Shy Bladder? You're not alone!

Shy Bladder? Can't pee in public? Stage Fright? You are not along and you can recover!

Here is a map of the locations of some of the recent visitors to this blog (don't worry, I don't keep detailed logs and will never publish any information here that could allow someone to be located)



We're everywhere. Good luck to your recovery in 2008!

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?