I don't know if I'm paruretic or not

I was 100% sure that I have paruresis but I've been spending time on the IPA website talk forums and there are a lot of things that don't match up with me, things like I find it harder to start my stream with a higher urgency, they talk a lot about paruresis being the fear of other finding out you have shy bladder and if you can get rid of that embarrassment and anxiety then you should be able to pee but I have neither in a public toilet and still lock up even with a strong urge in a cubicle, another one is I can't pee sitting down it makes it a lot more difficult where as everyone it seems on the forum says it makes it so much easier, the last thing that seems to be different is I can pee when I feel like I have my personal space so I find it hard to pee when someone is in the cubicle next to me because I feel like I don't have my space which has gotten worse of the years to where I couldn't pee in a public toilet when it was quiet, whereas on the forum nobody talks about that they just say it anxiety and embarassment are the two things that lock you up and if you get rid of them you can pee where as for me it's promixity to people and sound, embarassment is like a tiny trigger for me, proximity and sound are the worst. Do I have paruresis or has my need for personal space and not wanting for me to be heard just got out of hand like any phobia can, if so how can I recover? The one thing I want to emphasise is that the higher the urgency the more difficult it is for me to start my stream, whereas that seems completely different from everyone else, I was able to pee with someone next to me in a stall with low urgency but when I had a high urgency like 7-8 only 30 mins later due to drinking a lot I couldn't go at a services with 7 empty cubicles and very low traffic, it's so bizarre. Does anyone have any help?

#31 by Michael

Hi Michael. There are two issues here. Let’s take paruresis first. A long time ago we managed to simplify our definition of the problem as “An inability to urinate in the presence, real or perceived, of others”. Within that there are a whole lot of variations; the majority of people are similar, but outside that there are be individual differences. Probably dependent on what event originally triggered it.

There is primary paruresis and secondary paruresis. Primary is the fact of locking up in social situations. Secondary is the beating yourself up about it. I have met a guy who came out of
A toilet saying he had not managed to go; he was not upset or embarrassed about it, just matter of fact; he had no secondary paruresis.

Now for the other issues: sitting down or standing up; again this is individual to the person. Most find it easier sitting down, but for a few its the other way around. On our workshops we find some guys find it easier when it is quiet, other when it is noisy, and so on.

Re urgency again for most it is easier the higher the urgency but for a minority it is the other way around. I myself am like you there.

Matching yourself to others is not worth doing. The way forward is to set up a sequence going from easier to harder, and to practice at the easier level until you have cracked it, and then to move up a notch of difficulty. For you, it sounds like you need to start practicing with a low urgency, and gradually up the urgency, in small stages.

Another sequence for you is proximity: again start with a good separation, and gradually reduce it. Do not set yourself a goal of standing next to someone; half the guys do not like doing that which is why, if it is too busy, you see them using the option of a cubicle. Cos personal space is the issue here, try to use toilets dividers between urinals first.

Being heard is a common worry. That goes when you can get it into your head that peeing for others is totally uninteresting; to them its off the bottom of the scale. And your peeing is even more boring. So whether you are making a peeing sound or not is off their radar.

Going back to low and high urgency: I have a theory, which I cannot prove, that in my case it is due to years from early childhood of having to hold it in. So the external urethral sphincter, which I can control (i.e. what I do to stop wetting myself) has become over developed. A high urgency means obviously I have to clamp it shut, and it can go into spasm; which means it is very slow to relax. It does so eventually, and a very thin stream starts, which slowly strengthens as the sphincter relaxes. So like you I am better with a low urgency.

There is a second issue with a low urgency in that it obviously does not matter if I don’t pee, so subconsciously I must be more relaxed.

I hope this helps. To summarise; identify what triggers you to lock up: i.e. making/not making a noise, proximity, urgency. Start with them all at the easiest level. When you can pee there, change one of them a small bit; and so on.



#32 by andrew

No that's fantastic, thank you. So would I do low urgency in a cubicle alone then with someone in the public toilet and then build up to two people right next to me in both cubicles, then start again with a medium urgency, so alone in a cubicle and then increase as before? Do you have any tips on how to bridge the gap between someone in the next cubicle and it being empty as it seems like a big step? With regard to sitting down, is it something i'll need to get over like the other hierarchies

#33 by Michael

Hi Michael
You have mentioned three things: urgency, people in/not in adjacent cubicle(s), sitting/standing. As you find pee sitting down more difficult, you could put that on one side, since that is not really an aim compared to the other two.
Personally I would keep a steady level of urgency, using the level that you find easiest for peeing, and work on proximity. If a step seems too great, introduce a half-step by removing the need to pee i.e. do everything else as normal but do not pee. That way you can repeat the exercise until you have got used to the situation. When it feels right, you can re-introduce peeing.
Changing subject, it is worth introducing positive thoughts in the process. So when in a cubicle, say to yourself things like: I am in the right place for peeing, that guy in the other cubicle is busy with his own thoughts, guys do use cubicles when they want a bit more space to themselves.
Make sure your whole body is relaxed: legs, shoulders, belly, sphincter. Do slow steady breathing. Have a slight smile.

#34 by andrew

With regards to getting used to a particular stage in the proximity hierarchy, how long does it take to get used to someone being in the toilet with you as I've been going GE every day at a public toilet for the last 2 weeks and still find it difficult to start my stream when the bathroom is occupied by someone and often lock up as soon as my pee hits the water due to the noise, am I getting ahead of my self, does it take a long time at each stage? I know that everyone is different but I'm looking for a very general time scale, 1 month, 3 months, 6 months? Thanks

#36 by Michael

Firstly I suggest you pee on the porcelain, and not into the water, as that is easier (or less difficult). As for there being someone in the next door cubicle, it would be lower on the hierarchy if that person was someone who was helping you i.e. a buddy. Only when you can reliably pee onto the porcelain with a buddy next door, would you change one of those two things.
As for how long it takes. how long is a piece of string :-). You have to persevere with no expectations, and be content to let it take as long as it takes. otherwise you create a pressure on yourself, which is counter-productive. It could well be that this first step would take the longest, that something will click, and future steps move more quickly; but who knows?
In terms of completing the whole process, do treat it like training for a marathon from not being able to run at all i.e. many months. It takes a long time to get physically fit; similarly it can take a long time to unlearn "bad" habits and build up new good ones.
But it is so well worth doing; what are months compared to the many years of life ahead?
Finally it would be well worth your while to attend one of our beginners workshops in the New Year.

#37 by Anonymous
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