A person with paruresis finds it difficult or impossible to urinate (wee) when other people are around. Paruresis is believed to be a common type of social phobia, ranking second only to the fear of public speaking. Paruresis is often first experienced at school.


The condition affects men and women of all races. In mild cases, paruresis is an occasional event, like a form of performance anxiety. For example, a man at a public urinal may find that he is unable to urinate when flanked by other men. In severe cases, a person with paruresis can only urinate when alone at home.


The condition is also known as ‘avoidant paruresis’, ‘shy bladder syndrome’, ‘psychogenic urinary retention’ and ‘pee-phobia’.




A person with paruresis typically has a sensitive, shy, conscientious personality and is fearful of being judged or criticised by others.


Paruresis can be mild, moderate or severe. Signs and symptoms of severe paruresis can include:


  • The need for complete privacy when going to the toilet
  • Fear of other people hearing the urine hit the toilet water
  • Fear of other people smelling the urine
  • Negative self-talk while trying to urinate i.e. ‘I can’t do it. I’m never going to pee. I’m such an idiot.’








  • Inability to urinate in public toilets or at other people’s homes
  • Inability to urinate at home when guests are present
  • Inability to urinate at home if someone is waiting outside the toilet
  • Feeling anxious about needing to go to the toilet
  • Restricting drinks to reduce the need for urination
  • Avoiding travel and social events.
  • Similarities to Agoraphobia


Severe paruresis can affect a person’s life in a similar way to agoraphobia, which is anxiety about being in places or situations from which escape seems difficult (typically, fear of crowds or being outside the home).


If a person can only successfully urinate when home alone, they may avoid leaving the house. This can reduce quality of life and curtail job opportunities.


The cause is psychological


Paruresis is not a physical condition because nothing is wrong with the person’s urinary tract. The urinary sphincter must be relaxed in order for urine to flow from the bladder down the urethra. Anxiety about urinating overstimulates the person’s nervous system and ‘clamps’ the sphincter shut. Failure to urinate heightens the person’s anxiety, particularly if the bladder is uncomfortably full.


For some people, an embarrassing incident starts the social phobia: for example, the inability to urinate into a cup in front of a doctor or nurse. Worrying about the embarrassing incident makes the person feel anxious


Paruresis has been found to respond well to CBT and it is far more common than you think!



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