Some women and men find it difficult to urinate when others are nearby due to the fear of perceived scrutiny (J Psychosom Res 2017;98:122–129). The muscles that control urination tighten up involuntarily, making it impossible to start the flow. This condition is called ‘paruresis’ (pronounced par-YOU-ree-sis) or more commonly ‘bashful or shy bladder syndrome’.

According to doctors in the armed forces – who see many servicemen living in close quarters – it is quite common. In fact, 1 in 10 men may be affected. While paruresis can be mild, it can be distressing, interfering with daily activities, social life and travel. Some people even worry others may misinterpret their behavior at the urinal, which adds to anxiety.

One study published in Actas Urológicas Españolas (2007) found that:

• 60% of men with paruresis felt of the problem, and most tried to conceal the problem
• 25% had not told their partner
• 4% had not told their family
• 7% concealed it from their friends

This secrecy often adds emotional stress, especially in close relationships.

What Causes ‘Bashful Bladder’?

There is nothing physically wrong with the bladder or urinary tract in people with paruresis. The exact cause is unknown, but it’s believed  to be an exaggeration of a normal response – most people take slightly longer to start urinating when someone else is nearby.

One theory, published in The Lancet (1999), suggests that bashful bladder may be rooted in animal instincts. In the wild, many male mammals mark their territory by urinating. Perhaps the subconscious fear of ‘challenging another male’s territory’ suppresses the urge to urinate in social situations. While this is an interesting theory, it’s just speculation!

Tips to Overcome Paruresis

• Do mental math. Solving simple math problems in your head may help. A Lancet report from 1981 suggests that this activates the brain’s cortex, which can suppress the anxiety signals blocking urination.
• Try breathing and muscle exercises. Take a deep breath and tighten your pelvic muscles, as if you are pulling your anus (back passage) inwards, then relax and breathe out. Repeat this pattern until urination starts.
• Practice graduated exposure. Gradually work up to using public restrooms with others nearby. Start by using a stall in an empty restroom, then progress to busier environments.
• Visit the International Paruresis Association. Their website provides support and techniques for overcoming bashful bladder syndrome.
• Consider behavioral therapy. A trained therapist can teach relaxation techniques and help you desensitize your bladder anxiety in a structured, supportive way.

First published on embarrassingproblems.com
Reviewed and edited by Dr Diane K. Newman
Last updated: July 2025 by Dr Diane K. Newman