Breath Holding for Paruresis

In the United States alone, approximately seven percent of the population suffers from paruresis – the inability to urinate in public restrooms, to urinate under the pressure of time, or to urinate on airplanes, trains, busses, or other forms of public transportation. Unfortunately, there is no known medical cause and is often diagnosed as a symptom of social anxiety.

Paruresis is no laughing matter; imagine spending eight hours a day on the job unable to urinate in the company restroom. Even though the urge to urinate is present – even to the point of pain – you cannot relieve yourself because someone else is in the room with you, or you fear that someone will enter the restroom while you are urinating. This is a typical scenario in the day in the life of someone with paruresis.

What is Paruresis?

Individuals with paruresis have no known medical cause for this condition, just a psychological paralysis when it comes to using public facilities. Also known as “shy bladder” or “bashful bladder,” individuals who are diagnosed with this condition experience more than just embarrassment and physical discomfort – they have lost jobs due to their inability to take a urinalysis to screen for drugs and have failed classroom tests because they could not use the school’s public restroom (thereby “rushing” through the test).

This condition is so debilitating for some that they choose not to venture outside their homes for very long, which interferes with their ability to hold a job, attend school, or participate in social functions. Some individuals avoid drinking beverages so that they can avoid the anxiety – and pain – that accompanies the inability to successfully use a public restroom facility.

While most people have an isolated incident every now and then that interferes with their inability to use public restrooms, those with paruresis experience marked anxiety when they must relieve themselves in public. This anxiety prevents them from urinating, thereby causing much physical and emotional distress. While paruresis can develop at any time during a person’s life, most individuals report that the onset of their paruresis occurred during their teenage years.

What Triggers Paruresis?

Individuals diagnosed with this condition are referred to as “paruretics.” While most paruretics will not seek help for their condition, they report three common scenarios – or triggers – that exacerbate their inability to urinate in public:

1. The most common trigger is the lack of privacy – stalls and/or urinals without doors or barriers. Individuals with paruresis have a need for physical distance from other individuals in the restroom as well as privacy.
2. Individuals with a shy bladder experience more difficulties relieving themselves in public when strangers are present. In fact, paruretics may have no difficulty using public restrooms when only family members are present.
3. Finally, extremes in emotion – such as anger and fear – may also trigger paruresis.

Paruresis is a form of social anxiety that involves fear of judgment from others. However, the good news is that with treatment, prognosis for recovery is better than average. While there are different approaches to treating paruresis, breath holding has proven to be effective with certain individuals.

Breath Holding for Paruresis

According to the International Paruresis Association (IPA), breath holding “is thought to work because an increase in carbon dioxide in the bloodstream has been reported to reduce anxiety and induce relaxation in some patients. This technique is well suited for people who can usually urinate around others once they get a stream started, but have difficulty starting the stream.”

IPA suggests breath holding as one way to overcome paruresis in certain individuals. Here’s how it works:

1. You may have to practice holding your breath, gradually increasing the time so that this technique will be effective. You’ll want to practice at home before trying this practice in a public restroom. For instance, try holding your breath for 10 seconds. Once you’ve mastered it, try holding your breath for 15 seconds, and so on. Once you are able to hold your breath for a period of 45 seconds, you are ready to proceed.
2. When you try this technique for the first time, attempt to do it when the public restroom is empty. This will allow you to hopefully get comfortable with your surroundings. Once you are in the stall or at the urinal, breathe as you normally would, and then exhale approximately 75 percent of your breath. According to the IPA website, you should not take a deep breath before you exhale. Just breath naturally, and then let out your breath. It’s important to leave some air in the lungs. At this point, you should feel your pelvic floor “drop” and relax.
3. If this technique is successful for you, continue to practice it. As you become more comfortable, urinating in public will feel more natural to you. Some people, for instance, begin the breath-holding technique as they approach the stall or urinal so that they will decrease the time they need to relax and urinate.

Individuals with low levels of anxiety may be more successful using this technique – at first – than individuals with higher levels of anxiety. Some paruretics find it helpful to attend support groups. If you do not experience success immediately, don’t give up. Many individuals take up to one month to experience consistent success. Paruretics with high levels of anxiety have reportedly needed several months.

The success rate for breath holding is an individual experience. Therefore, results vary case by case. However, for paruretics who avoid social functions or schedule their lives around their bashful bladders, gradually learning how to relax and relieve themselves in public is a positive step forward in taking control of a shy bladder and taking control of their lives. With consistent – and persistent – breath holding practice, many individuals are able to experience significant improvement.

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