Q: How does alcohol affect paruresis?

A: Alcohol has two major effects. These can operate in opposing ways, making it difficult to predict how alcohol will affect your paruresis. First, it can reduce inhibitions. Because many who drink experience a reduction in social fear and inhibitions while under its influence, they report it is easier to urinate after drinking. However, for many people the amount of alcohol required is significant and carries major health risks, including addiction, liver damage, and impairment of ability to drive, operate machinery, or do work. Regularly using alcohol in this way amounts to “self-medication” of the anxiety associated with paruresis. Because alcohol does not treat the underlying causes of paruresis, it can create unwanted complications and over time may increase one’s symptoms because a person is treating the symptoms and not the underlying irrational thinking. IPA does not recommend alcohol use as a means of treatment.

The second effect alcohol has is to relax muscles in the body. Because of the way the urinary system operates this can have confusing, unpredictable results. Specifically, it may improve the ability to relax the urinary sphincter while one is under its influence. However, in many people it relaxes the bladder muscle as well, which reduces the urge and ability to urinate even with the sphincter relaxed. The relative relaxation of the bladder and sphincter will vary so that there is no way of knowing if it will be easier or harder to urinate.  Attempting to control the dosage of alcohol to find a “sweet spot” is also fraught with risk and uncertainty because as people drink more, they tend to control their alcohol intake less reliably. Finally, these effects disappear once a person is sober. So even if they work for you, you’ll need to be intoxicated all the time in order to say you’ve recovered from paruresis. Trading paruresis for alcoholism isn’t a good idea.