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 May 11, 2005
Bashful Bladder Syndrome
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Bashful Bladder Syndrome is the inability to initiate urination when in the company of others.


It has been estimated that one in ten Americans suffers to some degree from "bashful bladder" syndrome, the chronic inability to use a public bathroom when nature calls. A man will step up to a urinal and nothing happens even though he has a bursting bladder. Contrary to popular belief, the condition may not be a mere psychological quirk. In its severe form, it is a type of anxiety disorder that can be treated successfully without drugs. The anxiety of being around others, or being walked-in on, interferes with their ability to urinate. The disorder, which appears to run in families, ranges in severity. A mild case is needing to use a stall instead of a urinal. Moderate is being able to relieve oneself only in a stall and when the bathroom is empty. Severe is being unable to urinate no matter how private the surroundings. As a result, the disorder can force many otherwise healthy people to become practically housebound. In some instances, sufferers have bought homes close to their work so they could go home whenever they needed to urinate.


Treatment consists of six to ten weekly sessions of counseling. Patients arrive with a full bladder (made even more so through use of a diuretic) and repeatedly practice starting and stopping their urine flow in a variety of restrooms throughout the medical center. Patients begin in tiny bathrooms tucked away in remote corners and work up gradually to larger, more crowded lavatories. In the beginning, the therapist stands outside the restroom and reassures the patient that no one will enter. Once the patient is calm enough to start urinating, the therapist gradually moves closer and closer. Eventually, the patient is able to use a urinal even as the therapist stands directly behind him. Near the final session, the patient and therapist seek out the ultimate challenge: a football or basketball game or a concert - wherever people are lined up and waiting to get in. Throughout the therapy, patients are also assigned homework in which they practice relieving themselves in progressively "difficult" public settings.


Is there an underlying physical problem? Is the cause of this condition anxiety-based? What is the probable cause? How can this best be treated? What desensitizing program do you recommend?

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