Oh fine! What will I do about my shy kidneys?
Niles Crane - Frasier

The official name for this condition is Paruresis, and it means that sufferers are unable to urinate if there are other people around. It most often strikes sufferers in public toilets, for instance at work or university, but it can also occur when under time pressure or when travelling on moving vehicles. It is normally psychological (a social phobia/anxiety disorder), and is also know as 'pee shy' or 'shy bladder'.

The sufferer may have a bladder in perfect working order when alone, but using a toilet where there is a possibility that others may overhear those telltale tinkling sounds can change that. Despite a full bladder and what can often be an overwhelming urge to 'go', they are left standing or sitting, desperately hoping that the person in the next cubicle will get the hell out of there so that they can get on with it. It can seem like there are more men who suffer this condition than women, but that is possibly due to the nature of urinals.

In its mildest form, men might feel the need to use a cubicle, rather than a urinal, so that they do not feel overlooked. This often solves the problem. However, in its severest form, sufferers have been known to arrange their whole lives around being able to use the toilet in the strictest privacy, avoiding places where they have none, or avoiding leaving the house at all for very long. It might seem trivial to non-sufferers, but it can cause stress and a lot of unhappiness. Some employers regularly drug test their employees. The inability to give a sample can be interpreted as a wilful refusal and an admittance of guilt.

'Why Can't I Go?'

There are two circular muscles called sphincters that restrict the flow of urine from the bladder. The internal one is controlled involuntarily, but the external muscle is trained at a young age to remain tense until it is convenient to release the urine. It is possible that sufferers are reacting to the adrenaline that is released when we become anxious. This causes the internal sphincter to constrict, cutting off the flow. Because it is controlled by the autonomic nervous system, it is impossible to relax this muscle voluntarily. The sufferer has to wait until the spasm passes; for some it will not pass until they are alone.

What Can be Done

While there seems to be no 'cure' the sufferer can attempt to 'unlearn' the anxiety by trying aversion therapy. Many people have found this to be helpful, although it does require the help of a very good friend. Depending on how severe the condition is to start with, the therapy can be started at any stage. If these steps are combined with relaxation techniques, they can be very successful.

• Step One: Practise going to the toilet while your partner is in the house¹, on another floor if necessary. If this is still difficult, ask your partner to listen to the radio so that you are sure you won't be overheard. Gradually reduce the volume until you can happily 'go' while the house is silent.

• Step Two: Ask your partner to move up onto the same floor as you. Begin with the radio on again if it helps until you can manage to relieve yourself.

• Step Three: At this stage your partner should be able to move slowly closer to the bathroom until you can urinate while they are standing immediately outside.

• Step Four: Continue practising with your partner; it should eventually be possible to leave the bathroom door open with your partner outside.

If these steps are successful, the sufferer should be more relaxed about using public toilets. Other therapies that can be successful include hypnotherapy and breath control.