Q: Is it important to let my doctor know about my paruresis?

A: Yes. But be prepared to educate your doctor when you visit, as many are unfamiliar with this condition. First off, your doctor needs to make sure there is no physical cause of your paruresis. If one exists, resolving it might be the only treatment you need. IPA recommends that everyone seeking paruresis treatment first rule out any physical cause with his or her doctor. Older men can experience a common problem called benign prostatic hyperplasia that is easily treatable. There are many other physical conditions that have some of the symptoms of paruresis. Urinary retention is a side effect of some medications. Your doctor will likely ask questions about family history, any symptoms you are experiencing, and may run some tests. Depending on your individual situation, several possible tests may be performed, including:

• Ultrasound
• Draining your bladder with a catheter
• Performing an X-ray of the bladder (cystogram)
• Voiding cysto-urethrography, a process of imaging the bladder and urethra during urination
• Urodynamic evaluation, which may include urinating into a special toilet that will measure the volume of urine voided, the speed it was excreted, and how long the process took.
• Cystoscopy, a procedure that lets a urologist look at the urethra and bladder from the inside.

Some of these tests may not be possible if you are unable to void in the medical test facility. Be sure to talk to your doctor about your ability to void in different situations. There is no reason to go through unnecessary grief unless there is a clear medical reason that one of these tests will help with your diagnosis.

Talking to your doctor will also establish a diagnosis of paruresis once any required tests have been performed. Your doctor can then provide you with a letter establishing your paruresis diagnosis. This letter could be very important in helping you request reasonable accommodation for an alternative employment drug test. By showing you had a condition that was established long before the drug test, it may reduce suspicion that you are a drug user trying to avoid a test.

All of the above information assumes you have an understanding doctor or urologist who is informed about paruresis or is willing to listen to you and read any information you bring to your doctor from this website. Unfortunately, there are wide differences in the level of awareness in the medical community about paruresis, its diagnosis, and treatment. Most of our members have needed to bring information from the IPA to educate their doctors. Pay close attention to how your doctor reacts. If your doctor is unwilling to consider the information from IPA that you provide, tries to make light of your situation, or suggests to a man that simply using a stall is a solution, you’re seeing the wrong person. Find someone else immediately.

If you don’t feel your doctor is the right one, it will be well worth your time and effort to locate a specialist in urology or a different doctor who has experience and compassion for patients with paruresis. Your local IPA support group may be able to provide a doctor’s name whose services have helped other group members. See chapter six of Steve Soifer’s book, “Shy Bladder Syndrome” for an excellent discussion on how to deal with the medical community.

For many people, the doctor will be the first person they’ve ever told about their paruresis. It can be a very uncomfortable and bothersome experience to open up to another person about this condition, especially when the likely next steps include poking, prodding, and various medical procedures involving discomfort. There are a few things you can do to make the experience less traumatic. First, tell other supportive family and friends about your paruresis in advance of going to the doctor if you can. Perhaps one of these people will be willing to accompany you for the appointment. The experience of doing this will put you more at ease at your appointment. Talk to your doctor by phone in advance of the appointment. If he or she is reassuring, you will likely have a more pleasant office visit. If the telephone call isn’t to your satisfaction, finding a different doctor might be in order. Finally, take heart in knowing that paruresis isn’t a life-threatening situation. Your life may be unpleasant, but this isn’t a condition like cancer. Nearly all people who seek medical help end up going in for one or two tests and then working with a psychologist for a few visits. Treatment won’t involve an endless series of hospital visits or a lot of physical pain.

Most of us reach a low point before finally deciding we need to see a doctor. That may be an upcoming drug test, failing a drug test because of inability to provide a urine sample, an embarrassing social situation with friends, or feeling isolated from others after severe paruresis cuts off our contact with the outside world. If you’ve reached this point, seeing a doctor and getting control of your treatment and recovery is the next logical step. You are taking a very positive action for your own health.

Young people, teenagers, and younger adults often avoid medical visits out of a sense of modesty, privacy, and fear of embarrassment. Keep in mind that your doctor has examined thousands of people, and heard about far more embarrassing situations than yours. Courage and a good sense of humor will get you through.