The Love Song of J. Alfred Pee Fright
Why is it so hard to pee in front of other people?
Picture this. You’re out with your friends, you’ve cracked open a few Shiners this evening. Purple Rain is being sung by a drunk cowboy and someone who looks like a rejected extra from Don’t Be a Menace to South Central While Drinking Your Juice in the Hood. And it hits. The juice.
You have to pee.
You politely excuse yourself, toss a wave and a wooooo to tonight’s main event, and you mosey yourself along to the restroom. The floodgates are straining. They’re starting to crack harder than Indiana Jones’ bullwhip.
Just in time, party people.
Until suddenly—someone walks up next to you. Presumably also to pee. And the moment is lost.
You can’t pee.
You have never had to not pee worse in your life.
Why is that?
(Almost) everybody pees
There’s actually a word for that. Paruresis, or ‘shy bladder syndrome,’ if you’re nasty—means, as you’d imagine, that you can’t pee in front of other people.
It’s a psychological phenomenon. Not really a disorder—disorders are defined by your life being disrupted. If not being able to pee in front of someone significantly impairs your day to day life:
- I’m terribly sorry.
- You might consider getting that checked out.
Mostly, it’s a sporadic phenomenon. It affects only around 2.8–16.4% of the population consistently. Men, more often than women.
It’s an expression of social anxiety, and if it is consistent and affecting your life—it actually, all kidding aside, can be a disorder unto itself. Usually, it’s just a different kind of social or generalized anxiety.
- Social anxiety: an intense, persistent fear of being watched and judged by others. It’s not just shyness. It’s a pervasive fear of judgment or vulnerability, or both.
- Generalized anxiety: a condition of excessive worry about everyday issues and situations, that lasts more than 6 months, and usually also comes with visceral symptoms. Those are things like panic attacks, insomnia, persistent fatigue, tension headaches, etc.
Paruresis hasn’t been widely studied, but what we do know:
- It tends to only be one sign of social or generalized anxiety.
- It’s often comorbid (happens at the same time) with other bladder issues, uterine fiddlies, and sexual dysfunctions—most commonly erectile dysfunction or premature ejaculation.
- It can eventually take a toll on your overall health. You can end up with hyperhydrosis (too much fluid retention), kidney and bladder stones and infections, and an increased heart rate.
- People have actually been fired, because they couldn’t pee on command for a drug test, and often alternative tests aren’t an option—hair follicles, sweat, etc.
What makes it so shy?
The most likely reason that humans developed shy bladders, is actually the same reason we developed a lot of things—survival.
Consider.
You’re an early human, and you need to pee. Where do you go, to go? You can’t pee in the village. That’s gross. So you mosey off, Shiner in hand, cowboy hat tossed back on your head, to the woods.
And in the woods—are things that probably want to eat you.
We developed a sensitivity to threats. It’s where the “disorders,” of anxiety come from. Most, if truly not all, psychiatric problems are just things we’re wired for that get out of hand. They do the job too well.
That may well be the case for paruresis. That, once upon a time, being able to sense danger and not have to spontaneously pee, helped us survive.
Considering it often overlaps with sexual dysfunction may be the same—we don’t believe early humans had sex in villages, with a captive audience (OnlyStones maybe?). We believe that likely, many would go off, hand in hand, Fred and Wilma (or Fred and Barney. That happened, too), and proceed to do the horizontal stone-age tango under the stars.
Which, just like going pee, presented some danger.
Being able to orgasm quickly, mean less time in the forests, so less likely that a saber-toothed kitten would come and decide y’all looked like a whole snack.
There’s also the level of social judgment anyway. We’re a social, tribal creature. Before we developed agriculture (and even less, since the Industrial Revolution and the Information Revolution), we relied on strict social hierarchies for surival.
A lot of the modern talk of how this is just how we’re meant to be, it’s bullshit. Agriculture, industry, and information changed that. We don’t need it to survive anymore. But we can’t exactly unlearn centuries of evolutionary modification to our brains overnight—so we have some issues with it.
What fixes it? Do I need a plumber?
Not a plumber, no. But a therapist seems to be the best option—Cognitive-Behavioral Therapy, Dialectical Behavioral Therapy, and Psychodynamic Therapy tend to have the best success rates.
Because paruresis, for the most part, is based on anxiety, learning coping mechanisms and working through some deeper issues is a good start.
Checking in with your family or internal medicine doc (or your gynecologist) is also a good first step—they can start ruling out any potential problems with your plumbing, your brain (rarely, it coincides with neurological problems. Very rare. But it happens), or any other body system.
But first!
Don’t feel bad about it. Things like this don’t reflect on you, as a person. Things happen. I have my own irrational fears—spiders that go boinggggggg.
If studying psychology truly taught me anything—it’s that we all go a little weird, sometimes. “Normal,” doesn’t really mean anything. It’s just an average.
And sometimes? It’s just a natural reaction to an unfamiliar place, or unfamiliar people.
And the more you work toward positive changes, the easier it gets. That’s also how we’re wired.