How to get rid of paruresis yourself

General information

The patient's complaint that he cannot write is described in the medical literature as urinary retention. This condition involves problems emptying the bladder, despite its fullness. That is, urine is formed normally, the kidneys are working, but for some reason urine cannot flow out. Its constant presence in the bladder not only leads to the development of unpleasant symptoms, but is also a risk factor for the entry of pathogenic microorganisms and infection of the genitourinary system.

It is noteworthy that at a young age, the inability to urinate occurs equally in both sexes. But with age, men are more likely to experience this problem. This is due to the fact that they may develop pathology of the prostate gland (prostate), which is often accompanied by problems with urination.

Treatment should be aimed at both relieving symptoms, i.e. emptying the bladder, and eliminating the underlying cause. Otherwise, severe complications may develop.

Symptoms

Pathology begins its development with a simple embarrassment to relieve oneself in a public toilet when there is a stranger in the next stall. The symptoms are familiar to everyone: a person cannot concentrate for a long time until the next booth is free. The next stage of the inability to urinate syndrome in the presence of strangers will be the inability to urinate even in an empty toilet room. The most terrible condition will be when a person has difficulty relieving himself even at home in the presence of his relatives.

This condition may be accompanied by symptoms from the nervous system:

• embarrassment;
• disorientation in space.

Physical symptoms:

• pain in the lower abdomen;
• feeling chills in the presence of other people;
• increased blood pressure;
• cardiopalmus;
• darkening of the eyes;
• dizziness, fainting.

Main reasons

Urinary retention is not an independent pathology. This is just one of the symptoms of other diseases. Therefore, if a patient is unable to urinate, one should always look for the cause.

One of the main reasons is a mechanical obstruction to the outflow of urine caused by obstruction (blocking) of the lumen of the urethra. The blockage can occur due to tumor growth, the presence of a stone in the lumen, strictures (fusions) of the urethral opening, phimosis (fusion of the foreskin) to a severe degree. In addition to changes in the urethra itself, blockage can occur due to the growth of tumors in neighboring organs. In men, these are most often changes in the prostate gland, both inflammatory and oncological in nature.

Another reason is a disorder of the innervation of the bladder muscles. When the spinal cord is damaged, spasm of the sphincters and detrusor (the main muscle of the bladder) develops. As a result, a person cannot go to the toilet in a small way.

Another answer to the question “Why can’t I urinate?” are stress factors and mental changes. Increased activity of the sympathetic nervous system leads to inhibition of reflexes necessary to relax the bladder muscles and initiate the process of urination.

Some medications also cause urinary retention. These are narcotic drugs, anticholinergics, sedatives and sleeping pills. In this case, there is a complex effect on both the peripheral and central nervous systems. Complex mechanisms develop that interfere with the process of urination.

I can't urinate in front of strangers.

Denis, the answer to the question is obvious: You need to learn voluntary relaxation. Both muscular, muscular, and mental, “brain”, psychological.

Of course, the so-called “clamps” are to blame, which are expressed in areas of muscle tension and, naturally, similar areas of tension in the brain.

The brain controls ALL the muscles in our body. That is, it is certain areas of the brain that are responsible for relaxation and tension of the corresponding muscle groups. The brain is tense and the muscles are also at work. This is not necessarily expressed in bright and tangible tension, no. The work of muscles can be very imperceptible, almost microscopic. We don't notice such muscle tension. But it exists, it affects, it accumulates and at some point it can both help and harm!

There is one trick that will help us. The point is that there is also feedback. That is, by forcing a muscle group or an individual muscle to work, we activate the corresponding part of the brain: the muscles are tense - the brain works too!

This is exactly what can help you and me cope with the problem.

The task is to learn to relax your muscles!

After all, free urination is the coordinated work of different muscles. Some muscles must tense in time, while others relax!

It is very difficult to regulate this at the level of consciousness. Therefore, we will start with muscle work!

Progressive muscle relaxation will help us - a special and very simple set of exercises that must be done often and regularly.

The essence of the complex is the alternation of states of relaxation and tension in various muscle groups.

Literally: “tensed - relaxed.” They tensed up a lot - they relaxed deeply. They just tensed up and relaxed deeply. Almost imperceptibly they tensed - they relaxed DEEPLY.

Do you understand? Regardless of the degree of tension, your relaxation must be DEEP!

We tense up as we inhale, and relaxation comes as we exhale. Inhalation and exhalation should be calm, nasal. You can inhale through your nose and exhale through your mouth, as if you were blowing into a tube.

By the way, the process of urination itself requires relaxation of almost all muscles + exhalation!

So:

Tighten and relax different muscle groups, 3-4 times for each group, counting: once - tense, two - relax. Relaxation should be “maintained” for as long as possible, up to 10-15-20 seconds.

You need to completely relax!

First, the tension must be bright, high-quality and tangible, so that relaxation is also noticeable. Then, in the process, you need to reduce the level of tension, bringing it to barely noticeable, but relaxation should remain at the same level.

Start with your arm muscles.

1. Brushes. Clench and unclench your fists.

2. Forearms. Raise your arms to your shoulders, squeezing your biceps. We don’t tense our fists.

3. Shoulders. Pull your shoulders towards your ears and calmly lower them.

4. Neck. With tension, lower your chin to your chest, feeling the tension in your neck. Raise your head, relaxing your neck.

5. Face. Clench your jaw tightly, wrinkle your forehead, and purse your lips tightly. Relax your facial muscles.

6. Calf muscles. Shift your center of gravity to your heels, raising your feet. Feel the tension in your calves. Relax, standing in the starting position, on the entire foot.

7. Hips. Forcefully bring your knees inward (“x”) and feel the tension. Relieve tension by taking the starting position.

8. Back. Bend forward with effort, tensing all the back muscles. You can stretch a lot. As you exhale, release tension and relax.

9. All muscle groups at the same time.

Some things will work out right away, some won’t. But it's not that important. It is important to learn to relax and feel this relaxation, regardless of the degree of tension.

Exercises can be done whenever and in any form. The main thing is that the more often the better!

Naturally, you need to include some format of auto-training.

While relaxing your muscles, imagine a variety of options for the “process”)))))): on the street, in the toilet of a theater, train, at home, at a friend’s, in the toilet of a barracks, in the country, etc. Muscle relaxation and - IT IS!

Imagine the strangest and most uncomfortable options when you really want or just NEED to go to the toilet.

There are also “tricks”.

If you have a favorite melody, then keep it in your head, hum it, hum, purr. Let this become a kind of signal, an “anchor”, like a light bulb for Pavlov’s dog.

After all, everything we are talking about is a reflex zone! A full bladder triggers the need to empty it. This signals the muscles how, in what order, they need to work to make this happen.

Somewhere the connection was broken. Something is either too much or not enough.

So we will add signals, try to cope with unwanted anxiety at “this” moment, because you are constantly waiting for failure!

A melody in your head will help displace uncontrollable thoughts.

In principle, any poem, oral counting, listing cities, car brands, names, etc. will be suitable for this.

And let's not get stuck in childhood memories, because we don't have a psychoanalyst's office with a sofa and cozy curtains!

By the way, it wouldn’t hurt to consult a psychologist in person.

I'm with you. Write. Do it. Everything gonna be alright! A. Zhuravlev.

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The main links of pathogenesis

Pathogenesis is the period of development of the disease from the very beginning until recovery. It is very important to know it for a complete understanding of the reason for the complaint “I can’t write.” The pathogenetic development of the problem directly depends on the nature of its occurrence.

The easiest to understand is mechanical obturation of the urethral lumen. Blood clots that form after surgery, urethral strictures after surgery, compression of the urethra from the outside by an enlarged prostate - all these factors can lead to mechanical obstruction of urine exiting the body. The function of the kidneys and bladder muscles is absolutely not impaired.

Elimination of the etiology - mechanical obstruction - will quickly lead to the restoration of normal urination. The main thing is to quickly find the cause, since prolonged inactivity of the bladder leads to its atrophy.

If the nature of the pathology is a disorder of the innervation of the bladder muscles, the pathogenesis is more complex. If the innervation of the detrusor is primarily affected, atony of the bladder occurs. It simply cannot contract with enough force to push the urine out. When the tone of the external sphincter increases, urine does not flow out, since the necessary relaxation of the sphincter cannot be achieved.

Types of urinary retention

There are several types of urinary disorders based on the type of retention. They differ from each other in the mechanism of development and clinical manifestations. The main ones include:

1. Acute delay - begins abruptly, most often occurs due to mechanical obstruction, but can also be associated with neurogenic causes. With complete retention, no urine output is observed at all; with incomplete retention, urine comes out in weak drops.
2. Chronic delay - bothers the patient for a long period of time. Often associated with compression of the urethra from the outside by neoplastic processes of the prostate. In incomplete form, a large amount of residual urine remains in the bladder - up to several hundred milliliters.
3. Paradoxical ischuria is the most rare type. Occurs when the sacral parts of the spinal cord, where the center of urination is located, are damaged. It is manifested by the constant release of urine in drops against the background of an almost completely full bladder.

Symptoms that accompany urinary retention

Clinical manifestations of urinary retention can be divided into two large groups: symptoms associated with the underlying cause, and dysuric manifestations, which are accompanied by the complaint “I can’t write.”

When the urethra is obstructed by a stone, urinary retention does not occur immediately. First, the patient complains that it hurts to urinate. This symptom appears when the stone travels through the ureters to the bladder and then enters the urethra. Actually, urinary retention develops when the stone stops moving and completely blocks the lumen of the urethra.

Impaired urination due to prostatitis (inflammation of the prostate gland) is also accompanied by the patient’s complaint that it is painful to urinate. In this case, pain in the perineum is associated with swelling of the prostate and irritation of the nerve endings.

If urine output is obstructed due to neurogenic causes, other clinical manifestations may include weakness in the limbs (paresis), impaired sensitivity (hypesthesia) or its complete absence (anesthesia).

About shy bladder syndrome

A person with paruresis is unable to empty his bladder outside his own home.

Paruresis is not classified as a separate disease by ICD-10, but psychiatrists and psychotherapists consider this disorder within the framework of social anxiety disorder.

Paruresis can manifest itself in different ways, on a psychological and physical level. Some patients are unable to go to the toilet in an unfamiliar environment due to psychological discomfort, while in other patients the syndrome is manifested by a physical inability to empty the bladder and even spasms of the smooth muscles of the organ. In this regard, shy bladder syndrome is considered by three specialists at once - a psychiatrist, a neurologist and a urologist.

Anyone can experience the fear of urinating in public, but most often it first appears during adolescence. The disorder must be treated, as this phobia poses a serious danger to the entire body. Due to the fact that the patient will constantly restrain the urge to urinate in crowded places, there is a risk of developing diseases of the urinary system and kidneys.

Despite the fact that paruresis or paruresis is classified as a phobia, this disorder goes much deeper and affects not only the psyche, but the entire body.

Symptoms of prolonged urinary retention

But regardless of the initial cause, urinary retention for a long period of time is accompanied by the following symptoms:

• an increase in the size of the abdomen due to an increase in the size of the bladder;
• pain in the abdomen and above the pubis for the same reason;
• restless state of the patient, throwing;
• deterioration in general health;
• increase in body temperature with the addition of a secondary infection.

Manifestations of fear of not reaching the toilet

One of the main symptoms of fear can be called strong, painful experiences. Such torment has the worst impact on a person’s psychological well-being, affecting all aspects of his daily life. Such people may go to the toilet several times in a row before leaving the house, but it will still seem to them that this desire is present.

Usually they control the amount of liquid drunk, which can significantly affect health, because a person simply needs to drink enough water per day. Many of them hope that some of the consumed liquid will come out before they leave the house.

People who suffer from anxiety often find themselves checking to see if any drinks or medications have diuretic properties.

Before attending an event, such individuals, first of all, think about whether there will be an opportunity to “get away” and study the map for the presence of public toilets or deserted places. Often they have to give up various trips and return home without reaching the store, park or any other place. If a person is afraid that he will want to go to the toilet “in a big way,” then before leaving the house (or the whole day) he refuses to eat.

In many cases, people planning to visit a particular public place simply feel that they are experiencing a constant urge to urinate, or this desire appears to them precisely because of fear itself. It is known that many irrational phobias can provoke frequent urination or nervous diarrhea. In a calm home environment, as a rule, such people do not experience any fears and do not run to the toilet every 5 minutes.

Physiological symptoms usually begin to appear when a person plans to visit a particular public place (trip) or is already in a situation where there is a risk of not finding a toilet or a real impossibility of getting there. Among them:

• a strong urge to urinate or defecate;
• cardiopalmus;
• labored breathing;
• trembling in the limbs, constant weakness, often dizzy;
• nausea, vomiting;
• blood pressure surges;
• redness of the skin of the face and neck, fever, compression in the chest area.

It should be noted that in people experiencing these concerns, symptoms appear not only in the absence of access to a toilet, but also in situations where visiting it is undesirable. Social phobes, for example, may simply be afraid to get up and leave a movie theater filled with people because they are afraid of disturbing others and, as a result, leaving a bad impression of themselves.

Diagnostics

When searching for the cause of urinary dysfunction, you should pay attention to both the clinical manifestations that accompany urinary retention and data from additional laboratory and instrumental examination methods.

After a thorough conversation with the patient and his examination, it is possible to establish the presence of acute urinary retention, and sometimes to assume the probable nature of its origin. Only after collecting complaints, anamnesis and examination, additional examination methods are prescribed:

1. Ultrasound examination (ultrasound) - allows you to evaluate the structure of the bladder, prostate, urethra. With its help, mechanical obstruction of the urethra, inflammatory processes, and neoplasms are clearly visible.
2. Magnetic resonance imaging (MRI) of the spinal cord is performed if the neurogenic nature of urinary retention is suspected.
3. Cystoscopy is an examination of the bladder using a small camera. Allows you to visualize obstruction, changes in the walls of the bladder, and determine the amount of urine in it.
4. Retrograde cystourethrography is an x-ray method for examining the organs of the urinary system.

During a diagnostic search, it is necessary to clearly differentiate urinary retention from anuria. The latter occurs when there is a violation of urine excretion by the kidneys.

Treatment methods

I can’t urinate - what should I do? The answer to this question depends on the cause of the problem. In any case, if you have urinary disorders, you should consult a specialist. Moreover, this problem is dealt with by doctors of several specialties:

• urologist;
• neurologist;
• nephrologist;
• oncologist.

Therefore, it is more advisable to first go to a general practitioner or family doctor, who will be able to determine which specialist is best to contact next.

But it takes some time to eliminate the cause of the disease. If you hear the complaint “I can’t urinate,” what should a man or woman do as quickly as possible? Regardless of gender, a bladder catheterization procedure is performed. A tube is inserted into the urethra and reaches the bladder. This way you can quickly ensure normal urine flow.

Reasons for fear of not reaching the toilet

There are 3 main reasons for the development of fear of wanting to go to the toilet and not reaching it.

1. Fear from childhood. Parents often tell their children not to forget to go to the toilet before a long drive, walk or long event. Such instructions sometimes end with the words: “if you don’t go now, there won’t be an opportunity later.” The child begins to get nervous, constantly checking to see if he “definitely doesn’t feel like it,” and runs to the toilet every 5 minutes so that “he definitely doesn’t want to later.” As a rule, such restless actions either provoke false sensations of the urge to urinate, or cause a real desire to “relax a small need.” Such anxious feelings can haunt a person even into adulthood.
2. Intense fear of social shame. Of course, all cultured people have a fear of relieving themselves in places other than the toilet. But for people with a strong fear of shame and condemnation, this is simply a catastrophe comparable to death. Because of this, a phobia on this topic appears.
3. Bad experience. Fear can also develop if one day a person still does not have time to reach the “destination” or embarrassment occurs due to the absence of such a place. The situation is aggravated if someone could see the incident or, worse, laugh, start making fun of or shaming.
4. Consequences of pregnancy. It is known that during the period of bearing a child, a woman’s bladder is not able to stretch in the same way as it normally does. Because of this, pregnant women constantly want to “go small.” The prospect of desperately searching for the toilet in crowded places is frightening for women expecting a baby, and this fear can continue to haunt them even after giving birth.