Struck by stage fright? Why 'shy bladder syndrome' stops you peeing

This is something many of us have experienced in our lives from time to time, but if you happen to find it happening more than on the rare occasion you may be experiencing ‘’shy bladder syndrome", or paruresis. For those struggling with paruresis regularly, it can be more than a small inconvenience and stop the enjoyment of activities and socialising.

Let’s take a closer look at paruresis and how you can overcome shy bladder syndrome. 

Why does our bladder freeze?

Let’s first understand the role our brain has in shy bladder syndrome. The intricate relationship between our brain and bladder is key to overcoming paruresis, and that’s because our bladder and urinary system are highly sensitive to signals from the brain. These dictate when and where it’s appropriate to have a wee, and for the sphincter to ‘let go’ to allow pee to freely flow into the toilet.

Usually, this system functions smoothly—our brain receives a signal that the bladder is full, and we find a suitable place to empty it. However, when anxiety or fear creeps in, this process can get disrupted.

How does anxiety affect our ability to pee?

The mind/ bladder connection is more significant than we initially think, but those jokes about peeing yourself in fear aren’t for nothing!

When we're anxious - especially in situations where we feel vulnerable, such as using a public toilet - our body enters a state of 'fight or flight'. This is an ancient biological response designed to protect us from danger, but it’s not always helpful in modern life when we are rarely fleeing from real danger!

When in 'fight or flight' mode, our body prioritises survival over non-essential functions, which can include peeing. If our brain connects a situation with fear, stress or threat, it signals to the bladder muscles to tighten, making it difficult to relax enough to urinate - yes, even in a public loo! 

Figuring out the root causes of the anxiety around peeing can help and often this is tied into a sense of judgement.

For many of us, peeing where others can hear our ablutions can create an intense self-consciousness, which further amplifies the anxiety and prevents the bladder from relaxing to allow our wee to freely flow.

Does social conditioning cause stage fright?

Yes, for women especially. We’re taught throughout our lives that bodily functions, such as peeing, pooping and menstruation should be kept private and it’s only in the last decade that social media has enabled women to destigmatise a lot of this conditioning and connect with each other.

However, if you’ve grown up feeling shame or inhibition around bodily functions like toileting, then this can lead us to feel embarrassed or ashamed of needing to pee in the presence of others. Over time, this feeling can become so ingrained that it triggers a physical response, and this is why our bladder ‘freezes’ in the face of potential judgement.

This reaction can be particularly strong in public or shared toilets where the noise, the presence of strangers, or even the design of the facilities can all contribute to heightened anxiety.

Breaking the vicious cycle of shy bladder 

Unfortunately, once shy bladder syndrome takes hold, it can become a self-fulfilling prophecy. The more we worry about not being able to pee, the more likely we are to experience difficulty.

This can create a vicious cycle where the fear of not being able to wee causes anxiety, which in turn makes it harder to do so. We’ve pulled together some tips to try if you are experiencing paruresis to help you relax and break the cycle of anxiety. 

3 Tips to Overcome Paruresis 

The good news is that with a little patience and practice, it is possible to manage and overcome shy bladder syndrome and ease stage fright. Here are three tips that can help:

1. Practise Relaxation Techniques

One of the most effective ways to counteract shy bladder syndrome is to teach our body to relax on command, which granted, sounds easier than done. 

Before entering a public toilet, take a moment to calm your mind. Try focusing on your breath - inhale slowly through your nose, hold for a moment, and then exhale gently through your mouth. Repeat this a few times, imagining your muscles loosening and your anxiety drifting away. The goal is to switch off that 'fight or flight' response and encourage your body to return to a more relaxed state.

Try other mindfulness techniques such as deep breathing, visualisation, or even progressive muscle relaxation can be helpful.

2. Create new habits to train your brain

Creating a new habit can help distract the brain from anxiety and signal to your body that it’s safe to relax. This might include things like choosing a particular stall in the restroom, listening to soothing music or white noise on your phone, or even reading something that engages your mind.

This helps by training your brain to associate these actions with calmness, which can, over time, reduce the intensity of your anxiety in public toilets. 

3. Challenge negative thoughts

We all get those negative thoughts creep in from time to time, and our anxiety is often fuelled by our brain saying things like “What if I can’t go?” or “What if someone hears me?” but more often than not, they aren’t rooted in reality. That’s why it can help to challenge these thoughts and replace them with more positive, realistic ones.

Here’s an example: Remind yourself that using the toilet is a normal, natural part of life and that others are likely too focused on their own needs to pay attention to yours.

If you catch yourself spiralling into negative thinking, try redirecting your thoughts to something more neutral or positive. You could even repeat a calming mantra to yourself, such as, “I am calm, and my body is relaxed.”

Take back control of your bladder

Our brain and body are complex, and sometimes they react in ways that aren’t helpful, If you are struggling to manage a shy bladder, speak to your GP who can help make a referral for you for talking therapy. Cognitive-behavioural therapy (CBT) is particularly effective for addressing anxiety-based conditions like shy bladder syndrome.

The next time you feel that familiar stage fright creeping in, remind yourself that your bladder is just a little shy, and that’s okay. With practice, patience, and a little bit of self-compassion, you can overcome the stage fright. 

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