Paruresis or Shy Bladder Syndrome: An Unknown Urologic Malady?

Steven Soifer; Greg Nicaise; Michael Chancellor; David Gordon

Disclosures

Urol Nurs. 2009;29(2):87-94. 

In This Article

Abstract and Introduction

Abstract

To date, shy bladder syndrome, or "paruresis," chiefly has been seen as a psychological problem; consequently, little attention has been focused on this debilitating condition. The best estimate is that 7% of the general population, or approximately 17 million people in the United States, suffer from paruresis. While much has been written about urologic topics, such as incontinence and the neurogenic bladder, urologic literature does not contain any articles that specifically refer to paruresis. Little is known about the underlying causes of paruresis, but research indicates that the condition may have a physiological basis in addition to the more obvious psychological factors. Paruresis is a complex medical condition of unknown origin. The lack of awareness among the medical, nursing, and therapeutic communities contributes to the significant unmet needs of patients suffering from paruresis and its related symptoms. Only with education and research, in addition to clarification and agreement of the terminology for this phenomenon, can progress be made in understanding and effectively treating paruresis.

Objectives

  1. Define paruresis.

  2. Discuss the phenomenon of how both physiologic and psychologic stressors on the bladder control system may cause paruresis.

  3. Explain therapies being used to treat paruresis.

Introduction

For decades, primary care doctors, internists, urologists, physician assistants, nurse practitioners, bachelor of science nurses, registered nurses, licensed vocational nurses, physical therapists, and social workers have reported being asked by patients, "This is a bit embarrassing, but I am unable to urinate in the presence of other people. Is there something wrong with me?" In the vast majority of cases, the patient is told (a) not to worry, that it happens to a lot of people, and/or (b) tests will need to be run to rule out any urinary obstruction. Occasionally, patients are told to drink a lot of fluid, the theory being that eventually he (or she) will fill the bladder, and thus, have to urinate. In some instances, patients are simply ignored, and the subject is changed.

In many cases, the health care provider is unaware that the patient is suffering from the common social anxiety disorder known as paruresis or shy bladder syndrome. The best estimate is that 7% of the general population, or approximately 17 million people in the U.S., suffer from paruresis to some degree or another. According to a subsurvey of the 1997 National Comorbidity Study, 6.6% of the population have difficulty urinating when away from home (Kessler, Stein, & Berglund, 1998). This figure may seriously underestimate the problem if paruresis is considered a continuum disorder, with degrees of severity ranging from mild (an occasional problem urinating at the ballgame) to severe (being housebound by the problem).

While the occasional sufferer may find it to be a minor annoyance, the person who suffers from severe paruresis must deal with the adverse implications of the social phobia each and every day. Part of the phobia is the feeling of embarrassment; therefore, it is critical that when a patient mentions the problem to a health c a re provider or worker, the patient's needs and fears are addressed. For a patient to overcome the fear and embarrassment, and risk bringing it to the doctor's attention, paruresis is almost always already having adverse affects, and thus, must be taken seriously.

The urology literature has been silent on this topic. While much has been written about topics such as incontinence and the neurogenic bladder, these authors could not find one article using the terms paruresis or shy bladder syndrome in the urology literature. The lack of consistent terminology hinders the quest for information, further complicating the ability to manage paruresis.

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