Shy bladder syndrome (paruresis) is a form of social anxiety. The causes of shy bladder syndrome are complex and numerous. Social anxiety usually results from an individual becoming emotionally distressed in someway when they are in a social situation. Symptoms of social anxiety are numerous and include: sweating, blushing, shaking and panic attacks. What remains common to all these symptoms is that the person experiences a subjective increase in their personal anxiety levels.

Shy bladder syndrome results from a malfunctioning or miscommunication between the brain and the bladder. Under normal circumstances when someone feels the physical urge to urinate, they find a 'safe' place to do so (let's say a public bathroom or toilet). It's a safe and unstressful situation for most people where they are able to perform one of lifes most necessary and basic needs. A paruretic, on the other hand feels the urge to urinate and usually immediately becomes anxious at the mere thought of having to use a public restroom. This physiological response (feeling anxious) is triggered in the person by a simple thought process.

The anxiety triggered from the thought is a result of past experience where the individual will have attempted to use a public bathroom / urinal and been unsuccessful. This causes feelings of personal shame that become part of their thinking patterns. The embarrassment that this may happen again, is sufficient to cause a physical response (anxiety) that almost guarantees that this will be the case and it will continue to happen again (not be able to urinate). It's as clear a 'catch 22' as there is. The paruretic becomes firmly fixed in their own self-generated prison which becomes more and more ingrained within the individual. Often the associated feelings of shame and embarrassment this causes, lead to withdrawal and isolation.

In addition to past experiences of failure to be able to urinate with others around, the paruretic is also at the mercy of his or her own body. The anxiety they experience causes certain physiological reactions within the urinary organs that 'lock up' the bladder. This is due to a biological reflex that means when we are stressed or anxious, we revert to a 'fight or flight' mode. In this state, the last thing the body will do is relax to pass urine. The person finds themselves in fight or flight mode because they perceive a public restroom as 'unsafe' or 'dangerous'. This is a result of social anxiety causing an individual to feel that others around them will automatically be judging them in a negative way. With shy bladder, the individual is unable to urinate and therefore believes that everyone else around them is aware that they may be taking longer than is 'normal' and will therefore be negatively judging them.

Thinking patterns remain at the route of shy bladder and perpetuate and maintain the problem. Interestingly, what gave me the impetus to write this article was coming across a statement made by a 90 year old lady as she reflected back on her life. She said: "What other people think of you is none of your business". True enough and if we could all absorb this, shy bladder syndrome would cease to exist.