Paruresis Stories

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Bladder training – may be very helpful


 Not a very exciting title, but yet there is truth here worth paying attention to. Having paruresis can lead to a habit-forming dread of a full bladder. To avoid, we urinate before leaving the house and we urinate more often during the day to avoid ever placing ourselves in a difficult situation. The bladder is called the detrusor muscle and can shrink or expand based on usage. The smaller it gets, the more often we have to pee; it can get to be a vicious circle.

We recommend that you talk to your doctor about this and get a good urology book if you intend to expand your bladder. There are lots of data on what an average bladder can hold. One book (Conquering Bladder and Prostate Problems by Jerry Blaivas, MD) states that the average bladder holds between 200-600 ml before the urge to urinate becomes uncomfortable. The bladder produces between 30 – 100ml/hour depending on the type and amount of fluid that you drink.

The reason you should talk to a doctor about bladder expansion is: Trying to expand a bladder too much can cause a strained or misshaped bladder muscle that will not be as effective as contracting. It could be that for your size and shape, that your bladder is the right size for you. The book I mentioned also shows a page from a "voiding diary" where the patient records for a 24 hour period every urination and the following details: on a scale of 1 to 10, the intensity of pain or urge to void, the time of urination, C for convenience or H for urge, estimated volume, actual volume, events (waking up, breakfast, etc) and the type of oral intake (water, coffee, soda, wine, etc thru the day). Caffeine and alcohol are diuretics, so this can affect the rate at which your kidneys are producing water.

By the way, a sample voiding diary is displayed for a patient, name disguised I would assume, who was frequently voiding as little as 20 to 50 ml per time. Some types of diseases and infections can limit the expansion capability of the bladder and require smaller volumes. Examples are urinary tract infection, interstitial cystitis, enlarged prostate, bladder cancer, neurogenic bladder (multiple sclerosis, stroke, Parkinson's disease, etc). This is another reason to consult a doctor.

There is one urodynamic test that a urologist can perform where a catheter is inserted into the bladder, the bladder is slowly filled while the doctor records volume, what the patient is feeling, urgency to void, etc. (The voiding diary can also help to establish this information if one is conscientious about it). Also, Blaivas gives inadequate volume of urine as one cause of voiding hesitancy. He says that the bladder muscles have more strength with a full bladder and delaying urination until one has a full bladder can be an effective treatment.

If one has difficulty getting thru meetings or finding themselves with more anxiety during the day due to voiding frequency, this might be a productive approach in alleviating many symptoms. PhilNW

————A quick question on bladder training – RichardUK

Hello all,

I'm reading a bit about bladder training at the moment, as I've come to realise that AP has pushed me into some odd habits, i.e. the familiar one of always voiding before going out, or at every opportunity; as a consequence I got used to going to the loo loads of times a day; a self-fulfilling prophecy, as I suspect the bladder then just gets smaller in terms of its capacity, and one therefore needs to go more often. Not a helpful loop to get into.

So, I've started retraining as per the methods recommended for others with continence issues, (e.g. stress incontinence etc) and the effect is quite remarkable; now I go every 4 or 5 hours and its no big deal, seems quite natural.

My question is this; does retraining the bladder like this actually stretch it in an abnormal way, or is it a muscle like any other in the sense that it can slowly respond to new situations and demands?

(As an aside I've also heard that there is an optimum level of urine to retain before voiding strongly. Perhaps 300ml? Personally , beyond that I get so worried about being stuck somewhere, it has the opposite effect and I find it tricky to go, especially when practicing desense.)

Answers anyone?

————Re: A quick question on bladder training – SteveR-UK

I also have the problem with high frequency and blame this on my AP for the same reason as you outlined. My urologist gave me a chart to fill in on my urinary volumes the most I passed was 350 ml and this was when I first woke up. During the day I average around 150 - 200ml which is very low. I just like to go to the toilet when ever I get an urge just in case I can't go this gives me more time to find somewhere safe to go but on the down side this has lead to me having a smaller bladder.

————Re: A quick question on bladder training

RichardUK wrote…


I too found that bladder training helps. I used to void 200 ml every 2 hours. I was under pressure to be empty before going out and also to go as often as I could when I had the chance. I tried an experiment a few years back. I drank 250 ml of water before bed. I woke up 7 hours later and measured my morning pee at 500 ml or so (the so-called average capacity of the bladder). I continued to do this. Then I began daily bladder training and now am also able to wait about 3 1/2 to 4 hours and voiding about 350-400 ml. (I find it easier to maintain training in the morning and early afternoon – something I don't understand.) But I have found that it is possible now to urinate most of the time in a public rest room.

————Speed of bladder filling

The reason that you find it harder to hold a larger amount in the afternoon is that the bladder sensors not only respond to how much the bladder is stretched (i.e. how full it is) they also respond to how fast it fills. If your bladder fills faster, it responds more to the stimulus thus making you feel fuller; on the other hand if it fills slowly, like when you are asleep at night, it responds less to the stretching as if it gets used to it. So during the morning your bladder will only be filling slowly because you've been asleep and not drinking but as you go through the day and have your lunch you will drink more thus speeding the rate at which the bladder fills.

Opposite thinking – Carl Robbins
Breaking the silence barrier


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Saturday, 13 August 2022

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