Best pee-buddy of all, a 2yr old?

Ok, that sounds really weird. Let me explain.

I have a son, he's about 2 year old and is showing some interest in the toilet and in potty training. I think it's difficult for boys, especially those who stay home with their mothers since they generally only see people urinating in a sitting position.

Perhaps I'm overly sensitive to issues of toilet training for boys but I decided I needed to show him how men are supposed to do it.

This weekend I had a couple of opportunities to take him with me to public bathrooms. Each time we took a large stall. The first time he watches me stand over the toilet bowl and..and..Nothing. Shy Bladder strikes.

He's watching me, absolutely fascinated as to what we're waiting for and what is going to happen next. Staring wild-eyed in a way only a 2 year old can, no hint of embarrassment for my predicament.

I'm thinking to myself, he's 2 years old. I'm suffering Shy Bladder in front of my 2 year old. After what seems an eternity but is probably only 10-12 seconds I decide that we should sing a song he knows. We sing and within a few seconds I'm able to go.

Later episodes were similar except that I didn't have to resort to the singing, I was just willing to wait a few seconds more knowing that I would be able to go at some time as soon as I'd relaxed enough.

The moral of the story? I'm not sure there is one but one of the reasons I decided to try to beat my Shy Bladder was exactly this - I wanted to be normal around my Son and be a good role model to him. It seems that Shy Bladder can run in families and I didn't want to pass it on.

How to make a plan for graduated exposure.

In his book, Edmund Bourne explains how to construct a plan for Graduated Exposure Therapy. This is also covered in Steven Soifers book on Shy Bladder. If I put those together with my own experience here's what I think you should do (Remember, I'm not a doctor, this is not medical advice).

Step 1 : Identify Where You Are.

You want to get started on defeating your Shy Bladder symptoms but first it's a good idea to take a hard look at your condition. It might help to answer for yourself some of the following questions and writing down your answers. You can always shred the paper later but writing this down may give you some insight into your particular case.

Questions :
* What was the first time I experienced this problem?
* How has it affected my life?
* Does anyone know that I suffer with this?
* If I have told someone, what was their reaction?
* Does anyone in my family have this condition? (it does seem to run in families)
* What have I already tried to overcome this condition?
* Under what circumstances am I able to go?
* Under what circumstances am I definately unable to go?

Step 2 : Get Physicians advice.

I know, I know. This is the step we all hate and many of us skip. It may be you know that you don't need to see a MD but it's always a good idea to remove any physical problems from the picture. Chances are however that if you can go at home but not in a public restroom the problem isn't an enlarged prostate or other problem, it's Shy Bladder.

Step 3 : Choose your weapons

Another good reason for getting a physicians advice is that you might choose a Selective Serotonin Reuptake Inhibitor (SSRI) drug. It's worth reading the International Paruresis Associations (IPA) drug page for a full treatment of this subject. It may be that not all SSRI's are created equal. The IPA hints at anecdotal evidence that Paxil may actually be useful for Shy Bladder. Again, this is not medical advice, talk to your physician.

Hypnosis? Some have reported that they used Hypnosis in their programs to overcome Shy Bladder.

Cognitive Behavioral Therapy (CBT). This is a form of Psychotherapy that works to "restructure" the negative and unhelpful thoughts that plague Shy Bladder sufferers - you know the ones "Everyone is watching me, they've noticed I can't go" or "Someone is going to come into the bathroom any second..." Normally CBT will be combined with Graduated Exposure Therapy.

Graduated Exposure Therapy. My tool of choice and the one recommended in all the books as a therapy that's simple, cheap and effective (if you're persistent).

You can do graduated exposure therapy yourself and/or you can choose to jump-start your recovery by attending a Graduated Exposure Therapy workshop (run by the IPA), by joining a support group or by finding yourself a Pee-Buddy.

Step 4 : Identify your scale

Maybe you can't go anywhere except at home with the door firmly locked and only when you know there's nobody else in the house or maybe you can go in a public restroom but only in a locked stall. We all have to start somewhere. The important thing is to identify the steps that it will take to reach freedom.

So create a scale, a series of steps 8-20 in all that will act as milestones in your progress. When I started I was unable to use a public restroom except in a locked stall, sitting down to minimize the noise. Here's my scale :

1. Locked stall, standing up.
2. Unlocked stall, standing up.
3. Unlocked stall, door ajar, standing up.
4. Unlocked stall, door wide open, standing up.
5. Unlocked stall nearest the urinals, door wide open, standing up.
6. Urinal #1 (of 3), waiting until someone else comes in.
7. Urinal #2 (of 3), waiting until someone else comes in.
8. Urinal #2 (of 3), waiting until someone stands next to you to initiate flow.
8. Urinal #2 (of 3), in a crowded bathroom.
9. Any urinal at a high-throughput venue such as a stadium, airport or bar.

Since Shy Bladder is a Social Anxiety I ensured that I only practiced when people were around.

I figure once I reach #9 I'll be pretty much free though I may always have a tendency to slip back so I will always have to practice at least a few times a week. I've made it as high as step 8, but right now I'm somewhere around step 6-7. This is a normal pattern of advancement and dropping back slightly.

Step 5 : Have a backout plan

In step 6 you're going to start practicing the graduated exposure therapy but first plan an exit strategy in case you are unable to go. Make sure you have a bathroom identified (at home maybe) that you can reach in case you get into trouble. This might include knowing where the nearest hospital is in case you need to be catheterized to relieve the pressure. I've never needed this safe bathroom in my progress but you might.

Step 6 : Execute the plan.

Now the fight. If you're doing hypnosis, CBT and drugs you have it relatively easy. If you're doing Graduated Exposure Therapy you have to overcome the natural tendency not to drink. You need to drink, a lot, in order to give yourself opportunities to practice and you need to maintain high urgency levels.

Drinking 100+oz's of water a day isn't easy and it can be torture waiting around with very high levels of urgency in order to ensure that there are others around when you go. You'll be sitting in meetings and all you can think about is how bad you need to go. But you can progress this way, rapidly.

Step 7 : Keep a diary

Not really a step this more a peice of advice. I've kept a diary via this weblog and I am always amazed as I read it how often I failed or fell-back. I've also re-experienced the euphoria of a good day - these are all things that I wouldn't remember if I wasn't keeping a detailed diary of what I did, how if felt and what I thought. You're progress won't be linear, you'll jump ahead and fall-back on your steps but keep trying and you'll have a breakthrough day or two as I did when it seemed like you were already free of Shy Bladder and that give you a glimpse of what you're life will be like once you made it through.

Good luck! Post in this blog to let us know how you're doing.

Further reading :

What to do when you fail.
Recovery Stories
My plan to beat Shy Bladder.
Getting help for Shy Bladder

What is a normal level of hesitancy?

You're at the urinal and in the presence of others, what is a normal delay before you can urinate?

If you suffer Shy Bladder you probably know, you've counted the eons worrying that this time you just arn't going to start at all or that the next guy is judging you because you don't seem to be able to start.

I was in a stall recently (for all the right reasons mind you), right next to the urinal and I couldn't help but overhear two guys at the urinal. I counted, it was five seconds before one of them was able to initiate a flow.

Five seconds is an age when you're standing there counting it. It would probably have made me anxious but this guy doesn't suffer from Shy Bladder so he didn't even think about it.

Can you cure shy bladder just by drinking water?

There seems to be an idea floating around the internet of a "water cure". The suggestion is that dehydration is the cause of many modern ills and that if we just stopped drinking coffee, soda and tea and stuck to good old plain purified water we'd be so much better off.

There may be some truth to it, but as a cure for Shy Bladder (as some have suggested) I think it's pretty unlikely (I'd like to hear from anyone that the "water cure" worked for - please post a comment)

Since Shy Bladder is a social phobia it seems unlikely that just drinking more water would be an effective cure. Would it cure, for instance, a fear of travelling in elevators (another social anxiety)? Very Doubtful.

What drinking lots of fresh water WILL do for you is give you plenty of chances to visit the bathroom and practice your graduated exposure therapy. That's a technique that will work to lessen the effects of and (if you're persistent enough) cure your Shy Bladder symptoms.

Having said that, there's nothing dangerous about the water cure and I'd be very happy to hear that it is an effective cure for Shy Bladder.

Book : Coping With Anxiety.

This book by Edmund Bourne and Laura Garano has a chapter on Phobia's (Chapter 4, Face your fears). This is a great chapter on Exposure therapy. Among the highlights :



* You need between 8 and 20 steps in your plan.

* You will have up and down days, hit plateau's, jump forward and fall backward. This is normal! They write about people with a social phobia of going to the supermarket :

On a given Monday you might spend five minutes alone in the grocery store for the first time in years. On Tuesday you can endure five minutes again but no more. On Wednesday you are unable to go into the store at all. Thursday or Friday you discover that you can last ten minutes in the store. This up-and-down, two-steps-forward-one-step-back phenomenon is typical of exposure therapy. Don't let it discourage you!

* You just practice regularly 3-5 times per week. Generally longer sessions of exposure are better than shorter sessions.

* It can take between a month and a year to fully recover.

* You have to trust your own pace.

* You can use Imagery desensitization to help "practice" situations in which you suffer Shy Bladder.

* If you want to really get cured you have to progress through all steps, stopping at some level of comfort short of cured will not do it.

It's just one chapter of the whole book but I found it very helpful.

Progress Report #15 : Back and Forth

Attempt #1 : Urgency 7.5/10. Went to the bathroom, met someone else just going in. He took Urinal #3, I took Urinal #1. Stood up to the urinal and became aware that I was thinking about going rather than going. Naturally, nothing happened. I have a kind of nervous habit that I've developed in this kind of a situation, I scratch my nose. Despite my lack of flow my anxiety didn't spike and after about 3 seconds (which seemed like forever) I started my flow and was able to go normally.Success!

What I'm learning : Recently I've had a spate of hesitancy before finally being able to go. It happens when my urgency isn't 10/10. My anxiety isn't kicking in like it used to in these situations though and I am able to go after a few seconds. Hesitancy is normal Sure. People can tell you that, you can read it, you can even see it in other people at urinals but unless you can understand that yourself at a subconscious level it doesn't help you. But I think that my subconscious mind is starting to grasp it, the fact that my anxiety doesn't start up after a second or two of waiting suggests I'm "getting it". Just how much hesitancy is normal?

Attempt #2Urgency 7/10. Arrived at bathroom during high-traffic time. Felt a flash of anxiety. Someone at urinal #2, took urinal #1. Froze. Was able to start flow as soon as they left urinal and were in process of leaving room. Maybe I would have started had they stayed in the bathroom longer. Dissapointing failure. Failure.

After a weekend...

Attempt #3Urgency 8/10. Again arrived at bathroom during a high-traffic time. Did not feel anxiety, someone at Urinal #1, Someone at #3. A perfect practice set-up. I stood up to urinal #2 and was able to go immediately. It probably helped that the guy at #3 flushed and left at that moment. The guy at #1 was still there when I finally left the bathroom. I guess Shy Bladder comes to us all - but not me this time! Success!

A few days later..

Attempt #4Urgency 8/10. Arrive in the bathroom, someone is at urinal #1 so I take #3 which, for some reason has me feeling more exposed (I guess I'm not next to the wall as usual). I stand there but nothing happens until the other guy leaves the room. I shrug and realize that sometimes you're just going to have a bad day. I don't worry about it.Failure.

Summary

I seem to be in a pattern of moving forward and falling back with my Shy Bladder progress. I was pleased to discover that Edmund Bourne says that this is normal in a program of Graduated Exposure Therapy. Read more about his book.

Slate article on Shy Bladder

Here : http://www.slate.com/id/2065670/

One of the interesting quotes from the article (by Steven Soifer, author of the book, and recovering Shy Bladder sufferer himself :

Even with therapy, will a shy bladder ever feel at ease at the ballpark trough? "I've suffered from paruresis for 30 years," Soifer says, "and I've been in recovery for the last six. I'm not cured. It's a lot like alcoholism. You can recover close to 100 percent, but it can get set off again in certain situations. That's why I don't talk about a cure.

This is not the sort of thing I like to hear. I want to know that I can make it to 100% cured and stay that way. Even so, I would be happy to be in remission for the rest of my life. Suffering Shy Bladder might be like an addiction in that way, you can be "free" but the experience of ever having had it leaves you forever changed and forever potentially susceptible. "JohnW" suggests as much in his recovery story (analysis of recover stories here).

That's a good enough reason to work on Graduated Exposure Therapy now, so that should I slip back I will always have the tools necessary to cure myself again.

Further reading :

Can you ever really be cured of Shy Bladder?

Progress Report #14 : I'm Back!

Attempt #1 : Urgency 9/10. Waited at Urinal #1. Someone came in, took urinal #3. Able to go quite normally. Success. Time to get back into urinal #2.

Attempt #2 : Sat through an hour meeting and drank water all through it. By the end of it I was actually hoping that the group would all take to the bathroom at once. A colleague and I arrived at the bathroom at the same time. He took urinal #3 and I took #1. Urgency about 9/10. No problems at all. Success! This is the sort of "normal" event that for years I never experienced. Felt perfectly normal and natural to use the urinal in this setting. Wish there had been someone to take urinal #2, would have been better practice for me.

Attempt #3 : This one at the bathroom at the mall. Urgency 7/10 but I wanted to try there. Bathroom was quiet, about 10 urinals in a row. Took one near the middle. A few seconds later a guy came in and took the urinal 3 away, he was able to start his flow immediately. I must confess to feeling inadequate since I had about 5 seconds of hesitancy. Thought nothing was going to happen at all and then suddenly I was able to go. A few seconds in another guy came and took the urinal next to me. Felt very strange having a true stranger (rather than someone I know from work) that close but I was able to finish up no problem despite feeling self-conscious. Success! Definately need to practice in this kind of setting more.

Attempt #4 : Back at the office, urgency 8/10. Bathroom empty on arrival, take urinal #1 and wait. Someone comes in and takes urinal #3. They start conversation, 2 seconds hesitancy (which I now consider normal) and am able to go just fine. Success!

Summary

Okay, I'm not back to taking Urinal #2 (the middle Urinal) but I feel like I reclaimed some success and I also feel like I'm getting a more normal relationship toward hesitancy. Breaking the chain of :

hesitancy = anxiousness = Shy Bladder

so that it becomes a more normal

hesitancy = normal = able to urinate

is a key step.

All the same, I'm still aware that I'm sparing myself some tough tests, namely going for the center urinal. I hope next week to get back into that mode, I've been long enough in recovery mode.

How do I know if I have Shy Bladder?

If you think YOU suffer from Shy Bladder

You may not have a name for it but you'll know. Everyone experiences some hesitancy in public bathrooms from time-to-time but Shy Bladder sufferers experience total failure except in very specific circumstances they consider "safe". If you can go without any trouble at home but can't use the bathrooms in the office you probably suffer from Shy Bladder.

Not all urinary problems are related to Shy Bladder and you should check with your physician before starting any treatment to cure Shy Bladder to rule out other diagnosis.

However, if you can urinate at home easily and freely but can't in a public bathroom chances are what you have is Shy Bladder.

The research isn't conclusive but there may be a strong hereditry aspect to Shy Bladder, if you suffer from it, it may be that others in your family also do.

How to know if someone else has Shy Bladder

This one isn't so easy. Not being able to urinate in a public setting can happen to anyone from time to time. Shy Bladder sufferers can also have complex systems of avoidance behaviours that mask their symptoms. Some signs of these avoidance behaviours include :

* Seeks out isolated bathrooms where the chances of meeting someone else are lessened.

* Avoids long trips, seems very home-bound (because unwilling to travel far from safe bathroom)

* Never uses bathroom at work, returns home to use bathroom several times a day

* Never uses a urinal, only ever a stall

* Never goes to the bathroom in the group, always seems to hang back and go after everyone else.

* Does seem to drink a lot

* Never seems to need the bathroom, is considered to have a "bladder of steel"

* Makes frequent trips to the bathroom (keeps going in and leaving trying to find it "free").

* At the mall or a game never hangs around afterward but heads straight home (to use the bathroom)

* Closes the toilet door (firmly) when sharing a bathroom with spouse/partner.

There's nothing shameful about Shy Bladder

Many people suffer from Shy Bladder but it is rarely if ever publicly discussed. Most sufferers do so in silence too embarrassed to explain why they can't take part in certain activities or act strangely around bathrooms. Shy Bladder is a genuine Social Disorder. Having it doesn't make you mad or any less of a person.

The good news is that you can improve this condition, you can get help and find a cure.

What causes Shy Bladder?

Where does Shy Bladder come from? How do people develop it?

Little is really known about the mechanism by which Shy Bladder develops. A study conducted in 2004 found that of 264 men who took part in the study most (58%) had their first experience of Shy Bladder at school as a result of bathroom-related bullying or teasing.

Some people report that their Shy Bladder started as a result of a traumatic bathroom experience (assault, sexual abuse) but for many people it is just something that develops.

Shy Bladder is a form of Social Anxiety.

Predisposition to Shy Bladder?

The 2004 study suggested that people (mostly men) that develop Shy Bladder are more self-conscious or self-aware than the general population, meaning that they tend to be more shy or to dwell on their thoughts, especially negative ones. People who develop Shy Bladder may be "over-thinkers" who have an active inner-life and who have an interest in their own thoughts and motivations. 50% of the study sample had undergraduate or advanced degrees. Shy Bladder sufferers can be highly successful and intelligent.

Hesitancy is normal

Everyone experiences some hesitancy before urinating in a public bathroom. This is a normal response to making ourselves vulnerable in this situation. The problem for the Shy Bladder sufferer is that we are hyper-aware of that hesitancy and begin to feel anxiety about it. The anxiety triggers our flight-or-fight response : "I am feeling anxious and I am vulnerable therefore I must be in danger". This response clamps shut our sphincters making it harder or impossible to go.

Avoidance Behaviours

If you've experienced Shy Bladder once, the next time you are in that situation you will have an increased susceptibility to experiencing the same condition again. This is an unpleasant and embarrassing experience and the Shy Bladder sufferer begins to develop Avoidance Behaviours such as using the stall, waiting until the bathroom is clear, drinking less and holding off going until a "safe" bathroom can be found.

While these behaviours allow Shy Bladder sufferers to avoid embarassing situations they also reinforce the condition.

Breaking the cycle

Any cure of Shy Bladder has to break the cycle of Avoidance and Anxiety. The brain has to be re-trained to see that some hesitancy is normal and that the bathroom is not a dangerous situation.

There are different ways to do that but Cognitive Behavioural Therapy combined with Graduated Exposure Therapy are the current best known methods. The Cognitive Behavioural Therapy can help with restructuring the thought processes around a visit to the bathroom since Shy Bladder sufferers have a skewed understanding of what is "normal" there and the Graduated Exposure Therapy can re-train the body's reflexes to reduce the level of anxiety felt in the bathroom.

Read more about Graduated Exposure Therapy.

What is a pee buddy?

As with so many things, terrible name but a good idea.

Simply stated, a pee-buddy is someone you enlist to help in your Graduated Exposure Therapy. Their role is to make things more challenging for you. Having a pee buddy can greatly accelerate your progress.

Graduated Exposure Therapy with a Pee Buddy

Lets say you currently can only use the bathroom at home when you know that nobody else is in the house, a pretty severe case of Shy Bladder. You enlist the help of your friend and neighbor "Bob" by explaining your condition to him. To your suprise it turns out he doesn't always find it easy to use the urinal and his sister suffers from anxiety, he is sympathetic and agrees to help.

You decide to meet on a Saturday. That morning you drink a quart of water and when Bob arrives you are ready to go.

To start with you get Bob to stand outside the front door with the door closed. That might be enough of a challenge for you to begin. You're able to go (but you don't totally relieve yourself!) so you ask Bob to stand inside the house right by the front door. Again, you're able to go.

By lunchtime you've drunk more water than you thought you'd ever drink in your life but now you are able to use the bathroom upstairs while Bob is watching TV downstairs.

Days, weeks or months later you and Bob go to the mall and you are able to stand next to Bob and pee quite naturally.

Ok. Things might not run that smoothly for you, there are likely to be sticking points and hurdles along the way but that is the general idea.

Why Having a Pee-buddy will help you beat Shy Bladder

One of the problems I have experienced in trying to tackle my Shy Bladder alone is that it's hard to get strangers to reproduce difficult situations for me.

For instance, I might be able to pee at a urinal when someone else is 2 urinals away but I need to practice with someone at the very next urinal. I can't ask a stranger "Hey Bud! Come over here and stand next to me!" (Okay, I could but I probably wouldn't live long) but if I have a sympathetic pee buddy he'll stand next to me and pee all day long and I will progress much faster.

If you have a brother, sister or best buddy who can be a pee buddy for you my advice is to try to enlist their help.

If you don't have a pee buddy

Don't worry, a pee-buddy isn't a necessity for progress. You can do it alone but it will likely take longer. Hey, you've already suffered with this thing for a few years most likely, a few extra months to beat this thing is bearable and you can do it.

Alternatively, the Shy Bladder Institute runs occasional workshops where you can meet other sufferers and act as pee-buddies over a weekend. People who have attended these workshops often report large improvements. The schedule can be read here.

Unfortunately, the cost is around $450 but the sessions in the US and Canada are led by Steven Soifer, the author of the book, and one of (if not the) leading expert on Shy Bladder so this could be money well spent and set you on the road to recovery.

Progress Report #13 : Lucky for some?

Had a poor showing the last couple of weeks so decided I had to get back in gear and get back into practice.

Attempt 1 : Spotted a colleague going into the bathroom. Sure enough, at Urinal #3. I take urinal #1, have hesitancy for about 5 seconds. Decide to start a conversation, a couple of seconds into chatting, able to go normally. Success!

Attempt 2 & 3 : Someone comes into the bathroom, I'm able to pee normally. They don't take urinals however. Note to self : Don't waste these opportunities. Failure. Note to self: Stick to the rules!

Attempt 4 : Can't wait any longer. Note to self : Don't empty. Come back later. Failure

Attempt 5 : Someone in stall, someone at sinks. Use urinal. Hear a voice, it's the guy who said "Always uses the stall when I'm talking to him". Satisfying to pee freely while he's washing his hands. Mild Success

Attempt 6 : Waiting at Urinal#1, someone comes in and takes #2. Had an urgency of about 7/10 but was able to go with only a couple of seconds of hesitancy. A few seconds in someone else comes in and takes urinal #3. Doesn't affect me at all. Success!

Attempt 7 : Walk into bathroom, someone is using urinal 1, I take urinal 3. Again, 2 seconds hesitancy and I'm able to go totally normally. Urgency was 8/10. Success!

Attempt 8 : Walk into bathroom. Couple of guys are having a conversation at the sinks, pretty loud. Urgency about 7/10. Able to go just fine with no hesitation. Mild success

Attempt 9 : See a colleague going into bathroom ahead of me. He's at the center urinal. I have an urgency of about 6/10. Decide to try anyway. Total failure, unable to start. As soon as he walks away I am able to go. Annoying but I won't let it get to me. Need more focused practice and higher urgency. Failure

Summary

Overall not a bad showing. I had a couple of weeks where I didn't make the effort to progress followed by a high-intensity set of failures. This was my come-back attempts. So far though it looks like I didn't fall back as far as I had thought. I'm claiming some success for attempts that weren't 100% to plan because I'm in a fall-back mode, just trying to see where my limit is currently set.

So where am I? It seems that I've got my Shy Bladder beaten back now to the point where I can go freely if there are others in the bathroom but not using the urinal. I don't seem to suffer with anxiety that someone will come in while I'm standing alone in a bathroom either. I still have a long way to go but that's satisying progress.

Have noticed that I'm talking at the urinals more maybe as a cover for hesitancy. That will be something I have to watch, can't become dependent on that since you generally can't chat with strangers at the urinal. Attempt #9 suggests that I still have a problem with side-by-side encounters and low urgency so I'm going to have to go back into the discomfort zone and get back up to 8+/10 urgency (which is the part I hate about the whole process, it's unpleasant). At the same time the fact that I was able to stand there while someone else finished up without burning embarassment suggests that my attitude toward hesitancy is healthier, I know it's not the end of the world now - that alone makes me a better functioning person.

Graduated Exposure Therapy is a process and more art than science. My feeling is that so long as you are making even tiny strides forward it's worthwhile. I've come too far to let things slip back now.

What to do when you fail

A bad couple of weeks

It's been 14 days since my last progress report and that was primarily because there was no real progress to report. I stopped testing myself and, inevitably, I didn't progress.

In the workplace I didn't fall back to the stalls but I wasn't severely tested either. A few times I stood waiting at the urinal for someone to come in to test myself but I got tired of waiting.

Last week I had a major test, a business trip with a number of colleagues. That meant using high-traffic bathrooms at the airport and high-pressure situations between breaks in long meetings when everyone headed to the bathroom at once.

It was a pretty miserable experience. I let my avoidance behaviour push me around and used the stall (successfully, standing up) 3 times on the trip. The bathrooms at the business meetings were just as bad - used the stall and while I was using the stall I had one of the team comment that he always sees me using the stall. Nothing was meant by it and I laughed it off but it triggered my Shy Bladder in a big way (although I was finally able to go).

This is about as bad as it gets.

What to do when you fail

So I had a bad couple of weeks mostly brought about by not actively working to progress. I forgive myself ;) Everything I have read about Graduated Exposure Therapy suggests that it's a process of retraining yourself to find the bathroom non-threatening. Persistance is absolutely required. No practice, no gains.

For me the course is pretty clear, drop the goal a little to reflect the fact that I've slipped and start to work up again. The Graduated Exposure Therapy has worked for me I just have to keep with it. So new plan :

1. Use urinal #1
2. If someone in stalls, come back later
3. Wait until someone enters room before using urinal.

That's a step back from my "use the center, only when someone comes and stands next to you" plan of a couple of weeks ago but it's a good base, something I know I can do and with persistance I will be able to build back up.

As I keep saying, Graduated Exposure Therapy works but it isn't easy.

Shy Bladder Research

From May to September 2004 an Australian, Dr Russell Gibbs carried out an internet study of 286 men suffering with Shy Bladder at the University Of New England (UNE).

It's a pity that the study is now closed. Here's a screenshot of the front page :



The URL, if you're trying to make it out is :

http://esurvey.3tt.com.au/survey/survey.asp?ObjectUID=34206

I logged in with the userid "pta" and the password "pta010"

If you missed taking part (as I did) then at least you can read the results of that research here.

Sadly the results don't show what the questions asked were although it hints at the following questions being asked in some way :

1. Your age
2. Your level of education
3. When did shy Bladder start for you
4. Where did shy bladder start for you
5. Location : Country and/or State
6. Marital status
7. Do you feel anxiety when using a public restroom?
8. Does failure to urinate cause you stress?
9. Do you feel others are judging you when you void?
10. Do you search for vacant restrooms?
11. Do you use the stalls instead of using the urinal?
12. Do you restrict your liquid intake?
13. Has the condition limited your job opportunities?
14. Can you only urinate at home?
15. Have you ever sought help for the condition?

16. If yes, after how many years?

17. What treatments have you tried (check all that apply)

a) Psychotherapy
b) Graduated Exposure Therapy
c) Self Help Group
d) Medication
e) Cognitive Behavioural Therapy

18. Has your condition improved or worsened with time?
19. Have you ever been asked to provide a urine sample?

20. If yes, were you able to?

21. If you have not been asked to provide a urine sample, could you if asked?
22. (A set of questions about your feelings and self-awareness, eg. are you shy? etc)

It would be great to read the original questions. I hope there will be further research into this field and that wider access to the data will be provided in future.

You can contact the author at gibbs.psychology@bigpond.com

Recovery Stories

The Shy bladder Institute has a number of recovery stories.

I wanted to examine these stories and see what the common threads were. Here's my summary :

Am I cured? (JohnW)

Age Shy Bladder Started : 16
Reason : Not stated (hints could have been faster with support)
Age at posting : 63
Started Treatment : mid-30's
Time for cure : Not stated
Full Cure : Yes

Treatments tried :

Graduated Exposure Therapy
Professional counselling
Meditation/Relaxation

A cure story from Don in CA

Age Shy Bladder Started : 13
Reason : Bullied in Bathroom
Age at posting : 44
Started Treatment : 43
Time for cure : 1 year
Full Cure : Yes

Treatments tried :

Graduated Exposure Therapy (also using Pee-Buddy)
Support group through IPA website
Read all available material on Paruresis (Shy Bladder)
Professional counselling (Psychiatrist)
Seratonin based Medications
Self-Hypnosis tapes
Religious faith

Cured by knowing International Paruresis Association exists

Age Shy Bladder Started :15
Reason : Bullied in Bathroom
Age at posting : 33
Started Treatment : 33
Time for cure : Immediate
Full Cure : ? (Says still can't use Urinal)

Treatments tried :

Just knowing that this was a real condition and they were not alone effected an immediate relief of symptoms

My Successful Road to Recovery

Age Shy Bladder Started :Not stated
Reason : Not stated
Age at posting : Not stated
Started Treatment : Not stated
Time for cure : Not stated
Full Cure : No (Still in progress)

Treatments tried :

Found IPA Website (support)
Graduated Exposure Therapy

One Year Since....Telling Others....Self Acceptance....and Success

Age Shy Bladder Started :Not stated
Reason : Not stated
Age at posting : Not stated
Started Treatment : Not stated
Time for cure : Approx. 1 year.
Full Cure : No (Still in progress)

Treatments tried :

Found IPA Website (support)
Read the book
Group ShyBladder therapy (through IPA)
Medications : Lexapro and Lorazepam
Telling other people (support)
Graduated Exposure Therapy (with Pee-Buddy)
Relaxation (Phobease)

Conclusions

I have to admit it's not a great data-set. It may be that many people who make full recoveries don't take the time to report them and are just glad to be free. There are a few conclusions that I draw from this breakdown :

0. You CAN make a full recovery.
1. Getting cured takes time but you can improve your condition quickly.
2. Just knowing that this is a real condition that other normal people suffer from is a form of therapy in itself.
3. Graduated exposure therapy is a component of all recoveries reported - the person who found out about the condition and was instantly "cured" still could not face using the urinal.
5. Professional help is a component of all full recoveries reported.
5. Drug therapies should not be discounted but they were always used in combination with Graduated exposure therapy.

As you can see, we are lacking good data on sucess stories. So for the record, here's me :

Age Shy Bladder Started :16
Reason :Teased in bathroom / Just Developed.
Age at posting : 36
Started Treatment : 36
Time for cure : Approx. 2 months
Full Cure : No (Still in progress)

Treatments tried :

Telling wife (support)
Found IPA Website (support)
Read the book
Graduated Exposure Therapy

Hypnosis for Shy Bladder?

Today I saw this website that offers a downloadable hypnosis mp3 for the treatment of Shy Bladder.

The price is $8.95 but it's not clear how long the material is or what you're really getting for the money.

In his success story (at the IPA website) "Don" mentions that he used self-hypnosis tapes as part of his full recovery.

As for me, I'm going to stick with the desensitization technique. I want to see how far I can get with just that.

But if you have tried to use hypnosis in the treatment of your Shy Bladder please post your experiences so we can all get the benefit of your experience.

In the stall

Today I had occasion to use a stall in the bathroom - for the reason they're provided - not as a shield for my Shy Bladder.

It seemed strangely unfamiliar and I realized that I hadn't been in the stall for weeks. I felt that my relationship with the stall had returned to a pre-Shy Bladder footing at least.

I'm not sure it really means anything but I'm noting it anyway.

Progress Report #12 : Maintenance?

I've had a couple of busy work days and I just didn't have the time or determination to really test myself. If I was on a diet, these would have been the days I succumbed to the donuts.

On the positive side, I didn't retreat back into the stalls and I kept up the water drinking but I decided to use Urinal #1 instead of the center.

End result is that on four of my bathroom trips people came in and used the far urinal a few moments behind me. Suffered no hesitancy and all seemed quite normal but on a focused day that would have been four tests that might have moved me forward.

I need to complete my tests with taking the center stall and only initiating once someone has stood up next to me. Once I've mastered that I'll need to find a more crowded bathroom where I can work on walking up to a crowded urinal.

Maybe this weekend I'll get a chance to test myself in a mall or bar.

Progress Report #11

I should have a definate plan for today but I'm not sure what it is. Maybe just "maintenance" trying to keep the advances I've made alive. I feel like I've made some big leaps. The one from the stall to the urinal was huge. This lack of focus might prove to be a problem, it could make it easy to slide backwards but I'll see how it goes.

Attempt #1 :I guess I'm just in the habit of testing myself so I'll stick with the "Attempt" moniker. Went to the bathroom with urgency about 8/10. Had been chugging water all morning as normal. Standing there at the center urinal waiting. After 2 minutes I succumbed to weakness and just started to go. Lucky for me a co-worker came in after a few seconds and took the urinal next to me. There was a time when I would have had a surge of anxiety at the door opening. I've been in that situation before and watched my flow shrink to a dribble and stop. Not this time though, everything was normal.

I know my recent successes don't mean I'm cured. It just means I've managed to push my Shy Bladder anxiety beyond the situations I'm currently being challenged with. Will I be able to go at a crowded sports stadium trough?

Attempt #2 :This time I wait at the center urinal. Urgency 9/10. Another guy comes in, I start to pee, he goes to the stall, comes back and takes the urinal next to me. I know him, we chat. All is normal.

Starting to look like I need a new challenge.

Attempt #3 :I'm in the bathroom with an urgency of about 7/10. I take the center urinal. While I'm waiting I decide, on a whim really, to test myself by waiting until the other person comes in and stands next to me before starting my stream. Normally in these situations I'm starting my stream as soon as they come in. So, someone comes in. They stand next to me. Nothing happens. It turns out that it's someone I know, he starts some small talk but I'm still not able to go. I don't have a rush of anxiety but I can't go until he's finished up and flushes. The moment he's not actually standing at my shoulder I'm able to go. Failure. But I have identified a new challenge. Frustrating that my Shy Bladder has so many levels but I am determined to break down every one in turn. Should probably be able to manage this with a higher urgency level.

Attempt #4 :I take up position in the empty bathroom. Center urinal. Urgency 9/10. I wait a few minutes then someone comes in. I get a spike of anxiety and the guy takes the urinal next to me. I'm not sure if I'm going to be able to go or not, the urgency is overriding my anxiety at least. After a second of hesitancy I start to go, a good, normal flow. I know the guy, he says, cryptically "You enjoy standing there?" English isn't his first language so it's hard to know what to make of the statement, you can't always read things into what he says. I laugh it off, say I had some things to think about. He makes some small talk. We finish up. Maybe he saw me jump when he came in? Anxiety starts to blow this out of proportion : Have people noticed my hanging around in the bathroom? It seems unlikely - it was probably a comment about me standing at the center urinal. Overall a success.

Attempt #5 :Someone is in the bathroom washing their hands. I walk up and use the urinal with no hesitation. Wanted to test myself again with someone standing next to me but the conditions don't always work out that way. Will have to take this up tomorrow.

Further reading :

Read what happens next in Progress Report #12

Can you really be cured of Shy Bladder?

This is a question I ask myself from time to time. As my progress shows you can certainly recover from it, taking back your life through Graduated Exposure Therapy and maybe other treatments. Based on my progress so far I expect to be able to make a full recovery some day (maybe soon).

But what form will that recovery take? My observation of the mensroom tells me that everyone suffers from some hesitancy and everyone has some avoidant behavior. Give a guy a choice of a urinal next to someone else and an open stall and a certain percentage will choose that open stall. I've seen this in action over and over.

With Shy Bladder this hesitancy and avoidance behavior spirals out of control. It's not just sometime, it's all the time.

Do sufferers have a pre-disposition to the condition? If so, can you eradicate the underlying cause or are we simply wired that way? If I cure myself through Graduated Exposure Therapy will I stay cured? Or will I inevitably slide back into it and be forced to confront my Shy Bladder time and time again?

People have reported curing themselves of Shy Bladder. But are these rare cases? I don't know, I'm not sure anyone does. I do know that Graduated Exposure Therapy is working for me and if I do slip back I now have a system to defeat it again.

I've had a couple of great days where it was as if I was free from the condition only to slide back again so I know that just because you think it's over doesn't mean it is. I accept the fact that I am going to have to continue to challenge myself and not allow my avoidant behavior an opportunity to come back in.

Even when I'm symptom-free I suspect it will be easy for me to avoid using a public restroom and "wait until I get home" when at the crowded mall. If I never get that kind of thought again, maybe then I can truly call myself cured.

Further reading

Analysis of recovery stories from Shy Bladder Institute Website.

Analysis of Shy Bladder from an Internet-based study carried out in 2004.

Progress Report #10 : Keeping up the pressure

In yesterdays post I'd decided to take the center urinal whenever possible and try to desensitizing myself to someone standing next to me. I had mixed but encouraging results. I realized then that I needed to maintain that momentum so I'm sticking with that same plan.

Attempt #1 : Empty bathroom, urgency of 10/10. It was very very tempting to give up to the thoughts running through my mind..
You had a good day yesterday, you made some progress, you can afford to just go now. There's always later for testing yourself...

But I stuck with it. This Graduated Exposure Therapy isn't easy but it is effective. The gain is worth the discomfort.

It was a couple of minutes before someone came in and took the urinal next to me. I was in the center again. I started my flow the moment I heard the door open and didn't experience any anxiety only a relief that I could finally go. As I was finishing up someone else came in and took the other urinal. It was too late to feel anxious then, I'd already finished but probably helped desensitizing me a little. A great start. Lets see if I can keep it up. Success!

Attempt #2 : Urgency came on very suddenly at about 11/10. I attempted to wait at the urinal for someone to come in but I started to get a pain low in my back on the right side. I've felt this a couple of times before. Decided to listen to my body and release the pressure. Hope this isn't going to plague me, suspect it's just a result of drinking 60 oz of water in a few hours. Failure. This didn't move me forward.

Attempt #3: Went to lunch with some colleagues. Afterward was talking to one of them and I needed to go to the bathroom so I started to walk away. It became clear that he was also headed that way. In the past this would have made me very anxious and I would have had to suddenly realize that I needed to be at my desk or to speak to someone else. But I remembered a time before when I was talking to a co-worker at the urinal and I was just able to go quite naturally. So I went along. We walked into the bathroom, took urinals 1 and 3 (2 was empty) and I was able to go with no anxiety or hesitation. It was as if I didn't have a problem at all. Then another co-worker came in and took urinal #2. We all 3 just carried on chatting. Success!

It may sound corny but I feel like I got a slice of my manhood back again. One of the things that Shy Bladder robs you of is the cameraderie of the mensroom. I wish it was that way every time for me. I am getting better. In the last month I've had more success in the bathroom than I've had in 20 years. I'm going to get free of this thing. I know I'm not cured yet, I have to keep on fighting.

Attempt #4:Entered the bathroom. Someone was just drying their hands. Went to the center urinal and urinated just fine. No anxiety about someone in the room. Strictly speaking a failure because I didn't pee while someone else was at the urinal. I guess I was coasting on success #3. Failure. Again, this didn't really move me forward.

Attempt #5:Headed for the bathroom, urgency of 9/10. Saw someone go in ahead of me. Sure enough, they are at Urinal #3. Would be poor etiquette to take Urinal #2 in this circumstance so took Urinal #1. Peed like I'd been doing this regularly for 20 years. Other guy didn't seem to suspect that I'd taken a 20 year hiatus from using the urinals with others around ;). Wasn't shoulder-to-shoulder but Success none the less. No anxiety, utterly routine and mundane.

Attempt #6:It's the end of the work day and I decide to go to the bathroom one last time before heading home. One problem : I have low urgency, maybe only a 6/10. On the way to the bathroom I see someone else going in. I get a surge of anxiety but I decide I have to face it anyway. I get inside the bathroom and they went to a stall. I'm able to go just fine. Not sure how to classify this one. Didn't follow the rules, so a failure but discovered that urgency is a dimension of my Shy Bladder that I will have to work on. I want to be able to urinate at a crowded urinal if I just "need to go" and not be reliant on painful levels of urgency.

Even after an otherwise good day, I discover new depths to my Shy Bladder problems. I am progressing though, just gotta keep on.


Further reading :

Read what happens next in Progress Report #11

Progress Report #9 : Mixing things up

Most of the success I have had at the urinals has been when I am waiting for someone else to come in to use the urinal, starting my flow as they enter the room. I seem to be able to do that pretty consistently.

One thing that sets off my avoidance behaviors pretty powerfully is the idea of standing shoulder-to-shoulder with someone else in the urinals. As I found out in progress report #8, if someone is using the center urinal of 3, I just can't bring myself to stand up next to that person.

That happened to me a few times last week and it knocked my confidence and set me back a little. What would happen, I wondered, if I decided to use the center urinal myself? I set myself a new plan :

1. Use the center urinal if you can.
2. If someone is in a stall, leave and come back later.
3. If the bathroom is empty, wait until someone comes in.

The idea is to desensitize myself to having someone standing next to me at a urinal. This is a tough test and I'm prepared to fall-back a little if it doesn't work out but I want to try it, I might learn something.

Attempt #1 : Waited at the center urinal with an urgency of about 8/10. Eventually someone comes in. My heart starts beating out of my chest but I manage a thin dribble. I know it's going to stop completely if they come and stand next to me. They don't. Instead they go to a stall to pee. The pressure off, I'm able to finish up just fine. As I go to wash my hands I discover it's one of the guys who last week was himself standing at the center urinal, causing me to use the stall. Natural justice at work. Unfortunately my anxiety has me literally shaking as I leave the bathroom and minutes later I still feel jittery. Success? Failure? A little of both but a very Interesting experiment. I managed to pee some. I'm going to stick with it but go for a much higher level of urgency. I down another 20 oz of water and wait.

Attempt #2 : Took up position in an empty bathroom as before. This time urgency about 9/10. Someone came in and again, felt a rush of adrenaline and anxiety. Again, was able to push out a thin stream and again felt anxious that if they came to stand next to me it would come to a halt. They took a stall and again, I finished up normally. This time I'd say the anxiety was about 80% of the last time. Still feeling that this is worthwhile so I'm going to continue.

Attempt #3 : Took up position as before, this time with an urgency of 10/10. Eventually someone came in the room. I was able to start immediately with a better stream than before. The guy coming in took a stall to pee. For goodness sake, does everyone around here have Shy Bladder! Anxiety was again down, maybe only 70% of that first time so I feel like something is happening. I'm going to stick with it, see how this works out. Maybe someone will be brave enough to take a urinal next to me.

Attempt #4 : Urgency 9/10. When I arrived in the bathroom someone was already at the center urinal. I took a (mental) deep breath and decided to go for it. I stepped up and waited to see if I would be able to go. There was definite hesitancy but within a few seconds I was able to go quite normally. I felt a slight amount of anxiety but nothing like before - much more like my breakthrough day in fact. As before, nothing felt different I just didn't get anxious. Success!

Attempt #5 : Urgency 10/10. The bathroom was empty so I took the center urinal and waited. I stood there for what seemed like eternity but must have only been 5 minutes. Someone came in and I started to go with good flow. They walked up and took the urinal next to me. It certainly didn't hurt that the guy who came up was a lot younger than me, barely into his teens. I didn't feel at all threatened by him.

Then something happened that made me realize where some of my Shy Bladder might have come from in the beginning : my pee began to spray. If you're uncircumcised, as I am, your foreskin can roll-back so that it interferes with the flow and you'll start to get spray - just like putting your hand over the end of a hosepipe. I stopped my flow, re-adjusted and continued just fine but my anxiety leapt markedly.

Could this be the source of some of my problem? I think I am somewhat anxious about this kind of thing happening to me in a urinal. It would be horrifically embarrassing to miss the urinal in a public setting. But the solution is so simple, just pull back my foreskin a little!

Apologies to readers who find this too much information. I'm trying to work through things here and pulling punches won't help me or anyone else.

Summary

Overall I'd say today was a mixed success. I faced down some heavy anxiety early in the day and was once able to step up next to someone else and pee quite normally - perhaps because I'd already gone through more anxious situations? If past experience is anything to go by, tomorrow will be a pivotal day - either frustratingly worse or suddenly better. If I focus and don't let good opportunities pass me by I should be able to increase my chances of another day of good progress.

Further reading :

Read what happened in my next report (#10)

Progress Review

It's been a month since I first started on my plan to beat my Shy Bladder.

When I started my plan my usual bathroom habit was to make for an empty stall, preferably one with nobody occupying the one beside. I'd take a sitting position and I would usually be able to urinate. If someone was in the stall beside me I would find it much harder especially if they were particularly quiet because then I'd feel that they were listening to me (and by extension judging me). In those circumstances I'd often try to make noises like I was trying to take a #2 to cover my concern that they were judging me for using the stall just to urinate.

What a tangled web.

The first plan was to get back to standing up, in a stall with the door closed (but not locked). I considered going with a locked door but decided I could do it with just the door closed. I had to aim for the water to make as much noise as possible : "Judge this suckers!"

In the event, I managed that pretty easily. This was exciting, I felt I was taking tiny steps to get my life back. At least I was standing up like a man again!

My second plan involved staying in the stalls but moving to the stall closest to the urinals and leaving the door ajar slightly.

That time didn't go as smoothly, mostly because I didn't stick to my plan and so didn't feel I could graduate to a harder test although I found that I could urinate with the bathroom door left wide open which was more progress than I expected. I spent another week at this stage, not really focused enough on my treatment to move ahead.

Looking back I'm now happy that I kept a diary of my progress because it allows me to see that I had some early success and then plateaud for three weeks, not really progressing but not falling back either. If I see this pattern again I will know that it doesn't mean the end of my progress, it's just a plateau. Perhaps I should have challenged myself more but I wasn't ready to make the leap from the stall to the urinal yet.

It wasn't until Progress Report #5, nearly a month after starting my original plan that I faced the fact that I'd have to move to the urinal to progress.

I made up some new rules to help myself succeed :

1. Use the urinal while someone else is at a urinal.
2. If someone is in a stall and nobody is at the urinal, leave and come back later.
3. If the bathroom is empty, wait at the urinal until someone comes in.

That experience ended in near total failure. Moving to the urinals was as difficult as I feared it would be. First I allowed myself to fall back on avoidant habits and run to the safety of the stalls. Next I was only able to push out a tiny stream when someone else was at the urinal.

This was very dissapointing at the time but I learned a few things about myself in those attempts. First, I did manage a small stream which was more than I'd managed in that situation for some years, second other people had hesitancy at the urinal and that it was OK.

I'm glad I stuck with it because the very next day I had my first real success. I was able to walk up to a urinal while someone else was using another and pee. Not a strong performance considering my urgency of 11/10 but progress!

Three days later I had a breakthrough. In one day I seem to go from one weak success to using the urinal at will. I'm asking myself how this happened, am I cured? Of course, I know I'm not, this is just one battle in a war of attrition I'm fighting with this condition but what a day!

It takes exactly 1 week to bring me back down to earth. I have an early failure to perform in a situation I managed before and it knocks my confidence. Then I allow my Avoidant Behaviour to run the show and it drags me down again. It's pretty depressing but I do manage at least one success in the week.

I ask myself, what changed? And I realize that sometimes you're just going to have a good day when you seem to break through but that doesn't mean you can't drop back down again. The important thing is how far down you drop, so long as you're always making progress, however small, you are winning.

My guess is that I'm at the plateau again. I need to keep working at it until that breakthrough day is everyday.

I know I'm winning because already I know that I can go in a stall standing up with the door wide open. I know that I can go at a urinal if I'm the only one in the bathroom - I'm not plagued by anxiety that I won't be able to go if someone comes in because I just spent a week training myself to WAIT until someone comes in before I would go. I also know that I can go at the urinal if others are in the bathroom (even close by) but are not at the urinal.

All the same, I'll be happy when I can stop drinking 100oz of water a day and just use the bathroom at-will like most other people.


Further reading :

Read how things went from here in Progress Report #9.

Progress Report #8 : 1 Step Back

After a fantastic week in which my Shy Bladder seemed to be fading away I had a fall-back week this week.

Loading up on water and hanging out in public bathrooms while desperate to go is, as I've said before, torture.

In previous posts I tracked each an every attempt to void but this week I just didn't have the focus for it.

A poor start

Monday started badly, I walked into the bathroom with an urgency of about 9/10. Someone was at the urinals already and I walked up confident that my breakthrough last week would carry me through this. I felt confident, then nothing happened until the other guy finished and walked away from the urinal. I was able to go as soon as his back was turned but it blew my confidence.

Things get worse

Then I had a series of situations where I entered the bathroom and someone was already at the urinal. This would have been a perfect opportunity but for the fact that the psychopath had decided to take the center urinal meaning there was nowhere to stand except right next to them. That was more than my Avoidance behavior was ready to undertake. As happened to me before, my Avoidance steered me into the stall where I decided to wait until the coast was clear and try again. Then, my luck, an endless stream of people kept coming into the bathroom and holding conversations. I just gave up and urinated there in the stall (sitting down) feeling like I'd slid back to square one.

Some success at last

But I didn't give up. I managed to get at least one occasion where I was waiting at the urinal in an empty bathroom for someone to come in and use the urinal and when they did I was able to urinate fine (admittedly they didn't come and stand right next to me).

Managed to go in two quiet (but not deserted) large public bathrooms away from my usual test bathroom and didn't feel the usual adrenaline/anxiety rush while approaching or before voiding in that kind of setting.

Summary

So overall, 2 steps forward, 1 step back. Consistency is key, just gotta keep pushing on.

Further reading :

Read my one-month review of progress so far.

What is Graduated Exposure Therapy?

From Wikipedia (edited for emphasis) :

A highly effective treatment which involves slowly and incrementally increasing a patient's exposure to a feared situation.

Such therapy would typically begin with a low-intensity exposure to feared situation....and gradually derive small steps of increasing intensity until the goal situation can be comfortably faced by the patient...

Graduated Exposure Therapy for Shy Bladder

Even if you have a chronic case of Shy Bladder you will be able to urinate somewhere under the right conditions. This might be the one "safe" bathroom at home or it might be in an empty public restroom.

Graduated Exposure Therapy means identifying a "next step" to take, a challenge that you might expect to be difficult but which you feel is do-able.

Going it alone

Graduated Exposure Therapy is something that you can do on your own and my experience shows that you can make significant progress this way. However, you do not have to face it alone. Having a so-called pee-buddy help you will significantly speed up your progress. There are also support groups run the International Paruresis Association that can help you work with Graduated Exposure Therapy.

When I started my program I was only able to go while sitting down in a stall. My condition was better than some, I could go if others were in the stalls beside me if they weren't too quiet.

Start from where you are

Like any journey, you have to start where you are. Taking back the parts of your life that Shy Bladder has taken from you might take many small steps. Each might seem inconsequential but each one is a victory.

The first step in my recovery was to try to use a stall away from the urinals, with the door closed but standing up. Standing up! It was a micro-step but you can make great progress with only micro-steps if you're persistent. Currently, I can use the Urinal when someone else is also using the urinal (in the right conditions). I'm not cured yet but I am winning, I am taking back my life!

Next steps

What could you do today to progress?

Please think about one other thing, step zero : If you have a partner, tell them about your condition. Read why I think this is so important.

Further reading :

Read my latest progress on how Graduated Exposure Therapy is working for me.

Read more about Graduated Exposure Therapy at Wikipedia.

Can you really be cured from Shy Bladder?

Beating Shy Bladder

Can't pee with other people around?
Think you're the only one?


If you suffer with Shy Bladder I have some good news :

* It's a medical condition known as "Avoidant Paruresis"
* You're not alone.
* There is a simple cure, it's not easy but it's free and it's painless.

You can read all about it in the book

Further reading :

What is Shy Bladder?

What causes Shy Bladder?

How do I know if I or someone else I know has Shy Bladder?

A cure for Shy Bladder

How to plan your own recovery from Shy Bladder

About this site

If you or someone you know suffers from Shy Bladder I hope this site helps you to reduce the effect of this condition on your life and even to find a cure.

Please, please comment on posts, I want to make this site useful for other sufferers as well as a way to document my own progress.

As for me, I've decided to try Graduated Exposure Therapy myself. Read my plan. Then, if you still haven't had enough, read how I started to retake my life in a review of my progress after the first month.

Progress Report #7 : Breakthrough!

Last week I had my first success at the urinal.

Now I'm on a roll, I didn't want to miss any opportunity for further advancement so I started out again with the fluid loading from my original plan. I have progressed since then so to recap the latest plan from progress report #5 :

1. Use the urinal while someone else is at a urinal.
2. If someone is in a stall and nobody is at the urinal, leave and come back later.
3. If the bathroom is empty, wait at the urinal until someone comes in.

If you don't want to read the blow-by-blow account, skip to the Post-mortem.

Attempt #1 : This plan is harder than it looks. It took 3 trips to the bathroom to find it empty. Each time there was someone using the stall. I know that I can use a urinal if someone is in the stall (in this bathroom at least) so I had to keep leaving and going back.

By the time I found the bathroom empty and took up position at a urinal my urgency was again 11/10. It was very tempting to relieve the pain but I didn't want to lose any opportunity for success now that things seem to be going well.

After four or five minutes the colleague who I saw in progress report 5 (attempt 2) came in and took the far urinal. I think I initiated my stream the moment I heard the door open but I was able to maintain it with no trouble. He didn't seem to have trouble this time either.

Wow, I did it! SUCCESS!


Attempt #2 : On my first trip to the bathroom I found someone was in the stall so I left. As I was walking back to the bathroom to try again (urgency 9/10 and rising!) I saw someone entering ahead of me. This made me slightly worried since I've been working on the assumption that I'll be waiting for someone to enter the bathroom in order to go and haven't yet tried walking up to a urinal already in use.

Sure enough, he was at the urinal. I decided to stick with the plan, walked up and amazed myself by going without any delay. SUCCESS!

Attempt #3 : I walk into the bathroom, urgency at 9/10. Someone is in the stall so I decide to wash my hands and walk out again. While I'm washing my hands, someone comes into the bathroom and uses the urinal. I decide this is a perfect chance and instead of walking out I step up to the urinal. I void instantly and with normal (meaning "at home") flow. SUCCESS!


Attempt #4 : Had to wait in the bathroom with painful urgency 10/10. Waited until someone came in to use the urinal. Started flow with no problems. Tested myself further by stopping and re-starting my flow. No problem. SUCCESS!


Post-Mortem
This is amazing, am I cured? How did it happen this fast?

The strange thing about each time was that it didn't feel any different to the way it normally does when I approach the urinal. Despite my string of success I didn't approach it with any less doubt, I kind of expected to fail. But I didn't.

For me, this is one of the most difficult things to handle about Shy Bladder : Dealing with the fact that you don't get to choose. Some deeper level of your subconscious is running the show, a will-of-iron to succeed or a fatalistic belief that you will fail doesn't seem to make any difference, your subconscious decides regardless.

But I am winning! It's almost as if my Shy Bladder is fading away. Each success makes me feel more confident that this is the turning point. I had dreaded the jump to the urinal from the stall but it has gone far better than I could have hoped.

I know I'm not free yet. I haven't yet had to deal with a crowded restroom or tried to use the middle urinal of 3 but the grip of this condition is loosening, I am reclaiming my life.

I can't believe I've come so far in the few weeks since I started with my simple plan.

Further reading :

Resd about the next week of my progress.

Progress Report #6 : First Success!

The current plan is to use the urinal when someone else is doing so, waiting around for someone to step up to the urinals if necessary.

Today I had something of a breakthrough. I entered the bathroom with an urgency of about 11/10. It actually hurt to walk. When I got in there a colleague was using one of the urinals. I was able to step up to another and almost instantly pee. True, my flow was not so strong that it risked damaging the porcelain but it was not a trickle either. SUCCESS!

If you don't suffer Shy Bladder it's hard to explain how exciting this is. Put it this way, this is the second time in about 20 years that I've been able to walk up to a urinal and pee while someone else was standing nearby.

Question is whether this worked for similar reasons to the first time or whether I can do it again.

Either way, the graduated exposure therapy and water loading is WORKING. I feel like I am curing myself.

Further reading :

Read what happened next.

Progress Report #5 : Not easy to pee

Up to now I've been testing myself by using the stall, peeing directly into the water to make as much noise as possible and I managed to progress to using the stall nearest the urinals with the door left wide open.

To the uninitiated this may not seem like much but only 6 months ago I couldn't pee in the bathroom at all unless it was in the stall, with the door closed, sitting down. So my plan of graduated exposure is working but I have to keep moving forward or I'll drop back.

I've done as much as I can do in the stall so the time has come to try to move to the urinals. This seems like a leap of a hundred miles, moving from the safety of the stall to the urinals.

A word about the testing ground : There are 3 urinals in a line with dividers. This is good because it means that I can still move up to un-shielded urinals and to open troughs (assuming I can find some) as my self-therapy progresses.

So to the test. As before, I'd load up on water until I feel high urgency (7/10 or more) and enter the bathroom. The rules of this game go like this :

1. Use the urinal while someone else is at a urinal.
2. If someone is in a stall and nobody is at the urinal, leave and come back later.
3. If the bathroom is empty, wait at the urinal until someone comes in.

Attempt #1 : Went into bathroom with an urgency of about 8/10. Saw a colleage in there, was gripped by avoidance and so used the stall next to the urinal. Left the door open, had no trouble peeing and carrying on a conversation with the colleage. Failure broke Rule #1.

Attempt #2 : About a 9 on the urgency scale. Went into the bathroom, took the first urinal of 3. Waited for someone to come in to start flow. After a minute or so a colleague did come in and took the furthest stall. Was able to push out a tiny stream but couldn't maintain it and closed down. Dissapointing failure.

Attempt #3 : After standing at the urinal for 5 minutes with nobody showing up urgency got too much and had to pee. Failure.

Attempt #4 : Bathroom stalls occupied, urinals empty. Took a urinal and peed. Failure. Should have followed Rule #2.

Nobody said it would be easy.

Thinking about attempt #2 later I realize that the colleague coming in didn't exactly make a big splash either and in fact flushed the urinal about halfway through (like running the faucet to encourage peeing). I work with this guy and I know he doesn't normally have a problem going so I guess it's normal to sometimes be hesitant and/or not have a great flow.

This has definately been a setback but mostly because I was weak with myself and allowed my ShyBladder to control me. Another name for Shy Bladder is "Avoidant Paruresis" and the Avoidance is a set of habits that you will fall back on if you don't actively fight it. These habits don't actually stop you peeing, but they stop you acting "normally" in the bathroom by steering you into a stall or whatever.

Further reading :

Read about the next stage in my progress.

Progress Report #4 : It's getting better

When I started this process I had a simple plan. It turns out that executing the plan is more difficult than simply loading up on water and trying to pee in progressively harder situations.

For a start, drinking 100+ oz of water in a work-day means you experience a lot more situations where you need to go to the bathroom with some urgency. This was part of the plan since the urgency helps you know if Shy Bladder is shutting you down or if it's simply the lack of a real need to go.

BUT (and it's a big BUT) that level of urgency is very uncomfortable to maintain. I've sat in important meetings and been unable to truly partake because of the discomfort. In addition, since the plan requires that other people be around when I void I'm often left standing in a stall really burning to go but unable to let myself until someone else enters the bathroom. This is ironic for someone who suffers Shy Bladder but it's also torture.

If you read the book you'll have seen the advice to find yourself a pee-buddy, someone who can help you overcome your problem by walking in and out of the bathroom 100 times if need be.

I am making progress and I'm pleased with what I've achieved so far (though I still need to make the move to the urinal) but I realize that going the do-it-yourself route isn't easy and is much less controlled than having a buddy with whom you can set up progressively difficult scenarios.

So what have I achieved so far? Well, in my test bathroom at least I'm able to go in any stall with only momentary hesitancy with the door left wide open. It's really time I made the move to the urinal but that seems such a leap from the enclosed safety of the stall.

Further reading :

Read how this plan worked out.

Good Summary Article on Shy Bladder

This is an excellent article on Shy Bladder which sums up the condition pretty succinctly.

One of the interesting things the article has to say is :

First, familiarity with other people present in the restroom can trigger BBS, with strangers usually (but certainly not always!) leading to greater inhibition than friends or relatives. Because of the personal nature of elimination, the degree of familiarity and perceived acceptance often determine whether or not the paruretic will successfully urinate.

This might help to explain an unexpected success I had a year or two ago.

The bathroom had been empty and I was standing at the urinal trying to go (unsuccessfully) when a friend walked in and took the urinal next to me. I said "Hi" and we struck up a small conversation. Suddenly I was able to go absolutely normally with no self-consciousness at all.

I thought at the time I'd been spontaneously cured but now I understand that I felt accepted and safe in this person's presence and so was able to go.

Further reading :

Shy Bladder article.

Can Meditation help Shy Bladder sufferers?

One of the symptoms of Shy Bladder is that you often have uncontrolled thoughts in the bathroom. You know that nobody is grading your performance in the bathroom but you simply can't help feeling that way. Your mind seems to race, you feel as if everyone is watching you. This is one of the reasons that a slang term for Shy Bladder is "stage fright".

I wonder if Meditation would be useful for this problem?

At the most basic level, learning to relax is a skill that could be a big help.

But I read an article this weekend and it suggests that at advanced levels meditation can help you "break through" to a higher state of awareness about yourself. I suspect that if you had that ability, fixing your Shy Bladder problems would be a very simple matter. Of course, it might take years to reach that state but being held captive to Shy Bladder for 20 years isn't exactly a good use of time either.


Further reading :

About.com How To Meditate (advice for anxiety sufferers)

How Meditation Works by Shunzen Young.

Beating Shy Bladder : Progress Report #3

In the last week I've been too busy to be systematic about my progress. I didn't have time to stand waiting in the bathroom for someone to come by so I could try to pee.

But I didn't allow myself to regress either. I was lucky enough to find the bathroom occupied on more than one occasion a day and each time I used the stall with the door left open wide. Each time was a success but because it wasn't a progression of success through harder and harder situations I didn't get as much confidence from it as I had hoped. Oh for a pee-buddy!

But I am starting to think that I could move out of the stall into the urinal when there is nobody in the bathroom and wait at the urinal, trying to go when someone enters the room.

This will be a big challenge and I am afraid of slipping backwards but I think I can do it and I'm going to have to try at some point.

Further reading :

Read how this plan worked out.

What is Social Anxiety?

From Wikipedia :

Social anxiety is an intense feeling of fear, apprehension or worry regarding any or all social situations or public events. It is sometimes known as social phobia and, less commonly, social trauma. In psychiatry, it is diagnosed as social anxiety disorder, a form of anxiety disorder. It is currently the third largest mental health care problem in the world, according to United States epidemiological data.


Read more about Social Anxiety at Wikipedia.

Alternatively, this article from SocialPhobia.org discusses some of the forms of Social Anxiety,

More information :

This article by Dr Winston Bush is an excellent article on the causes of Social Phobia, explaining the structures of the brain responsible. It discusses Cognitive Behavioral Therapy (CBT) in some detail and explains why it is so effective in treating Social Anxiety. From that article :

Social phobia (also called social anxiety disorder) is an excessive fear of what other people might think of us. Our opinions of each other should matter — if they didn’t, we’d be living in a corner of hell, not a civilized society. But when someone is suffering from social phobia, he or she is feeling an exaggerated concern for public opinion — one that goes far beyond what we need in order to relate to other people for our mutual benefit.

Read the rest of what Dr Bush says here.

Shy Bladder : A cure!

First, realize you're not alone

The first step to curing Shy Bladder is the realization that you are not alone. There may be as many as 17 million sufferers in the US yet every sufferer thinks they are the only one.

Nobody is talking about it. I'm trying to change that.

Things that don't work

Over the years I tried many things to shake the problem. Drinking a lot in the hope that I would need to go so badly that my body would "let me", trying to Will myself to go - standing at the urinal until I could go. Alchohol to reduce my anxiety. None of it worked. I never sought medical help because I was always 100% normal outside of a public bathroom. This may be just as well since it seems that Shy Bladder or "Avoidant Paruresis" as it is medically known, is not well-understood in the medical community.

Like most sufferers I didn't understand where this problem had come from and I hoped it would one day go away. It didn't and it was slowly getting worse before I decided to look for some help.

Shy Bladder is a Social Anxiety

Shy Bladder is a form of Social Anxiety sometimes brought on by negative bathroom experiences and sometimes just developing out of the blue, for no apparent reason.

Once you experience one failure you can become anxious about your performance resulting in further failure and a self-reinforcing downward spiral.

These experiences train your subconscious to think that the bathroom is a dangerous place and it protects us by amping up our fight-or-flight reflex which in turn shuts down our ability to go at all.

That's the bad news.

A therapy that does work

The good news is that since it's a trained response it can be successfully treated with Graduated Exposure Therapy. By slowly and deliberately pushing the boundaries of what your subconscious considers safe you can start to regain your confidence and your life.

In my case, my Shy Bladder had reached the point that I could only go successfully in a closed stall while sitting down - because I felt that people were judging me for using the stall to pee.

Pee Buddy?

The book (and the Paruresis association) recommend finding a so-called pee-buddy, someone who can help you to progress by deliberately making it easier or harder for you to perform : for instance, standing 10 feet from the bathroom door or standing behind you, muttering.

As a rule we Shy Bladder sufferers are bound into silence by embarrassment and shame at our condition so we don't always have someone we can trust with this role. The Paruresis Association runs workshops where Shy Bladder sufferers can get together to help each other in this role.

While my experience suggests that you can progress without a pee-buddy it definitely would be easier with one.

Read more about how a pee-buddy can help you with Graduated Exposure Therapy.


Other therapies : Drugs? Hypnosis? Cognitive Behavioural Therapy?

The International Paruresis Association maintains a section on drugs and their affect on Shy Bladder (Paruresis). Some people have reported that certain medications did improve their condition.

You can also opt for Cognitive Behavior Therapy (CBT) which is a method of psychotherapy known to be effective in the treatment of Shy Bladder and other Social Anxity Disorders. It is likely a course of CBT will involve some Graduated Exposure Therapy.

At least one person has tried hypnosis as a therapy and reported some success.

Disclaimer : I am not a doctor and I am not giving medical advice. You should seek the advice of your physician before undertaking any course of therapy.

Making progress

There is hope for those of us suffering Shy Bladder and though graduated exposure therapy is challenging and time consuming at least it's something you can start doing immediately with no side-effects.

See how I started my recovery, on my own, with no drugs or therapy using the information I found in the book.


Futher reading :

What is Social Anxiety?

What is Graduated Exposure Therapy?

The Internation Paruresis Association maintains a great page on overcoming Shy Bladder

Article on Shy Bladder at WebMD

My plan to beat shy bladder.

Read about my progress one month into my plan.