Paruresis FAQ & Glossary


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

This description is a simplified version of the mechanism. The nervous system comprises one part that 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, the body's preparation for fleeing danger etc.

The bladder is surrounded by muscle fibre called the detrusor. The tube that empties the bladder is called the urethra and it exits 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 is supposed to happen 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?
What is a catheter?
What is a sphincter?
What is a urethra?
What does voiding mean?
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