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Avoidant paruresis
('bashful bladder' syndrome): |
What is
avoidant paruresis?
Avoidant paruresis (also known as 'bashful
bladder' syndrome or psychogenic urinary
retention) is a social anxiety disorder that
involves the inability to pass urine in the
presence of others. Avoidant paruresis can start
at any age and affects mainly boys or men,
although girls and women can also suffer from it.
The frequency of the condition is difficult to
estimate, but surveys suggest that up to 7 per
cent of the population may have paruresis, and
this figure could be an underestimate.
Why do some people get
avoidant paruresis?
The cause of avoidant paruresis is unknown,
although a combination of inherent biological
factors and factors in the patient's social
environment seem likely to play a part.
What are the symptoms?
Being afraid or unable to urinate when others are
nearby.
Sufferers worry that someone might knock on the
toilet door, or see or hear them urinating, or be
waiting patiently outside.
Feelings of anxiety, anger, and body shyness in
provoking situations. These emotions lead to
contraction of the internal and external urethral
sphincters (circular muscles that voluntarily and
involuntarily restrict the flow of urine), both of
which must be relaxed for urination.
Avoidant paruresis usually occurs when using
public toilet facilities, including those on
trains, buses, boats and planes.
Producing a specimen for a medical examination can
be especially troublesome.
The condition can also occur at home when there
are other people in the house, irrespective of
whether or not they are in the bathroom.
The difficulty disappears if sufferers are certain
that no one is around or likely to arrive.
How is avoidant paruresis
diagnosed?
The condition is diagnosed on the basis of the
sufferer's account of their symptoms.
In severe cases, sufferers can waste considerable
time waiting for everyone else to leave the toilet
before they can urinate, and might totally avoid
urinating in public toilets. This can seriously
limit social activity, prevent people from taking
holidays, and in severe cases, even determine
their choice of job according to the ease of
access to a private toilet.
How is avoidant paruresis treated?
Individuals with avoidant paruresis that is
significantly affecting their employment and
domestic activities are classified as having a
non-generalised social phobia.
Treatment will vary depending on the individual
circumstances. No one single treatment has proven
effective in all patients and often a
multidisciplinary approach to management is
necessary.
Treatment aims to enable the sufferer to urinate
normally without fear when there are others
nearby.
Drug treatment:
in some cases, medication is necessary,
especially when depression or serious anxiety
symptoms are present. Treatment by a GP is
possible, although sometimes referral to a
psychiatrist may be necessary when anxiety
disorders are involved.
Psychological treatment:
referral to a psychologist for
behavioural therapy has been found effective in
reducing paruresis symptoms in several individual
case studies. Findings after treatment include a
shorter delay in urination, greater urine output,
and less anxiety. This initial improvement in
symptoms is maintained six months later.
Bethanechol chloride, a drug that prompts
urination by contracting the bladder muscle, is
suggested to improve results of behavioural
therapy programmes for paruresis.
Self-catheterisation:
occasionally, severely affected patients need to
be referred to a urologist to learn how to pass a
catheter into the urethra to empty the bladder.
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