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What should I do if I feel anxious and can’t piss in public?

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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. 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. Individuals with avoidant paruresis that is significantly affecting their employment and domestic activities are classified as having a non-generalized 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.

In some cases, medication is necessary, especially when depression or serious anxiety symptoms are present. Treatment by a doctor is possible, although sometimes referral to a psychiatrist may be necessary when anxiety disorders are involved.

Referral to a psychologist for behavioral 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 behavioral therapy program for paruresis. Self-catheterization: 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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