Shy bladder is nothing to laugh at
Fear of public urinating leaves sufferers in a bind
Precisely because it’s so easy for the rest of us, it can be paralyzing for millions of others.
Snicker if you will, but the International Paruresis Association, or IPA, estimates that the fear of peeing in a public restroom or urinating when others are around affects an estimated 17 million Americans, or 7 percent of the population.
Think about it: You can avoid spiders or heights or flying and many other sources of common fears. But hydrating the body and releasing toxins is essential to life.
“We’re just told, ‘When you have to go bad enough you’ll go,’ ” says Steven Soifer of the Baltimore-based IPA and Shy Bladder Center.
“Well, it doesn’t work like that.”
Paruresis is so debilitating for some, it has destroyed careers and lives and made them virtually homebound.
Dating is a nightmare. Jobs with shared bathrooms or close working quarters add to the pressure. Long trips by car or, particularly, plane are nearly impossible.
Some sign up for quiet night shifts.
“Oh, we’re very creative,” says 54-year-old Soifer, who spent years working through his anxiety.
“One man took a job as a janitor so if he had to go, he could just put out a sign. And a guy in the U.S. Navy back in the ’40s or ’50s told us he signed up for latrine duty because of it.”
Growing up in Royal Oak, Mich., Mike O’Rourke, 43, attended a local community college for one reason: It was nearby. He stretched out his schedule so he could make it home between classes.
Leaving home for long periods of time simply wasn’t an option, he says.
Much like the fear of flying, it’s the inability to take control that feeds the panic, says O’Rourke, now a father of two who works in computer support.
“It’s not like you’re afraid of peeing,” he says. “It’s that you don’t feel comfortable in certain situations.”
The condition is a constant preoccupation, dominating meetings, recreational outings, conversations, says Carol Olmert, the IPA’s women’s coordinator.
“It takes on a life of its own,” she says.
Fear of being judged
It’s unclear what triggers the disorder, and doctors are still trying to understand the brain-bladder connection.
Our sphincter muscles are what keep us dry. Almost always tense, they allow the bladder to work like a reservoir, keeping the urine in while we’re typing on our computers at work, playing with our children, chatting on the phone or reading the newspaper.
Six or eight times a day, we ask it to relax on command – a command so natural for most of us that there’s no hesitation, no second-guessing in it, says Dr. Michael Chancellor, director of Beaumont Hospital-Royal Oak’s neurourology program.
But for some, a momentary hesitation can lead to panic and finally to a frightened paralysis as muscles of the pelvic floor refuse to relax.
The fear is not in peeing, it’s not being able to – and having others notice, says Carl Robbins, director of training at the Anxiety and Stress Disorders Institute of Maryland and co-founder of IPA.
Much like the performance anxiety associated with stuttering, insomnia or sexual performance, he says, “the anxiety or fear of the event makes it more likely to occur.”
Ken Land, a 60-year-old Ann Arbor, Mich., social worker, tried for years to quietly find ways around his paruresis.
He talked about it with colleagues, as though it was a client of his who was struggling with it.
“But everyone you tell, they just kind of scratch their heads – psychologists included, neurologists included and family practitioners included,” Land says.
Even friendships can be tough when it’s hard to enjoy a few hours at a ball game or a shopping trip to the mall.
“I’ve had people hide it … from their spouses for 20, 30 years,” Soifer says. “When they finally are truthful about it, it’s such a relief (for the spouse).
“It’s, ‘What? That’s it? I thought you were a gangster or something.’ ”
As a young man, O’Rourke knew that a wife and family would threaten his privacy.
“I had doubts: ‘Do I even want to get married?’ When you’re alone, you control your own destiny, your day. You do what you want to do on your schedule,” he says.
“It’s both a psychological and physiological reaction. It’s the fear that someone will hear or see you and evaluate you negatively. It’s the fear of being judged,” says Olmert, who remembers being at a summer camp the first time she grew anxious in a restroom.
Working through shame
In high school, 56-year-old Kevin Melchert of Whitmore Lake, Mich., took the easiest classes to ensure his placement on the school’s honor roll – and access to the library’s single-use bathroom.
Public outings were anxiety-ridden to the point he could no longer concentrate on conversations around him: “I’d keep watching the bathrooms, seeing who was walking in and out and trying to time it just right.”
His anxiety began after he was sexually assaulted as a teenager. The more he tried to cope with the anxiety, the more panicked he became.
On a high school trip across the country, Melchert went for more than 24 hours without a restroom stop – an excruciating experience.
“The shame was instilled in me as a kid,” he says. The debilitating panic reinforced it – a cruel cycle.
Like so many others, Melchert kept his condition secret for years. His father died a few years ago without knowing about it.
Melchert and others say they’ve been able to regain control through local workshops put on by the IPA.
The three-day workshop works on a “pee buddy system” and begins with lots and lots of liquid – water, juice, tea.
It sends fearful voiders first to hotel restrooms and then to a Detroit Tigers baseball game to ease participants back into the public restrooms. Sometimes, they are challenged to simply walk into a restroom, comb their hair, wash their hands and leave – that, in itself, can be panic enough.
Over time, though, they work through the process together.
“One individual challenged me to tap him on the shoulder and say, ‘Hurry up, buddy,’ ” Melchert says, adding with a laugh: “I don’t think I’ll ever be that good.”
But patience is plentiful and essential, says Soifer, who’s also an associate professor at the University of Maryland’s School of Social Work. The condition is never cured, but rather controlled, he says.
“If you don’t continue to work at it, you … lose the gains you made,” he says.
“The question then is how to respond. Do you freak out? Or do you say ‘OK, it’s fine. This is how I’m going to handle it next time.’ ”