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.
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.