Paruresis FAQ & Glossary

Your Shy Bladder Syndrome FAQs & Paruresis Treatment Questions Answered

Why don’t I pee when I want to? What is stopping it?

This description is a simplified version of the mechanism. One part of the nervous system looks after voluntary actions (e.g. raising your arm) and a second part that looks after actions you do not consciously control (e.g. breathing when you are asleep or the body’s preparation for fleeing danger).

The bladder is surrounded by muscle fibre called the detrusor. The tube that empties the bladder is called the urethra and it exits the bladder via the internal sphincter (think of a tap). The detrusor and the internal sphincter are not under your voluntary control, but under “unconscious” control.

The urethra then goes through the external sphincter, which IS under your voluntary control.

What happens is that the bladder fills up and at a certain point sends a signal to say “time to empty”. The unconscious mechanism triggers the detrusor muscle to squeeze the bladder in order to force out the urine – think of compressing a small balloon in your hands. At the same time the internal sphincter opens. The only thing stopping you from wetting your pants is your voluntary control of the external sphincter which you keep closed. When conditions are right, you consciously “let go” which opens the external sphincter and you pee.

With paruresis, the environment you are in causes your brain to go into an alert state i.e. it thinks there is a danger somewhere. The brain’s action is to trigger the “freeze” response whereby the unconscious mechanism relaxes the detrusor muscle, and closes the internal sphincter. Hence even if you voluntarily want to pee, the unconscious is saying “wait, there’s something wrong”. So it does not help to be made to drink more and more in an attempt to force you to pee. The unconscious has shut the internal sphincter and the detrusor is not squeezing the bladder and so nothing will happen.

This is in contrast to a person who doesn’t have paruresis who, say, is trying to avoid giving a sample. In that case the detrusor is squeezing, the internal sphincter is open, and it is only the conscious desire to not pee that is keeping the external sphincter closed. Being forced to drink more and more increases the pressure of the urine against the external sphincter and eventually the person will be unable to hold it back.

Does hypnosis work?

The UKPT are very cautious about hypnosis as a treatment for paruresis for 2 reasons: We get people on our workshops who have tried hypnosis at some cost to no avail, and in some cases it has been a difficult experience.

One of our honorary advisors, a chartered psychologist, who was also a registered psychotherapist and a hypnotherapist, told us that in his opinion, hypnosis was not the treatment for this condition. Another clinical psychologist who works with us says the same. In cases of very mild paruresis where someone is comfortable with using urinals but from time to time locks up, hypnosis may be of help in showing them how to relax. But other than that, we do not feel it is of help.

The UKPT is interested in any evidence of the effectiveness of hypnotherapy. We would be looking for evidence such as personal case studies given by participants at our workshops.

Are there self-help strategies available for Avoidant Paruresis?

Paruresis has two elements to it. Primary Paruresis, aka shy bladder syndrome, is the state of not being able to urinate in a social situation.. This is controlled through Graduated Exposure. Secondary paruresis is what the individual makes of his or her primary paruresis i.e. loss of self-esteem and self-confidence, the feeling of being abnormal, and frequently depression. The recognised treatment for secondary Paruresis sufferers is Cognitive Behaviour Therapy (CBT).

The UKPT mainly helps people who have both primary and secondary Paruresis. Neither Graduated Exposure, nor Cognitive Behavioural Therapy generally work on their own. Instead experience has shown us that gradual improvements in one technique enhances the other.

However, there are possibly people with only primary Paruresis who see it as a mechanical “fault” and are not shy of asking for treatment. In such cases, using hypnotherapy to teach relaxation and virtual desensitisation, may be effective.

What is a catheter?

Catheters are small plastic tubes that can be inserted up the length of the urethra, through the sphincters and into the bladder, in both men and women, enabling the bladder to be emptied. Some people with Paruresis self-catheterise with medically available catheters for immediate relief in situations when they know they are otherwise likely to experience difficulty. So far, it’s the only sure fire way of peeing we know. The UKPT is committed to supporting severe cases (i.e. those who struggle at home) to get to grips with this technique, so that they can get their life back and, just as importantly, be enabled to attend a UKPT workshop.

If you reach the conclusion that you want to have the option to self-catheterise, visit your GP practice and ask to be shown how to do it. Your GP can also prescribe catheters. You should take along UKPT literature, or download information from the website to help you.

What is a sphincter?

A ring of muscle that when tightened closes a tube e.g. the internal sphincter closes the urethra at the point where it leaves the bladder. When the muscle is relaxed, the tube is opened. The anal sphincter closes the anus.

What is a urethra?

The tube that runs from the bladder to outside the body, down which urine passes.

What does voiding mean?

The act of emptying the bladder or bowel.

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