The Sympathetic Nervous System and Its Role in Your Paruresis
The Sympathetic Nervous System and Its Role in Your Paruresis
If you’re one of the nearly seven percent of Americans that have been diagnosed with paruresis, you are not alone. Also known as “shy bladder” or “bashful bladder,” paruresis is a form of social anxiety that prevents an individual from urinating in public restrooms.
Paruresis is the physical inability to urinate in public and is caused by emotional distress, usually a traumatic event early in life. This mind/body connection is not only responsible for the onset of the disorder but also serves to perpetuate it. The more the individual focuses on the inability to urinate in public places, the more ingrained the physical dysfunction becomes into the psyche of the person.
The Onset of Paruresis
Most often, paruresis begins during adolescence; adults with paruresis often cite that the onset can be traced back to a teasing or bullying incident in a public restroom. The onset is linked to two identifiable stages: primary and secondary. Primary paruresis occurs at the inception of the physical inability to “pee in public.” Secondary paruresis occurs when the individual attaches meaning or “importance” to the dysfunction. An individual with paruresis feels shy about urinating in public, fearing the scrutiny of others.
Individuals with paruresis respond differently. For some, urination is not difficult around family members, but the presence of strangers in close proximity – even with stalls as barriers – causes enough psychological distress to prevent them from relieving themselves. It’s the fear of judgment that perpetuates the disorder. Often, these individuals are considered shy or sensitive.
Individuals with paruresis – known as paruretics – have symptoms that range from mild to devastating. Some individuals can urinate in public under certain circumstances, such as when the public restroom is empty. Others can urinate only in the privacy of their own homes where they feel safe from judgment of others.
The Sympathetic Nervous System and Its Role in Your Paruresis
The sympathetic nervous system is responsible for what is often referred to as the “fight or flight” response. It plays a pivotal role in paruresis. Individuals diagnosed with social phobias, such as paruresis, experience arousal in their nervous symptoms under anxiety-provoking situations. When the sympathetic nervous system is excessively aroused, such as when the paruretic enters a public restroom, it causes physical “freezing” of the sphincter muscle, thus inhibiting the paruretic’s ability to empty his or her bladder.
According to the International Paruresis Association, this is how the sympathetic nervous system affects paruresis: “The individual enters public restrooms with aroused sympathetic nervous symptom activity, which creates a level of anxiety that is incompatible with urinating. As each forcible attempt to control the process fails, increased performance anxiety due to mounting levels of sympathetic activity decreases the individual’s chances of voiding at that time. In many cases this performance anxiety eventually generalizes to all or most public restrooms, so that the only safe toilet the person can reliably use is at home.”
Coping with Paruresis
Individuals with bashful bladder syndrome cope in a number of ways. For one, most paruretics never discuss their condition with anyone nor do they seek treatment. Many individuals experience shame or embarrassment regarding their shy bladders and develop avoidant behaviors to prevent from being “discovered.”
For those with mild bashful bladder symptoms, they may simply find restrooms that are not occupied or wait until everyone leaves before entering the restroom. Because the overly-aroused sympathetic nervous system causes the individual to “choke under pressure,” some individuals try breath holding or other relaxation techniques to relax both emotionally and physically.
Because the sympathetic nervous system is adversely affected when an individual is anxious, cognitive therapy is often indicated as a treatment for paruresis. For those who want to live an active life but are unable to relax their sphincter muscles to urinate in public, self-catheterization is another option. The sympathetic nervous system uses adrenaline, hormones, and neurotransmitters to trigger urination. Anxiety can “short-circuit” that response, so to speak. That’s why paruretics often use intrusive intervention, such as catheterization, to relieve themselves.
However, for paruretics with more disabling anxiety, the response is to urinate as frequently as possible before leaving home or to avoid liquids before going out in public. Paruresis may also be symptomatic of agoraphobia, although not all people with agoraphobia experience paruresis. In extreme cases, individuals with paruresis become housebound so they will not have to face the physical discomfort of holding their urine while away from home.
Learning to manage the anxiety associated with “peeing in public” may allow individuals to relax which will, in turn, allow the sympathetic nervous system to work for them instead of against them. The best way to treat paruresis, however, is to work closely with a primary care physician and/or therapist.
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