Q: Does paruresis put me at risk for other problems?

A: In general, the risk of significant health problems for those with paruresis is not believed to be high.  However, there are important risks to be aware of. Some men have reported having chronic prostatitis. Urinary tract infections related to retaining urine for too long a time are possible in both men and women. Some people try to cope by limiting fluid intake, and that can carry a risk of stones in the kidney, gall bladder, or salivary glands. Limiting fluid intake increases the possibility of heatstroke for people who live in hot climates or do a lot of physical exertion. If the bladder is allowed to fill beyond its normal capacity, it can become stretched and incapable of contracting fully. An overextended bladder produces higher risk of bladder infection because it can’t flush out all the urine. In severe cases, overfilling the bladder can lead to urinary reflux (where urine backs up into the kidneys) and even kidney failure.

Infrequent voiding and overfilling the bladder can also lead to neurological problems that are difficult to resolve. Possible consequences are urinary frequency, where a person fails to empty the bladder completely and instead experiences frequent urges to urinate. The signals to and from the brain and bladder can become weakened, making it difficult to sense urgency and to coordinate the bladder contraction and opening of the urinary sphincter.

There is a tendency for some individuals with high levels of anxiety to attempt to self medicate the symptoms through the use of legal or illegal drugs. Many of these drugs — alcohol, tobacco, marijuana, tranquilizers, and sedative-hypnotics — can create either physical or psychological dependency, leading to addiction. IPA hears reports from people on our web forum who have dealt with this kind of dependency or are currently doing so. These drugs do nothing to reduce the underlying cause of anxiety. They can make a person feel better temporarily, but as the body becomes accustomed to the drug ever-increasing amounts will be required to bring the same level of relief, resulting in an addictive spiral. The only solution is to treat the underlying anxiety, not the symptoms of it.

For all these reasons, IPA recommends people with paruresis drink plenty of water, use restrooms several times a day, and avoid overindulging in legal or illegal drugs. Besides the health benefits, repeated restroom use is a part of a graduated exposure therapy program which will help greatly with recovery. From a practical standpoint, using restrooms several times a day may seem daunting if you experience great fear while in them. It will be important to do the process gradually and choose restroom situations that provoke the least anxiety possible at the start of the process. Guidance from a competent therapist is often needed to begin this process. You can find out more about the process of graduated exposure by reading Steve Soifer’s book "Shy Bladder Syndrome: Your Step-by-Step Guide to Overcoming Paruresis."