No doubt about it -- there's nothing quite like using your own bathroom. It's familiar, clean (enough), and all your favourite reading material is right there on hand. Ahhh.

Now imagine a public washroom: cramped, grimy, silent. One other person walks in and suddenly you can't pee to save your life. Sound familiar? You may have shy bladder syndrome.

A bashful bladder
Shy bladder, or paruresis, is also known as bashful bladder, pee shyness, stage fright or shy kidneys. A shy bladder is not the result of an infection or inflammation, but a psychological condition classified under anxiety disorders. Responding to perceived dangers (i.e., listening ears, uncomfortable proximity to other people, dirty facilities, feeling exposed, feeling rushed, etc.), the body's sphincter muscle squeezes shut and prevents the flow of urine -- regardless of how full the bladder is.

At one time or another, about 17 million North Americans will experience some form of shy bladder syndrome, according to psychologist Dr. Avrum Miller, who treats shy bladder syndrome at the Anxiety and Stress Relief Clinic in Vancouver, B.C.

Shy bladder symptoms
Symptoms of a shy bladder can range from simply needing to create external noise (like running water) before being able to pee in a public environment, to a complete inability to urinate anywhere that is not your own home. People with an extreme form of shy bladder syndrome will avoid everyday social activities such as dining out, visiting a friend's house or attending a sporting event. "One to two million lives are severely hampered [in North America]," says Dr. Miller.

How does shy bladder begin? Dr. Miller explains most cases are connected to social approval. "People [with shy bladders] become exquisitely conscious of those around them," he says. "It often begins around puberty when peers may have teased, harassed or hurried you in the washroom, and suddenly you associate the washroom with anxiety." He adds that rarer cases of shy bladders are connected to physical, emotional or sexual abuse, and in some instances may stem from traumatic toilet-training experiences.

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What to do about it
There are many ways to remedy a shy bladder. First, talk about it with friends and family members. Most people with shy bladders feel they are the only ones with the problem, and just talking about it can help to resolve the issue.

Classic therapy is to put yourself in progressively more stressful bathroom situations until you overcome your shyness. Dr. Miller suggests starting out with something you can manage and taking careful baby steps from there. "A lot of people can work it out for themselves," he says.

You might also want to enlist a "pee buddy" who helps by standing down the hall or in the next room. He or she can edge progressively closer to the bathroom each time you pee until you're comfortable with them standing right outside the door.

Alternatively, you can also seek professional help. Dr. Miller says the exact therapy depends on the therapist and the individual, but overall it will teach you to relax, neutralize tensions, develop confidence, and move beyond any anxiety-provoking experiences stuck in your mind. "With me, we might go from the least anxiety-provoking situation to the most, and I help them walk through it all," he says.

Other useful tips
Also check out the International Paruresis Association for resources, online forums, workshops and support groups.

The best news is you can overcome shy bladder syndrome. According to Dr. Miller, the more confident you become and more empowered you feel about using public facilities, your symptoms will slowly go away.

So relax, take it easy, be good to yourself and those menacing public washrooms will become wonderful spaces of relief.

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