The University Record, March 28, 1994

Anxiety Disorder Program treats ‘bashful bladder’

By Kristen Lidke Finn
Medical Center Public Relations

It’s the biggest game of the year. Although halftime is almost over, there’s still a long line of people behind you waiting for their turn in the restroom. You finally get up to a urinal and...

nothing happens. No matter how hard you try, it’s a fumble. You and your bursting bladder gingerly make it back to the bleachers, where you suffer in teeth-clenching silence until it’s time to go home.

Nearly everyone knows someone who can relate to the above scenario. One in 10 American men may suffer to some degree from “bashful bladder” syndrome: the chronic inability to use a public bathroom when nature calls.

Contrary to popular belief, the condition isn’t a mere eccentricity or personality quirk. In its severe form it is a type of anxiety disorder —a social phobia—that can be treated successfully without drugs.

“There’s nothing wrong with these individuals medically. But their anxiety about being around others, or being walked in on, interferes with their ability to urinate,” explains Joseph A. Himle, a phobia treatment expert at the Medical Center.

The disorder, which appears to run in families, ranges in severity. A mild case is having to use a stall instead of a urinal. Moderate is being able to relieve oneself only in a stall and only when the bathroom is empty. Severe is being unable to urinate no matter how private the surroundings. As a result, the disorder can force many otherwise healthy people to become practically homebound.

“We’ve had patients who wouldn’t go anywhere that would require them to be away from home for any significant time. We’ve even had patients who bought their homes near where they worked so they could go home whenever they had to urinate,” says Himle, senior clinical social worker and lecturer in the Department of Psychiatry’s Anxiety Disorders Program, one of a handful of such programs nationwide to offer behavioral therapy for this type of phobia.

Treatment consists of six to 10 weekly sessions. Patients arrive with a full bladder (made even more so with the aid of a diuretic, or “water pill”) and repeatedly practice starting and stopping their urine flow in a variety of restrooms throughout the Medical Center. Patients begin in tiny bathrooms tucked away in remote corners and gradually work up to larger, more crowded lavatories.