Talk:Paruresis

Role of unfamiliar and or surprising sounds
This leads me to believe that if you know you have a test coming or may be tested, you could try ear plugs + running water if possible to both take out the unfamiliar auditory stimulus and insert some familiar stimulus (the running water).

Perhaps also effective is to try mentally image yourself using the toilet in your home or some other familiar facility, though this will likely require some practise. Or like was suggested below, do something else that will take the focus of mind away from the testing situation. However for long term "therapy" more effective might be simple practise of expanding the comfort zone by, say, going first to variety of quiet public toilets and slowly moving to some more crowded situations.

I also read about the breath technique here: http://www.paruresis.org/FAQ/faq_page_23.htm

I haven't actually tried it as they describe but it's sort of obvious that if going into very smelly public toilet I wouldn't be able to use the mental image technique I mentioned without also avoiding smelling the surroundings too much. For this I tend to cover nose with the shirt as it helps filter most of the environmental smell. —Preceding unsigned comment added by 213.243.182.67 (talk) 00:49, 4 July 2010 (UTC)


 * I know this was a LONG time ago now, but it's nothing to do with the smell... But just wanted to add that in, just in case anyone else happens to look at this talk page and gets confused. It's to do with the carbon dioxide levels in your blood, a physiological reaction. And using imagery, earplugs, sound effects/music etc can help some sufferers, but not all. It all depends on severity, situations etc. 80.1.144.137 (talk) 23:49, 15 December 2016 (UTC)

Unsorted discussion
According to some studies, 7% of the population may be suffering from it.

Can we have a source for that figure? Mr. Jones 17:20, 25 Jun 2004 (UTC)
 * The 7% figure is probably from http://www.paruresis.org/ --Ben Brockert 22:07, Jun 25, 2004 (UTC)

The 7% comes from a study undertaken in 1997. Kessler,R.C., M.B.Stein, and P.Bergland. Social Phobia Sub-types in the National Co-Morbidity Study. Boston: Department of Health Care Policy, Harvard Medical School. Other similar studies, and anecdotal evidence from urine specimen collection officers working in the military, suggest these figures could be an understatement.
 * I have only ever heard of this in relation to men. Can anyone back that up? If so, it should definitely be mentioned that this mainly effects males. Mak emi 05:07, 18 February 2006 (UTC)

This affects both men and women. However, the level of privacy in womens toilets tends to be greater than in mens, and it is thought that this is why fewer women have trouble with it. Another way of looking at it is that there are some men who cannot use urinals but can use cubicles. Women with the same level of paruresis don't have to use urinals, and have no trouble with cubicles. So there is a percentage of men who have a problem, but the corresponding women have no problem.
 * Ok, thanks, someone has already clarified this within the article. Mak emi 00:23, 7 March 2006 (UTC)

The paragraph under the "Context and Urine Samples" heading that reads, "There is growing evidence to suggest that some drug testing authorities find paruresis a nuisance, and some implement 'shy bladder procedures' which pay no more than lip service to the condition, and where there is no evidence that they have conducted any real research into the matter." may be a little short on neutrality, but I'm not inclined to make the correction myself without others in the discussion having a chance to weigh in on this. Is it possible that this is a quote or paraphrase that should be attributed to someone? — Preceding unsigned comment added by Ki4amd (talk • contribs) 14:47, 7 June 2011 (UTC)

Suggestions
I would like to see a reference to the claim that it's likely that most people were eliminated from competitive sport before they get to the Olympics. Given that it's a psyhological condition, it seems possible a number of sufferers involved in sports are able to overcome the condition given the demands that are placed on them (either by themselves or with help). I haven't read up much about it but from the treatments listed in wiki and general reasoning it sounds to me likely something which in many case will probably be treated in by the proper conditioning and 'learning'. I don't see any reason to assume most suffers drop out of competitive sport rather than overcome the condition. I also wonder whether many of those who aren't able to overcome it, might suffer the condition to quite a bad extent and it would seem likely this problem/condition might lead to wider social issues which will disinterest them in sport.

Also the way it's phrased now suggests that that anti doping is the primary problem for sufferers. Presumuably, sufferers may aslo be severely disadvantaged as sportspeople because the inability to urinate is likely to severely affect your training and ability to compete. (During training and competition, facilities which are not that private will presmuably be used a lot, if you can't urinate, your training and competing is likely to be affected).

Furthermore, I wonder whether this conditions could be frequently linked with more general shyness and uncomfortableness around crowds. Presuambly, in many sports these will be a hinderance to training as they may make you feel uncomfortable around and when being touched by the physiotherapists and coaches and will also severely affect your success in competitions (if you can't perform properly in the presence of crowds, how the heck do you compete as a sports person)...

I'm also skeptical about the WADA-Olympic link. AFAIK, WADA coordinate anti-doping testing in quite a number of competitions outside the Olympics and help other countries anti-doping agencies. Presmuably then, it seems easily possible they will receive reports from lower levels of competitive sport.

Finally, perhaps we should elaborate on the WADA urine sample collection procedures a bit more. A search suggests that you basically have to urinate in front of the people collecting the sample. Also, according to the discussion here you don't have to provide it on the spot, you are allowed to provide it later (while this won't necessarily help all people with the condition it should be mentioned since it means it's not an on the spot or you lose thing). A bit more detail on this is needed

Nil Einne 21:15, 19 March 2006 (UTC)

Response: there is a spectrum of severity of paruresis, and it is well known that there are people who have no trouble with using toilets or locker rooms on a day-to-day basis, but who do find it impossible to comply with an observed urine sample demand. The issue is that WADA say they are aware of paruresis, but that they do not cater for it - citing the fact that they have never had any reports of problems with it.

This seemingly mirrors what appears to be happening with workplace testing. Employers with an open policy of observed sample urine testing do not seem to have widespread problems with paruretic job applicants. But if they extend testing to existing employees where there was no testing previously, they do have trouble. The suspicion is that sufferers do not apply for jobs where they know that observed testing will take place, so you don't have the problem. But if you extend testing to areas where it did not previously apply, you start "uncovering" sufferers.

The suspicion is that sufferers avoid indulging in activities where they know they will be tested in this way, and that this applies to a range of areas of life, including sports.


 * This is interesting, but a "suspicion" is an awkward thing to have in an encylopedia. So it's something that the author of the article suspects?  Does anyone else suspect it?  The article would be improved if there were a source for this.  If this were a hypothesis put forward by the IPA, for example, instead of a suspicion by who-knows-who, that would be better.

Response:

I think that "inference" would be a better word to use than "suspicion". In any event, that part of the article has been re-phrased to remove the word "suspicion".

Clean Up, September 22nd, 2006
I have re-arranged the paragraphs, and put them under headings. Some of the statements made are supported by infomration on the IPA and UKPT sites, but were not linked to, so I have put as many in as I could find. Hopefully, all of the issues discussed above which were outstanding have now been addressed. A citation is provided re UK jury duty, so the paragraph here requesting that has been removed.

Effect of surplus water consumption
Just what will happen if a person with this drinks five glasses of water and is then told to urinate for a drug test after about half an hour? Will this condition still hold true? If yes, can it be risky for the person to subconsciously just hold it for long? If no, it would seem this condition is not as important as it is made out to be. --Amit 10:03, 13 October 2006 (UTC)


 * Regardless of how much liquid is ingested, paruresis will still hold a significant bearing on one's ability to urinate. I speak from personal experience.  I've had two physicals in my life, and both times I did just that about an hour before I left.  I felt the urge to urinate, but failed to produce a sample when asked to, and the physician eventually just gave up and let me take a container home to produce a sample and bring back. —The preceding unsigned comment was added by 71.75.73.93 (talk • contribs) 14:16, 15 October 2006.

The pressure of an overfull bladder in some people can of itself cause an inability to urinate - even if the person does not have paruresis. Therefore the assumption that given a full enough bladder, the person can urinate come what may is invalid, and in some people internal organ damage could be caused. This is why many drug testing regimes no longer insist of the subject drinking water - and some impose a limit on how much may be drunk voluntarily. It would appear that someone cannot prove they cannot urinate and claim damages, but they can prove they were told to drink water which then injured them. Which sums up what is really going on.

My personal experience was when I was 21 (it was transient problem from about 20 to 25). I didn't even know I had it until I went to a bar that had a very busy public trough-style urinal. I could not go in the trough. No matter what. It was extremely painful and I thought I had a kidney stone or something. My body would tell me to go but when I got to the trough, I couldn't release it and the feeling would pass until I left the trough. I ended up going in an alley because it hurt so bad (waht wrong with a subconscious that won't let you pee in a urinal but doesn't mind peeing in an alley). It was very strange to come across a subconscious psychlogical impediment that I had never experienced before. It has since passed but for about 5 to 10 years I couldn't use the shared urinals. DOn't know why it started or why it stopped, it just did. It wasn;t a conscious fear at all. I would go up to the public trough, pull it out and I just couldn't pee. There was no avoidance of public urinals or anything but it just didn't work. A private stall or urinal was fine. Just my 0.02. It wasn't auditory or anything as the article seems to allude to. And then it jsut seemd to go away.


 * I've also personal experience with the failure of the "overfilling" method. It just leads to more discomfort.  I do have one central question about the article/phenomenon altogether, however: what is the benefit of sharing the experience of urination with others?  Since paruresis is considered a sort of handicap, it follows that there is derived benefit from sharing the experience of urination with strangers.  What is the benefit?  I speak not of emergency situations like military bivouacs, but everyday life.  I regard the whole attitude as a bit of an imposition.24.165.210.213 06:53, 11 November 2006 (UTC)
 * Unless one is a fetishist, there's no such "benefit". A paruretic urolagnist, how awful for you. —The preceding unsigned comment was added by 68.124.136.195 (talk) 02:36, 9 May 2007 (UTC).


 * Sharing the experience of urination with others is part of the graduated treatment method for paruresis. It is like joining a support group. People with fear of public speaking go to Toastmasters, trauma survivors and PTSD sufferers go to group therapy sometimes, some alcoholics go to AA, just as paruretics benefit from talking to eachother and their friends.  It is an important part of the process of coping and recovering with social phobias and other psychological disorders.

I'm going to add my bit here. Last week I had to go to a clinic to do a drug test as part of getting a new job. I drank a soda on the wat there ad seriously had to use the restroom. I waited, the nurse took me to the back and handed me a specimin cup. I went in, but I could not pee. The door was closed and locked, and yet I could not go. The nurse was kind enough to allow me to come back later and try again, she suggested I drink caffeine. I drank 4 cups of coffee, 3 sodas, and about 2 cups of water. I really had to pee, and I floored it all the way there. I went in and couldl not pee. It was like my body was just stopping me. I had to go to place I was getting a job for and lie about losing the form to get another copy. I went back this evening and tried to sneak some of my own urine in(bad idea, I was caught). The nurse didn't mind, and had me rink some water in the waiting area. About an hour later the receptionst spoke to me and said that he was the same way. He said that it had cost him his last job. He told me to try thinking about math, like multiplying or dividing large numbers. I went back and was able to succesfully provide a urine sample by doing the 70s times table in my head. So even when having to urinate very badly paruresis still has an effect. MatthewT (talk) 03:03, 30 June 2008 (UTC)

I have suffered with this condition for most of my adult life. It is a source of overwhelming anxiety and shame. It has caused my to lose oportunities and limits my ability to enjoy life. Why can't a less invasive drug testing method be developed? A man on the moon, but we need to analize pee?! Cummon!!! Where is the scientific community on this problem? I can't help but feel a more reliable, and passive, testing method can be developed (thats cheap...of cource) and at least as, if not more, relaible and fool-proof than urinalisys. thx zomie

Hair follicle testing is an alternative, but it is too expensive for most companies to utilize. MatthewT (talk) 03:05, 30 June 2008 (UTC)

There's no such thing as a "less invasive" drug testing method. They've developed a saliva test, but it is considered less useful in terms of detecting drug use, as it detects use in the area of 2-4 days, compared to the 2 week detection from urine tests - so naturally the less invasive the test, the less likely companies and the government are to utilize it on a widespread scale. I "feel" for your genuine medical condition - but with the false positives/negatives, the invasion of privacy, and (especially in the US) the complete disregard for valid medical issues - these tests insult everyone who is forced to take them. MisplacedFate1313 (talk) 05:00, 9 November 2008 (UTC)

Question
Paruresis (pronounced /pærjəˈriːsɪs/), also known as pee shyness, shy kidney, bashful bladder, stage fright, urinophobia or shy bladder syndrome is a type of social anxiety disorder, that can affect both men and women, in which the sufferer is unable to urinate in the (real or imaginary) presence of others, such as in a public restroom. The analogous condition that affects bowel movement is called parcopresis.

The use of the word urinophobia, is this a misspelling for the word urophobia (fear of urine or urinating)? I can't find that word used anywhere but here.

This statement:

is a type of social anxiety disorder

I'm only aware of two "types" of social anxiety disorder, generalized and specific. Would it not better be called a symptom of social anxiety disorder or a specific social phobia or better yet a specific phobia because social phobia doesn't have a sublist of phobias whereas specific phobia does? Thunder2k (talk) 13:15, 17 February 2008 (UTC)


 * I think I'm the one who made up that word mistakenly (urinophobia). Go ahead and change it. :-) Go ahead for the symptom thing too. I think I'm the guilty one here, once again. ;-) —Preceding unsigned comment added by Erlang01 (talk • contribs) 20:20, 17 February 2008 (UTC)


 * I would imagine that "urinophobia" means "fear of urine". "Urophobia" could mean "fear of urine" or "fear of tails". Anthony Appleyard (talk) 05:09, 14 May 2017 (UTC)

Cultural specificity
I've been to Russia and Poland a few times and I've noticed guys avoid urinals and go into cubicles far more than in the west. Are there any figures for its prevalence in different countries? Slavic guys seem to suffer from it more than most I think... Just a thought:) Malick78 (talk) 11:44, 8 November 2008 (UTC)

Impact section - reasons for difficulty
The Impact section mentions: "possibly because he may be worried about them seeing his penis" as one possible reason for paruresis. Is there any evidence for that? Just curious... it's not my experience, so I'm wondering if that "fear of one's penis being seen" is a true cause for anyone else. In my case, it's more a feeling of vulnearability - like a subconscious, irrational fear that while I'm going, I could be struck from behind and not be able to defend myself, so my body's fight/flight preparations lock me up.

I'd like to add that feeling of vulnerability as a possible cause, in fact, though I have no outside source(s) for it. But I wonder if the other reason is merely speculation? Should it be removed or sourced? (Or perhaps it's just the wording that seems more speculative and less authoritative.) Memetics (talk) 08:03, 10 December 2008 (UTC)

The more obvious reason is the irrational fear of being thought of as 'not normal' in a toilet scenario i.e. person 1 enters the toilet and stands to urinate, person 2 enters and immediately urinates. Person 1 is now thinking (illogically) that person 2 thinks they're a sick weirdo or trying for a gay pickup because they are just standing at the urinal holding their penis. The longer the experience lasts, the harder it is to pee, the more reinforced the behaviour becomes.

Cultural references
Would the material in the Cultural references section be more appropriately labeled "Paruresis in popular culture"? Perhaps to allay the "miscellaneous information" concern atop the section, this section could be led with a paragraph describing how the public has slowly become aware of paruresis through pouplar cultural references. (And possibly how sufferers might have their plight more widely understood, or at least acknowledged, as a result?) Then an abbreviated list of pop-culture references following the paragraph would seem more appropriate. Memetics (talk) 08:22, 10 December 2008 (UTC)

Popular culture section
An "in popular culture" section has now been added. Based on the previous comment from 2008 it looks like a similar section may have been added in the past. If someone took this out, I think it is important for the article to have it. Please expand the list if possible. --Wykypydya (talk) 07:38, 20 August 2011 (UTC)

Elevators? (Impact)
I am baffled by this sentence in the Impact section:


 * Some people cope by deliberately holding in their urine, by refraining from drinking liquids, or locating unoccupied or single-occupancy public bathrooms or elevators.

What on earth does elevators have to do with it? There is no previous mention of them. Do people urinate in elevators? Mmcculloch (talk) 04:21, 2 December 2011 (UTC)


 * "or elevators" has since been removed, but I met a girl from Bermuda at a summer program last year who told me that people often urinate in public elevators there. Ian01 (talk) 00:53, 15 September 2012 (UTC)

Pronunciation
According to IPA: 'It’s pronounced: “par-YOU-ree-sis.”' Is that consistent with the pronunciation currently provided by our article:

I am not sure that the second syllable, "YOU," is equivalent to a Y followed by a schwa. Wouldn't it be more like "YUH" if the vowel were a schwa? Leucosticte (talk) 12:29, 13 June 2012 (UTC)

Removed dubious content
I removed this whole paragraph:
 * Some drugs can cause difficulty in urination, opiates such as heroin, hydrocodone, or synthetic opioids such as methadone in particular. It varies in severity and from person to person, but many users and abusers of these substances find themselves suffering from paruresis. Partly this is a physical side effect of these substances, but it is often seemingly a psychological symptom, directly related with "shyness", etc., like paruresis. While drugs such as heroin can make it more or less impossible to urinate, the effect can vary, and very often has a direct resemblance to "ordinary" paruresis, i.e. the user may find it impossible to urinate at all, or he/she may only be able to urinate when alone. Buprenorphine (such as in the opiate substitute Suboxone) seems to be slightly different than "normal" opiates, in that it causes symptoms more or less matching paruresis, with the difficulty directly related to psychological factors. In comparison, opiates can simply cause great difficulty regardless of things such as the presence (real or imaginary) of others. Many Suboxone users find themselves having a great deal of difficulty if they know or feel that others can see or hear them urinating. This can cause difficulties, as Suboxone (being used in substance abuse prevention programs) often requires patients to submit urine samples, which can be very difficult for many patients. Some Suboxone users never experience this, while others do only sporadically. It can affect patients even if they never had any problems with paruresis before beginning treatment. It is unclear by what mechanisms this is caused. It is certainly psychological in nature, as a person can experience it when alone, or unexpectedly have no difficulty even when others are close. Many users have found running water or other sound to "cover up" the sound of their urination is necessary, but once urine flow is finally started it will usually flow normally until completion. It is unclear as to how these chemical substances cause the psychophysical reaction described. The listing of this in the "side effects" of the medication is sporadic, with some pharmacies including it in the list of possible symptoms, while others neglect it.

Leucosticte (talk) 17:12, 18 June 2012 (UTC)

I removed the following sentence: There is growing evidence to suggest that some drug testing authorities find paruresis a nuisance, and some implement "shy bladder procedures" which pay no more than lip service to the condition, and where there is no evidence that they have conducted any real research into the matter. C4lypso_jargon (talk) 17:58, 13 August 2012 (UTC)

I removed paragraphs about drugs.
I removed the long paragraphs about opiates and Suboxone causing Paruresis. There is not one link to back any of this info up. Statements like- In comparison, opiates can simply cause great difficulty regardless of things such as the presence (real or imaginary) of others.,Many Suboxone users find themselves having a great deal of difficulty if they know or feel that others can see or hear them urinating. Who are the many Suboxone users? Also this-Some Suboxone users never experience this, while others do only sporadically. It can affect patients even if they never had any problems with paruresis before beginning treatment. It is unclear by what mechanisms this is caused. I even went to the Suboxone web page and nothing at all about Paruresis listed in the side effects. This statement- It varies in severity and from person to person, but many users and abusers of these substances find themselves suffering from paruresis, I could not find any info about opiates or Hydrocodone or anything about opiates causing Paruresis. This statement-The listing of this in the "side effects" of the medication is sporadic, with some pharmacies including it in the list of possible symptoms, while others neglect it. how in the world could that statement be proved true or false? can anyone check every opiate bottle in the world to see if a Paruresis sticker is on the bottle? I don't think these paragraphs should be added back in the article without links to back the statements up. It reads like someone's opinion,and not medical facts.--BeckiGreen (talk) 00:18, 29 April 2013 (UTC)


 * I suspect someone was confusing paruresis with urinary retention, which absolutely is a side effect, albeit fairly rare, of opioids. In addition, it can sometimes cause difficulty urinating too - but it isn't paruresis. So you were right that it's not the same thing. Although I do wonder if it's worth adding a section of differential diagnoses such as drug side effects, bladder stones, nerve issues/back injury, infections, prostate issues etc that can also lead to similar symptoms? Usually the big difference is that the person can pass urine when they are in a "safe" place with paruresis but this isn't true with other issues, but it certainly is worth considering. 80.1.144.137 (talk) 23:58, 15 December 2016 (UTC)

Citation for trauma of voiding cystourethrograms
I'm not entirely sure what link was removed, but a quick search shows that the quote is from this paper in Nephro-Urology Monthly, and the reference points to this paper in the European Journal of Clinical Pharmacology. Are one/both of these journals regarded as predatory, and if so, on what basis? Genuinely asking, as I couldn't find anything specific about either publication on the Beall list, journalsearches.com, or anywhere else that I normally check for the reputability of journals. 80.6.203.241 (talk) 17:19, 30 January 2023 (UTC)

More precise, or definitive, information needed
The topic seems to be presented by those who do not have paruresis, and have never suffered its consequences, while many who have responded in the TALK section do have paruresis. Perhaps someone with paruresis who is also qualified as a psychologist could put in additional information? Things like have any new kinds of pharmaceuticals been discovered that may be helpful for the condition, something along the lines that erectile failure that was once considered incurable is now helped with Viagra? (I'm fully aware that the two conditions are separate and distinct from each other) One thing I object to is the use of the word "phobia" in the opening statement, where some of those who have paruresis do not have a phobic type of response when in a situation where their paruresis is manifesting itself. For them, they are simply not 100% in control of urinating on demand, nothing more, without a racing heart, trembling, sweating, and in great fear. However, that is not to say that some of those who suffer from paruresis actually do have some kind of phobic response when having to use a public toilet, or are in uncomfortable surroundings, such as a jet airliner. I am one of those who suffered with "non-phobic" paruresis for probably 60 years, where the way it manifested itself was I could not always urinate "on demand", but sometimes could, depending on circumstances. Around loud and noisy strangers and in crowded public toilets was when I had zero control of urinating on demand. On demand meaning when I needed to, or I would not have another opportunity for several hours and the public transportation bus was waiting for me to hurry up and get out of the public toilet so the bus driver could be on schedule. However, if I had taken something like a benzodiazepine such as Valium, then there was no problem with being in 100% control of urinating on demand, which shows either a neurological or psychological component. In complete contrast to paruresis, I've never once had a problem with defecating "on demand" in crowded and/or noisy public toilets, even with ones where the doors to the cubicles had been removed. Go figure. Linstrum (talk) 04:13, 15 March 2023 (UTC)