladder. He points out that many male mammals mark their territory by urinating to leave their scent. He wonders if modern men with the problem are subconsciously thinking ‘If I urinate in this other male’s presence, I am asserting my supremacy over his territory – am I really ready to challenge this male to a fight’, and this prevents them from urinating. Of course, this is just speculation!
What You Can Do
- Try doing a series of mathematical calculations in your head. This activates the cortex of the brain and blocks the inhibiting impulses to the bladder. A report in the Lancet as long ago as 1981 suggested this as an effective remedy.
- Breathe in deeply and tighten your pelvic muscles, as if you are pulling your anus (back passage) inwards. Then relax and breathe out. Repeat until you start to pass some urine.
- Check the website of the International Paruresis Association for information about anxiety-reducing techniques and ways of gradually getting used to passing urine when others are nearby.
If it is really affecting your life, you could get help from a behaviour therapist, who would help you with some of these techniques.
First published on: embarrassingproblems.com
Reviewed and edited by: Dr Diane Newman
Last updated: October 2020