The word “paruresis” refers to a difficult psychological problem that hardly anyone dares to talk about. Paruresis is the inability to urinate in public toilets in the possible presence of other people. In English, the term Shy Bladder Syndrome has become established for this. Estimates put the number of paruresis sufferers in Germany at 1 million.
Paruresis: social phobia as a consequence.
It is not disgust with public toilets that has kept Thomas M. (name redacted) from using public toilets for eight years: It is simply unpleasant and embarrassing for him to be heard or seen by other people in the “loo.”
Another paruresis sufferer describes it like this: “In principle, I can also urinate in public toilets, but only when I’m alone. In the cinema, I only go to the toilet at exciting moments because I hope to be alone. If I’m unlucky, I sit there for ten minutes until everyone is out.” He writes this anonymously on the European Paruresis Association’s Internet Paruresis Forum – he is embarrassed to go to a doctor himself.
People like Thomas are therefore masters of avoidance: They avoid going to the bathroom because the only place to go is home, they avoid drinking, they find excuses not to go out with friends or even to travel. “They avoid public toilets and refrain from social activities because they cannot assess where and under what conditions it is possible to urinate,” says psychotherapist Dr. Philipp Hammelstein of the University of Düsseldorf.
The professional daily routine is partly determined by when an opportunity presents itself to urinate undisturbed and unobserved. Interpersonal relationships and partnerships suffer when joint activities outside one’s own four walls are canceled. It becomes particularly dramatic when self-doubt and depression are added to the mix. Paruresis is therefore considered a social anxiety disorder.
Paruresis: urination impossible
Paruresis almost always develops during puberty. It may be triggered by a stupid remark or a bad experience, such as when children were threatened in the bathroom. Such a key event is the beginning of a biologically very old reaction: the signal “danger” activates the “sympathetic nervous system,” the “fight-flight system,” which dates back to the time when man was a hunter-gatherer and all kinds of mischief threatened from nature.
In the event of danger, adrenaline is increasingly released, muscles are supplied with blood – and urination becomes impossible. This is because the ring muscles that control bladder emptying are also tense. If there is no danger, the “parasympathetic nervous system” is activated – the ring muscles are relaxed, and you can only urinate in a relaxed situation. So it also makes no sense at all to want to urinate under “stress” and to “push”, because the muscle tenses even more.
Paruresis: fear of expectation great
Paruresis sufferers suffer from a fear of expectation, because they have learned that they can not urinate, for example, in the presence of other people. One sufferer reports, “Public toilets, in department stores, train stations, airports, bars, discos are the big problem. Just where it’s noisy, and lots of people around. It doesn’t help at all to find an empty toilet, because especially when there’s not much going on, the chance of being surprised by a guest is even higher.”
So in the anxiety of expectation, the “fight-flight system” is active again. But that is not all. Over time, the bad experiences lead those affected to consider themselves “not normal” or to downright devalue themselves as failures. They feel inferior and are depressed. When the time comes, paruresis is established “in the mind,” as Hammelstein puts it.
