Wistful Whizzers

To master their bashful bladders, first they must learn to transcend fear

Scanning the empty hallway and looking once, nonchalantly, over his shoulder, Alan leans the door open and slips inside. Quickly he conceals himself, his heart machine-gunning his rib cage, and then he waits. Minutes pass, his breath ragged in the silence. Finally he draws a deep, steadying breath and begins to prepare -- and the door swings open fast and bangs against the wall. Feet shuffle, voices mutter and then silence falls, giving way to the stealthy sounds of air shifting and fluid trickling, splashing, hissing. A fruity acidic scent whiffs across his nostrils. He waits, palms damp in his lap. Finally the door bangs shut again.

Now he can't pee.

Urinating in public has been a cloak-and-dagger affair for almost as long as Alan can remember. He's reluctant to give his last name because everybody knows him as a regular guy, a 44-year-old St. Louisan with plenty of friends and a responsible job. He also has a son who looks up to him, as well as an ex-wife he never, ever told about his problem -- not once in 17 years of tense, evasive marriage. He spent those years fibbing ("Yeah, they were working on that restroom -- I had to find another one") and holding urine for hours, bladder stretched taut. He also deftly avoided daylong conferences, travel opportunities, crowded rock concerts and bars. "Halftime at a game? Forget it."

Mike Gorman

With the turn of the millennium, Alan decided he'd reached the level of ridiculousness: Being "pee-shy" was interfering with his career choices, his social life and his peace of mind. So he sought therapy -- and found that he shared the problem with an estimated 7 percent of the population (17 million people). "It's probably second only to the fear of public speaking," he reports happily, adding, "It was silly that I wouldn't open up to anybody about it. I thought I was choosing not to give this disorder any ability to control me -- when in fact I was giving it total control."

Once coyly termed "bashful bladder," difficulty urinating in public is now dubbed paruresis, or avoidant paruresis (AP), and it's fast emerging from the water closet. "Far fewer men than we think can just go up to a trough and go," observes Steven Soifer, an associate professor of social work at the University of Maryland who suffered with AP for 35 years before learning how to desensitize himself. Relieved by his own progress, he founded the International Paruresis Association and now gives workshops across the country. "Probably at least half of men would opt for the stall, given a choice," he remarks. "And both men and women generally experience discomfort in making noise while eliminating, especially if others are around to hear them."

Soifer says nobody's sure whether AP is physiological or psychological at its root, but very little can be traced to the most likely suspect: toilet training. In all his workshops, he's heard only a few anecdotes from that age -- "one man remembered his sister sitting on the toilet, and he tried to pee between her legs and their mother came in and bawled him out." Most emotional traumas come later, he says, as self-consciousness and social sensitivity intensify. He remembers, at 10, being teased at the urinal and going into a stall instead -- at which point the other boys ran at the door and tried to break it down. "If you're sensitive, you're going to remember an incident like that," he adds, resuming a clinical tone. "About two-thirds of the people at workshops will report some kind of traumatic incident at puberty or a little before, and that's usually when AP begins. There may even be a hormonal link; at puberty the male prostate begins to grow from pea to walnut size and might have a different impact on the bladder neck."

Alan's heard a few toilet-training horror stories and a few complaints about parents' pressuring kids to "hurry up and go already -- if you don't go now, you won't be able to go until we get to Grandma's," but he can't point to any such incident in his own past. He's more interested in practical solutions. In March, after attending one of Soifer's workshops, he returned to St. Louis inspired to start a local paruresis support group (see "Calendar"). "Basically, you go out and pee wherever you can," he explains. "Typically you start in a home or a hotel room, someplace safe. Then you go to a public venue -- a mall, zoo, museum, medical building -- and work on what you need to work on as a group." Members use relaxation, visualization and distraction techniques to aid their efforts, but mainly "it's a matter of being willing to wait," he adds. "We get frustrated and anxious, so we flush and walk away unsatisfied instead of realizing that nobody's really paying attention."

Alan's convinced that being intensely sensitive, self-conscious and self-critical paves the way for AP, but Soifer says anxiety and pessimism could just as easily be consequences. "I don't know how a happy paruretic would react," he says dryly, "although there are 'stall men,' men who are quite content and happy to use stalls and don't feel like less of a man because of it." Crude restroom design is, in fact, AP's main culprit, with bowl-shaped urinals splashing loudly and urine flying back up into the air when men try to "hug" the urinal to gain some privacy.

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