MOST people will find themselves a situation where they they can’t pee because something’s throwing them off at some stage of their life.
But shy bladder syndrome or ‘paruresis’ can get so bad that some extreme psychological sufferers can’t urinate at all.
For those worst affected, they can only urinate alone at home or, in the worst cases, the anxiety is so bad they need a catheter.
Andrew Smith, 73, is the chairman of the UK Paruresis Trust which he set up to help other blokes with the condition.
He has painful firsthand experience of the life-disrupting condition going all the way back to his childhood.
But since running his first treatment workshops in 2001, Andrew has seen the unbelievable havoc shy bladder syndrome can wreak on people’s lives.
One young man in his 20s, who lived in south London, contacted Andrew about attending a paruresis workshop in the north of the city.
Andrew said: “I said where it was, and he said: ‘Sorry, I can’t go, I never go more than 20 minutes away from my flat.'”
Arranging your entire social and working life to be within 20 minutes of a toilet you’re comfortable with is just one way patients were affected.
People with the condition also turn down job offers and promotions when they find out what the toilet situation is, or even struggle to get a job at all because they can’t face being in an unfamiliar bathroom outside of their homes.
Andrew explained: “We found quite a few guys would become self-employed, because that way they had full control over their movements.
“In a white van, they can pop home whenever they need to.
“One head of department in a secondary school, who’s female actually, lived at home with her parents with three toilets.
“When she got her own flat, she was OK except occasionally she got blocked when she heard footsteps upstairs, and that would stop her.
“The crunch point was when her fiance, who was an airline pilot, stayed over with her, she couldn’t have a wee in the night when he was asleep.
“She jumped in the car, drove 10 minutes to her parents’ house, and used the downstairs cloakroom and then drove back hope. This is all hidden.
“They’ll go to any lengths to hide the problem they’ve got because they’re too ashamed and too embarrassed to ask for help.”
Andrew said his own experience with the condition can be traced back to when he was just three-and-a-half years old.
He said: “I was in a gent’s public toilet, one of the pee up against the wall trough types, with my father.
“I remember just being very uneasy and anxious in that situation.”
That early age anxiety rooted itself in Andrew’s mind, following him through school to the point where he had to wait until he thought the toilets were empty whenever he needed to use one.
And when he went off to Cambridge University, his particular anxiety was having serious negative effects.
He said: “I never went to the pub because I couldn’t consider the idea of downing pints of liquid and getting trapped.
“So that affects social life.”
Andrew says the worry is constant, even when you’re not in the toilets.
He explains: “It’s always in the back of your mind like a little subroutine, just ticking off ‘where am I going to be in two hours’ time, where am I going to be this evening, what’s happening at the weekend,’ just checking I’ll be able to manage.”
It wasn’t until mid-life that Andrew developed strategies to cope with his condition, including arriving late to pub meetups or leaving early.
He also stuck to “drinking shorts instead of pints, which really marks you out as an oddball”.
Eventually, he managed to get the problem under control to the point where, instead of being incapacitated by paruresis, he ended up merely “on the shy end of normal”.
Andrew added: “Sometimes I use the urinals depending on the situation, other times I can’t, but I don’t give a toss about using a cubicle – I just do whatever’s comfortable for me, and that’s OK.”
Andrew now helps sufferers by using Cognitive Behavioural Therapy-led workshops which gets patients to challenge anxious beliefs they hold about going to the toilet.
In most cases, people with paruresis become worried people are noticing they’re not peeing, either by watching them or listening to them, which itself makes the fear worse.
Andrew explains: “They’re highly self-conscious about being in a cubicle, because in their mind a cubicle is there only for a number two, you shouldn’t be in there if you’re doing a number one, so they’re very self-conscious about their feet pointing the wrong way and that sort of thing.”
Broadly speaking, the severity of the condition can be divided into three groups.
Andrew says there are: “Those who can usually manage a cubicle, but can’t manage the urinal; there’s those who can usually manage in a domestic situation but can’t manage a cubicle; and then the severe cases are the ones who struggle in a domestic situation.”
Hard data on just how many people suffer from paruresis is difficult to estimate.
But according to the International Paruresis Association in America, around seven per cent of the population has it.
In the States, that represents a staggering 20million people.
If the same proportion is true in the UK, that would be a whopping 4.6million people.
And Andrew says the problem ends up surfacing among groups of men where you might not expect it.
He said: “The American association managed to get hold of a guy who’d worked in the armed forces and was responsible for drug testing and they asked him his experience of the reaction of people.
“Because in America the method of drug testing is Draconian — you actually have to pee into a bottle in front of somebody so they can see the pee leaving your body to go into it.
“He thought about three out of ten guys had absolutely no problem doing that.
“But five out of ten struggled to a greater or lesser degree.
“They gave all sorts of weird excuses why they weren’t peeing like ‘It’s because you’re a noncommissioned officer, it’s putting me off’.
“Two out of ten couldn’t do it, so sat on the bench.
“So that’s an example where you start raising the bar beyond the point where the normal male population is used to and they suddenly find ‘Oh! It’s not working! What the f***’s going on?”
NOT JUST MEN
One common mistaken belief about the condition is that it only affects blokes at the urinals.
When actually, paruresis affects women too.
Andrew said: “Women are just as secretive and ashamed of this, but are less forced to seek help because it’s acceptable to be in a cubicle, whereas a lot of men feel it isn’t.”
The different pressure here, instead of being worried that you’re being watched by other people in the bathroom, is that you’re taking too long.
Andrew explains: “What really screws [women] up is time pressure.
“Women’s toilets are always in an inadequate number, so there’s always queues.
“So to go to the toilet when there’s a queue of people all waiting to go and wondering why you’re taking so long, that absolutely knackers them.”