4 Cures for Paruresis

It’s been estimated that about 7% of the population (around 22 million Americans) have some sort of Paruresis.

Paruresis is the medical term for Shy Bladder Syndrome, or as most people will say “Pee Shy“.

Paruresis is people that have a difficult, or impossible time peeing in public, especially in a public bathroom peeing around other people.

It’s often caused by some childhood trauma (that is difficult to pin-point), and will generally follow people through life and sometimes get more and more severe with age (especially in Men if they develop an enlarged Prostate).

That makes Shy Bladder HELL!

Paruresis can take on many different levels. Some people can’t pee anywhere but in their own home in the safety of their own bathroom. Others, like me, can urinate in a public bathroom, but only under the proper conditions.

4 Cures for Paruresis

And then there are still others who only hesitate for a second, like in a busy bathroom, having a line of guys waiting behind them, standing shoulder to shoulder with someone as they urinate, or even just being made fun of by their friends as they pee in a trough “Nice Trim Job!

As far as I know of, there are only four known cures for Paruresis. Granted, I’m no Doctor, but I’ve done a lot of research on the subject, read plenty of books, and I’ve been all over the IPA forums.

And when I talk about “Cures“, I’m actually talking about the discovered ways that allow yourself to pee in public. I should also state that you’re never fully cured once you have this social phobia, you are always on the path of recovery, sort of like addictions. You may have some symptoms in some degree or another for the rest of your life.

The Cures for Shy Bladder are:

  1. Breath Holding
  2. Gradual Exposure
  3. Cognitive Therapy
  4. Catheters

Now let’s take a closer look at them…

1) Breath Holding

Breath Holding (Breath Hold) is the quickest way to cure Paruresis… If you can get it to work for you.

Most people can’t do it, but there are a few heroes who have succeeded. They are able to pee free and pee any where in public, even in front of hundreds of people. That’s amazing!

Those who master the Breath Hold technique make me jealous. It looks so simple! I tell you, I’m still practicing this trick and someday I hope to pee at an actual urinal for the first time in my life.

The Breath Hold Technique is Easy:

  1. You Inhale Deeply
  2. You let out about 3/4 of the air
  3. You then Hold your Breath Calmly
  4. Don’t Gasp. Don’t Panic. Just a Steady, Focused Breath Hold
  5. Concentrate on Urinating
  6. Try to feel your Pelvic Floor Drop
  7. As you get to the point where you NEED to Breath, keep holding it!
  8. Hold it for another 10 seconds (or so) until the stream begins

If you hold it long enough, without passing out, your body will seek Oxygen. It will take it from the tense muscle (called the External Urethral Sphincter) holding in your Urine. The increase of Carbon Dioxide in your Blood Stream will force your body to relax, and the hold on your bladder is let go. Your body is now focusing on more important things, like Breathing! You should start to Urinate, and then you should be able to slowly inhale and breath normally again! For most people, once you get the pee flowing, it doesn’t stop! You’re home free!

This technique will have to be practiced often! Every time you Pee! It will take you some time to get used to just holding your breath for a minute or so.

But don’t give up! Keep trying! Soon enough you should be able to hold it long enough (without struggling violently) for the stream to begin.

Then, you’ll be able to use this technique in public, in a restroom, next to other guys at a urinal, and they won’t even know it!

Incredible but True!

To see Breath Hold in action, check out Paruresis Exposed’s YouTube Channel and watch Max and Dominic as they demonstrate this technique. It could change your life!

2) Gradual Exposure

Gradual Exposure is all about desensitization. Getting used to doing things you’d rather NOT do!

It’s making yourself step into uncomfortable circumstances until you DO feel comfortable enough with them to allow yourself to void.

Generally this is done in Work Groups, or at Home with a Pee Buddy. A Pee Buddy is someone who can help you get over your anxiety of peeing with other people around.

This is accomplished in gradual steps until the person is right next to you, or directly behind you (as in waiting for a urinal – and tapping their feet impatiently!).

Gradual Exposure takes guts!

It’s probably the most well known and most popular “CURE” there is for Shy Bladder.

  1. You begin with a Friend (whom you feel comfortable with knowing your condition), or another Paruretic who knows exactly what you’re going through, what you’re feeling, and one that you can be totally open and honest with.
  2. Allow a certain amount of time for Urinating Practice (like the rest of the afternoon)
  3. Load up on water so the urge to pee is greater!
  4. Have the person stand at a safe distance away from you as you pee in the bathroom. For some this is outside, for others it is down the hall, and for some it might be on the other side of the bathroom door.
  5. You can choose to empty your Bladder all the way, or you can cut yourself off so the urge to pee remains.
  6. Drink more water and have the person move a little bit closer to you so you feel more anxious.
  7. Try to urinate again. If you can’t, wait it out and take a break before you begin again.
  8. Continue having your Pee Buddy move closer and closer in gradual, but manageable steps.
  9. Only when you feel comfortable with that stage and distance should you advance and try something more uncomfortable.
  10. Work yourself up until the person is at the bathroom door, or even with the door ajar, or open, or with them standing directly behind you!

After you succeed in doing this at Home or in a Hotel Room should you attempt to move this Gradual Exposure to the public bathrooms. This creates it’s own unique situations and anxiety.

Only you will know your own difficulty level and what feels hard for you. Create yourself a Bathroom Exposure Ranking Chart to see what obstacles you need to overcome.

Little by little, with the help of your Pee Buddy, you will get used to peeing in more difficult bathrooms, in front of strangers, and hair raising scenarios that you’d never thought you’d be able to pee under. You’ll face heavy traffic, janitors, people waiting, full stalls, and even a line out the door (Sporting Arena).

It’s teaching yourself that there really is nothing to fear. You can retrain your brain and pee in public, that is, with enough practice, time, and effort.

Work Shops usually last a weekend, and it’s a long weekend of nothing but drinking, practicing and talking about Paruresis! You will put yourself into difficult situations and you will slowly begin to feel comfortable again in the men’s (or ladies) bathroom.

It all begins with the very first step!

Get a Pee Buddy, or register at a Work Shop in your area, or check out the IPA Forums for more information.

If you want to overcome Paruresis, you have to start NOW!

3) Cognitive Therapy

Cognitive Therapy is all about changing your behaviors and thought process!

It’s breaking down negative thoughts like “I can’t Pee at a Urinal next to another Man” and replacing it with “I CAN Pee at a Urinal! Just watch me!

You have to look at all your negativity and find evidence against it.

People will notice that I can’t Pee!

Is there any proof of this?


In fact, people won’t even see you, let alone focus on whether or not you’re peeing.

You have to replace that negative thought with more positive thinking so you can break the vicious cycle and destroy it.

He’ll think I’m a Freak!

Will he? And how do you know this?

He’ll think I’m Gay!

So what? I’m sure he’s not really thinking that! And who gives a rat’s ass if he does!

He’ll Laugh at me!

And you’ve seen someone actually doing this?

Really? I Think Not!

It’s all perceived behavior that bears no weight. None of this is true, nor have you ever seen it happen. It’s all made up!

Change your mind from thinking that using the bathroom is a threat, to there is nothing to worry about, everybody Pees and it’s just a normal bodily function!


Not only can you change your thought behavior, but you can also change your actual habits as well with associations, which are called Cognitive Metacoding!

Cognitive Metacoding

Some people can link their Paruresis with other things (like how we link a Smell to a Person, or a Song to an Ex).

Links can be Visual things that you think of (like picturing an Arrow Hitting a Target, or a Relaxing Stroll on the Beach), or they can be Feelings that make you feel safe (like the feeling of a Warm Blanket or the Crackle of a Soothing Fire).

Links can also be Smells like the sweet smell of Sugar Cookies, or a Lavender Scented Candle! Your mind can recall these wonderful smells and you’ll actually be able to smell them as if they were really there!

In other words, linking can be anything and everything as long as you always think about it before you Pee.

Link things like: Counting Backwards, Humming a certain Song, Listening to Running Water, Rubbing your Fingers together, Cracking your Knuckles, Closing your Eyes, Standing Tall (Stretching out the Spine), Relaxing, Meditating, Deep Breathing, Rolling a Lucky Coin in your Pocket, or even Snapping a Rubber Band on your Wrist.

Cognitive Metacoding is something that you can do that will gradually be associated with the need to Pee. A Trigger! If you do it at home and out in public, each and every time you need to Pee (Before and During Urination), then your mind will eventually connect the two and associate the act of, say Snapping that Rubber Band on your Wrist with Peeing.

So when you snap the band, your brain will send the appropriate signals to your bladder to pee (so head for the bathroom!). Easy as that!

It may take a bit to change deep-rooted habits and thought patterns. But, you CAN change learned behavior from bad to good. You can re-circuit your mind!

You just need to think differently! Negative to Positive! Do some Associations and Linking to get over your “imaginary fears” and start better, more productive behaviors!

4) Catheters

I don’t really consider Catheters a “CURE“, but if it allows you to pee in public, and nothing else works for you, then it does give you an out and that’s the most important thing. It gives you your life back! (and an empty bladder)

There are many different Styles, Brands and Sizes of Catheters, and I am certainly NOT the person to ask about these since I have never used them.

Just thinking about lubing up some tube and sticking it in my Urethra all the way until it penetrates my bladder and makes the stream come out, makes me cringe! OUCH!


I don’t think I could ever bring myself to doing this, no matter how badly I needed to go. I’d rather just keel over on the side of the road and die from an exploding bladder LOL!

I suppose for some people it’s not an option and they get used to doing it and doing it quickly (and painlessly). But for me, NOPE!

Emergency or not, I’ll pass!

If you’re considering Self-Catheterization, then a good person to ask advice from would be Dave over at Paruretic.org.

He shows you how it’s done and he’s got a forum that you can join to find out more!

Go Dave!

Curing Paruresis is not Easy!

I’ve been attempting to recover and find a cure for a couple of years now.

I’m going back and forth with it because I’m in full denial right now: AVOIDANCE!

I’m scared to begin!

I have been practicing Breath Hold and have felt like I was making some progress, and was even close to urinating a couple of times, but trying this technique out in public didn’t work so well. My heart rate was too fast and I was too anxious to actually hold my breath. I failed!

So it’s not as easy as it sounds!

I am also working on Cognitive Metacoding as we speak. I am trying to link a song to peeing. I’ll keep you informed on my progress. It’s only been one day, but so far so good. Only once did I forget to sing that song in my head as I urinated. If it works, I’ll let you know.

I will say I have changed one horrible habit in my life…

I have learned to Pee Loudly!

Yes, I used to ONLY pee on the side of the toilet bowl where it was quiet and unheard. I have now taught myself for the past 2 years to pee directly into the water so it makes loud splashing noises. That way, no matter where I pee, anyone within earshot can hear me.

It was a huge accomplishment for me!

My biggest break through so far.

The next stage is to rally up my Best Friend Mike and to turn him into a Pee Buddy.

I’m sure he’ll appreciate that!

Who wouldn’t? ;)

But hey, what are friends for?

He’s asked me before “You want me to watch you pee?

If it cures me, “HELL YES!”

Because one day, one day I fully expect to be cured enough to pee in the men’s bathroom with little or no anxiety.

I don’t know what circumstances that’ll consist of yet, but it’s my goal and I’m taking it one step at a time.

This blog is changing the way I feel about Paruresis. It’s making me take a good honest look at myself and my current condition.

See how I tick!

Why do I think the way I do?

Why do I do the things I do?

What do I need to Recover?

That my friends, is the real question!

How about you?

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17 Responses to 4 Cures for Paruresis

  1. greg says:

    I done this stuff about 4 years now an the gains were very small for the effort. About banned at the IPA for saying this. Now off trying to find the real cure. The IQ I got is small. I don’t know how every one feels to me it not just a fear problem. There are a lot other troubles that cause this.

  2. Richard says:

    Hi Greg. If I were you, I would read as much as you can on my site here, starting with my Recovery Day 1, about a year ago. From there on you’ll see my progress and what I was able to do. I still have problems to this day, but it’s 1000% better than it ever was. I mean before I started recovery, I had NEVER EVER peed in a urinal. In fact, I had never even stepped up to one my entire life. And now, here I am, walking in public bathrooms, peeing in urinals with other guys around (and even crying on the plane). I find that I have a 75-80% success rate, which is awesome to me. And those times that I do misfire, I just keep on trying and eventually I WILL AND DO PEE in public. I’ve learned to keep on trying for I know it will work… It’s just shy sometimes. :) I really do owe it all to Fluid Loading. The first time I tried that this year (I always thought it was stupid), it worked like crazy. THAT changed my life. That and Breath Hold (which I do a modified version of now because I have a hard time doing a Full Breath Hold, Read: Beyond Breath Hold). It can get better. I got a Pee Buddy to help me desensitize and I’ve just been forcing myself to leave the house with a full bladder and making myself pee in public. It’s crazy, but I am getting better and recovering. It could take me a couple more years to fully relax, but I do see the light at the end of the tunnel. :) You can too! Keep your head up and never give up. -Richard

  3. rich shullo says:

    Interesting post; I work on various techniques inc hypnosis and EFT- LITTLE HELP SO FAR; BEGAN AT PUBERTY IN CAMP, I WAS ONE OF THE “SLOW” GUYS

  4. Wayne Johanson says:

    I have had this problem for as long as I can remember. I went to therapist and did exposure therapy using the techniques described in the shy bladder book. It got a whole lot better but I am still not totally cured. All depends if the splinter muscles down there stays loose or tight. I did notice that if I am tensed or feeling stressed it becomes harder to go even if I have the Public bathroom to myself. But at least I made progress. It affects all areas of my life, work and social and how far I can travel. the problems has basically made me a life time agoraphobic.

  5. Riel says:

    Hello there everyone! First, thank you so much for posting. I am fortunate to browse everything here. I have been having this same concern since high school and still fighting to overcome it until now. Hope to have more reading materials like you have shared here. Because it is such a relieve to me and to others who experiencing this. God bless you bro! Greetings straight from the Philippines. ^_^

  6. Dennis says:

    I’ve developed my shy bladder somewhere around the age of 20 and it was pretty bad, up till the point where I couldn’t even go in a secluded hotelroom bathroom. This was at my brother’s marriage (halfway across my country, the Netherlands) and I had to bail on his wedding day, spending agonizing hour in the car with a exploding bladder. I ram into a traffic jam, which nearly sent me to tears. Luckily, there was a gasstation close to where the traffic jam started. I pulled over and managed to finally take a leak, which sent shivers over my body from relief..
    This shy bladder thing wreaked havoc on my 20s, almost to the point of becoming a hermit.
    I finally sought help and managed to master a great deal of my problem. Through cognitive therapy, I managed to realise that other people weren’t as observant of my toilet visits as I subconciously was thinking.. Unlike before, I’m now able to use the bathroom at friends houses or (fairly) quiet places, such as restaurants or airports. Only bars, pubs and clubs enstill some fear in me, due to the toilets frequently being used and having guests that are less patient and quiet than sober people..
    I’m 39 yrs old now and lost most of my 20s social experiences to this phobia. But I’m glad I took the steps I’ve taken.. Though not completely cured, I still feel pretty much liberated being able to do things I feared in my darker days..

  7. Richard says:

    I know I had problems in my youth, but not to the point where it crippled me. I would just hold my urine for hours and hours… And yes, I hated it, but I never let it stop me from enjoying my time with friends or family. So I got lucky there. Only as I got older did it become more of an issue… And I still work on that daily. I have to. Otherwise it wins, and I refuse to allow that. Ever! Good luck, and keep up the practice. :) -Richard

  8. David says:

    I believe I’ve been a paruretic ever since childhood. I remember that I used to take trips to Las Vegas from California when I was younger, and across the long travel there, I would always hold my pee in the whole time. Now that I’m almost 19, it’s starting to really affect my social life and what situations I’m able to comfortably put myself in (for example, my first date at the movies was ruined since I had to pee badly the whole time, making me uncomfortable), and it’s starting to feel like psychological torture. I started feeling a bit better about peeing a few months ago, to the point where it wasn’t to much of a problem at home and at friend’s houses, but ever since I started college, it’s gone downhill once more, and it takes immense concentration to even go at home (mostly attributed to the poor location of my bathroom and the people I live with). This is probably the absolute worst thing I’ve ever had to deal with in my life, and recently I’ve been trying to seek medical attention for it since it needs to stop. I’m going to try your breathing method until I can start going to therapy or taking anxiety meds, and I’m really hoping it can work for me before this whole ordeal leaves a permanent mental scar.

  9. Richard says:

    I don’t know whether therapy or anxiety meds will work, but I do know that desensitization does. Breath Hold does, if you learn how to master it. And getting a pee buddy also helps. Good luck with your practicing, and don’t give up. Just know that it may take 2-3, even 4 attempts for you to urinate, but if you keep trying, you will go. And knowing that, makes it much, much better on your nerves. Practice, fluid load, and keep trying. :) Good luck. -Richard

  10. KIrk says:

    I recently discovered a technique that works really well especially for those for whom the holding your breath technique does not work properly. What usually happens is that
    -you go to the restroom
    -there are a few guys there
    -you try to piss
    -you really want to but you can’t so you return and have to hold your piss until you get home

    Now instead of immediately returning when you are unable to piss what you do is you just stand there trying to piss and count slowly to 60 and only leave when you complete the count.
    First 3 or 4 times it may not work but after that you will find that you are much more relaxed during the counting and you will be able to easily piss. The important thing to remember is that you MUST COUNT TO 60 before leaving whether or not you are able to piss. After a while you will be able to piss nearly every time you do the counting.

    It has nearly cured my paruresis and I’m only unable to piss like 1 out of 30 times i try this method.

  11. Erik says:

    Unlike most I can actually link my issue to the exact moment it happened. I was 11, in the powder room in my parents house and they had friends over. Old long term friends from before I was born. Well I’m in there pissing (which I was able to do w/o any thought until this point)… then I overheard the woman friend say “Listen how loud he’s peeing, I wonder if he has a big one?”

    From that moment on my brain associated penis size with how loud I was peeing I was done… I (now 38) have almost NEVER been able to pee in a public bathroom since… The only that thing that works is sitting down in a stall. For some reason I can go no matter what if there’s a door on the stall but…I have to sit down and pee… there are a lot of cultural things here with that but long story short… at least I get to pee!

  12. Richard says:

    Hi Erik. What a weird connection that women has about peeing loudly, lol. Sucks (unless it’s true), and it’s amazing that something like that can trigger an entire life of shame. Insane. Thanks for the comment… -Richard

  13. Dirk says:

    I’m kind of shocked I’m not alone in this and am very thankful for your taking the time to post all this (including all the people commenting). I used to pee in public no problem. When I was 21 or so I was in a bar peeing and these drunk lowlifes came in and started hassling me. From that time on I have been unable to pee in public with anyone around. I go in the stall and hide. This has been going on now for 30 years! I should have tried to deal with it right after it happened… somehow. I regularly have nightmares where I can’t find a bathroom or when I do, it is crowded or there is some problem. Lately I have something even worse. I can’t even pee in a plane. I feel like I have to go, but I just can’t. I sit, I stand, I hold my breath… nothing and it is agony on a long flight. The minute I get off a plane and go to the airport restroom I can pee (in a stall). It is torture. My wife wants to go on trips, perhaps to Europe, but my first thought is an 8 hour flight without being able to pee. I feel little hope, but I am finally taking the step of talking to a doctor about this – my family practice doctor and a urologist. I’ll try the counting to 60. Eric, I wish we had a time machine. We could tell that lady where to go and I could take on those two lowlifes, even if they kicked my a$$.

  14. Richard says:

    Hi Dirk. No time machine needed, just start rolling back the time Paruresis has tied you down. Practice. Fluid load. Force yourself into uncomfortable situations. You can and will get better, get to the point where you can pee in urinals again, and even on the plane. Just don’t give up, make yourself desensitize, and try everything you can. Breath hold works, and fluid loading is the best trick I know. It’s almost surprising. Good luck and keep me informed on your progress. -Richard

  15. Dirk says:

    Hey Richard, sorry I didn’t see this and am responding so late. Thanks for the words of encouragement. Seriously, I really appreciate it! I have a 3 hour train trip coming up and am living in terror. So much so that I am considering driving instead and paying $250 for seven days of parking! I think one problem is this. On my last train trip I didn’t drink anything, yet had a strong urge to go. When I tried, I could not. The second I got off I went to the train station rest room (stall) and peed like crazy. It is obviously all in my brain. I’m thinking that if I instead “fluid load” on the train I will be able to go, but am worried of being miserable if I can’t. Perhaps this is not the best test for me at this stage, but I have to go for business. I promise to practice fluid loading otherwise, I swear. And you are 100% right, roll back the time. Great way of putting it.

  16. Dirk says:

    P.S. The urologist I saw was worthless. He actually started bragging about how he can hold his urine for 8 hours and has no problems going any time. How is that helpful?

  17. JohnB says:

    I do not mind peeing in front of other people although anything else worse than that I would not do and I would not do it in front of guests unless it was my partner or some friend I knew darn well – although I have ‘gone’ or taken a pee in front of my immediate family members and they have in front of me so no one cares that way. If they are paranoid about it in the house it would fuel paruresis

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