Paruresis cannot be treated with medication. But it can be positively changed through behavioral therapy. Before starting therapy, however, physical causes, such as prostate enlargement, prostate cancer or urethral stricture must be ruled out by a specialist. The paruresis therapy has the following structure: Before the therapy a very detailed diagnostics is made, so that the therapy can be optimally adjusted to the paruresis patient.
It is explained to the paruresis sufferer how the bladder works and why the bladder does not want to function in some situations as the paruresis sufferer would like. Exercises are then derived from this to help overcome paruresis.
Paruresis: treatment by means of exercises
In the second part of paruresis therapy, the exercises are then performed and often lead to a significant improvement in urination problems. The body should learn that the toilet situation is completely harmless – and to do this, the paruresis sufferer must face this very situation. The therapist works out a list of different levels of difficulty together with the person affected.
For some paruresis sufferers, urinating while sitting in a cubicle is easy; urinating while standing is more difficult. The patient must have drunk a lot during all exercises so that the urge to urinate makes urination somewhat easier. The third part of the paruresis therapy then deals with the “paruresis in the head” – the negative thoughts. In discussions, the thoughts of the affected person are analyzed in detail, questioned and possibly also changed.
Paruresis: self-help for those affected.
First, the affected person must get to know “his” paruresis. In doing so, a paruresis sufferer should create a difficulty hierarchy, i.e., in which situation urination is easy (such as when no one is around) and when it is impossible (for example, for some it is impossible to urinate in the office when colleagues might come in), a third person may be afraid that the splashing is too loud. In the next step of self-help, the paruresis sufferer needs a “buddy,” that is, a confidant with whom he or she can consciously get through situations.
This confidant should know exactly about the problem, have understanding and be willing to seriously participate in the exercises to be a valuable help. Now, for paruresis self-help, the body is tricked: the body should learn that toilet does not mean danger. The exercise includes practicing interrupting the urine stream for three to five seconds – at home at rest, of course. This can be done by tensing the muscles. To prepare for the exercise, the paruresis sufferer must drink a lot (about two liters), preferably non-carbonated water, because the urge to urinate must be very strong.
Paruresis: help through self-help
Only the following step during paruresis self-help is a confrontation exercise: look for the situation in which going to the toilet still just works, so for example, for men urinating sitting in the cubicle when no one is waiting outside the door. In a public toilet in a department store, we now practice: urinating while standing with the cubicle door ajar – with the buddy present and waiting in front of the door. If this works, one tries to interrupt the stream.
The exercises, in which you always have to accept setbacks, are increased in difficulty. The next step is to do the follow-up exercises together with the buddy. The last easier exercise, which was successful, should be repeated first. Only then should one, for example, change the exercise locations and increase the training.
Defeat paruresis
The then following step in paruresis self-help means for the affected person to now practice alone, which will cost some overcoming. But by practicing with the buddy, one now knows lots of situations that can and should be tried often, graded by difficulty. All this takes time and always costs overcoming, but without it you will not overcome paruresis. The last step is the first step towards a self-determined life: the avoidance behavior must be successively reduced in order to be able to defeat paruresis.
