Paruresis - Impact

Impact

Some people have brief, isolated episodes of urinary difficulty in situations where other people are in close proximity. Paruresis, however, goes beyond simple shyness, embarrassment, fear of exposure, or fear of being judged for not being able to urinate. Other people may find that they are unable to urinate while in moving vehicles, or are fixated on the sounds of their urination in quiet restrooms or residential settings. In severe cases, a person with paruresis can urinate only when alone at home or through the process of catheterization.

Although most sufferers report that they developed the condition in their teenage years, it can strike at any age. Also, because of the differing levels of severity from one person to another, some people's first experience of the problem is when, for the first time, they "lock up" attempting to produce a sample for a drug test. Many women are unaware that they, too, are subject to paruresis; articles about women and urination emphasize other female urinary dysfunctions, such as urinary incontinence or frequent urination.

Some people cope by deliberately holding in their urine, by refraining from drinking liquids, or locating unoccupied or single-occupancy public bathrooms.

Severe cases of this disorder can have highly restricting effects on a person's life. In moderate to severe cases, overcoming paruresis can be extremely difficult without the help of a psychologist, therapist or support groups. Severe sufferers may not be willing to travel far from their home or be able to form intimate relationships. Others cannot urinate even in their own home if someone else can be heard to be there.

Some drugs can cause difficulty in urination; MDMA, amphetamines and opiates such as heroin, hydrocodone, or synthetic opioids such as methadone in particular. It varies in severity and from person to person, but many users and abusers of these substances find themselves suffering from paruresis. Partly this is a physical side effect of these substances, but it is often seemingly a psychological symptom, directly related with "shyness", etc., like paruresis. While drugs such as heroin can make it more or less impossible to urinate, the effect can vary, and very often has a direct resemblance to "ordinary" paruresis, i.e. the user may find it impossible to urinate at all, or he/she may only be able to urinate when alone. Buprenorphine (such as in the opiate substitute Suboxone) seems to be slightly different than "normal" opiates, in that it causes symptoms more or less matching paruresis, with the difficulty directly related to psychological factors. In comparison, opiates can simply cause great difficulty regardless of things such as the presence (real or imaginary) of others. Many Suboxone users find themselves having a great deal of difficulty if they know or feel that others can see or hear them urinating. This can cause difficulties, as Suboxone (being used in substance abuse prevention programs) often requires patients to submit urine samples, which can be very difficult for many patients. Some Suboxone users never experience this, while others do only sporadically. It can affect patients even if they never had any problems with paruresis before beginning treatment. It is unclear by what mechanisms this is caused. It is certainly psychological in nature, as a person can experience it when alone, or unexpectedly have no difficulty even when others are close. Many users have found running water or other sound to "cover up" the sound of their urination is necessary, but once urine flow is finally started it will usually flow normally until completion. It is unclear as to how these chemical substances cause the psychophysical reaction described. The listing of this in the "side effects" of the medication is sporadic, with some pharmacies including it in the list of possible symptoms, while others neglect it.