Last updated : May 12, 2025
Commonly known as shy bladder, paruresis is the medical term given to someone who becomes fearful or anxious at the thought of urinating with others nearby. Unfortunately, in a situation that requires them to produce a urine specimen, it can become a grueling—not to mention time-consuming—experience.
The drug testing scenario could go something like this. When someone can’t produce a specimen, they’re given something to drink. After downing the specified fluid amount, the test subject sits in the designated waiting area passing the time scrolling on their phone. Intermittent trips to the assigned restroom hoping to provide the ounce and a half necessary to send off for the test are often unsuccessful. An audible sigh may escape causing the collection specialist to glance over with a look of empathy. For many suffering from shy bladder syndrome, reporting for a drug test equates to a long three hours.
This social anxiety disorder affects men and women from preschool age through adulthood. There is no medical cause for the disorder—it’s strictly mental. The exact number of people who live with shy bladder syndrome is unknown because many suffer in silence never reporting the condition to their doctors. There are estimates, however, that approximately 7% of the United States population struggle with this condition.
What causes shy bladder?
A mental condition is likely the underlying cause of a shy bladder. Most people can pinpoint the moment it began. Most incidents occurred just before reaching puberty or during the early teen years. Those suffering from this condition felt harassed, teased, or even ridiculed about urinating. The result, of course, was anxiety so severe they couldn’t go.
Sadly, those feelings of anxiety and fear stuck with them. They may have even worsened with time.
Another explanation may be that if a person is prone to having anxiety issues, shy bladder syndrome is an outlet for manifestation.
It’s not a mental illness.
It’s possible that paruresis could be related to an underlying medical issue, seeing a doctor will ensure that isn’t the case. Overall, though, medical professionals consider shy bladder as a social phobia.
Debilitating anxiety is an unhealthy mental condition. Anyone experiencing it is worthy of treatment and support. Therefore, treating shy bladder syndrome involves mental health support. At times, physicians prescribe medication.
Medication, however, isn’t very effective in treating the condition thus far. The medications prescribed for treatment are often antidepressants and can pose problems concerning passing an employee drug test, as well.
Moreover, some medications carry a side effect that makes it more difficult to urinate.
Those medications include:
- Anticholinergics
- Atropine
- Glycopyrrolate, otherwise known as Robinul
- Noradrenergic medications
- Venlafaxine, otherwise known as Effexor XR
- Nortriptyline, otherwise known as Pamelor
- Bupropion, otherwise known as Wellbutrin
- Atomoxetine, otherwise known as Strattera
Forms of mental support
Cognitive behavioral therapy (CBT) has proven to be very beneficial in treating patients with shy bladder. It involves working with a therapist to determine how shy bladder syndrome has changed your behaviors and thoughts. The next step would be to gradually expose the patient to those trigger elements allowing them to relieve their fears. Coping skills can soon become second nature in dealing with feelings of anxiety. Reports show that 85 out of 100 people can manage their shy bladder after only 8 – 12 sessions of CBT.
Joining an online or in-person support group is another beneficial step toward managing this condition. Having the opportunity to discuss their issues with others who know may decrease anxiety levels enough to “let it all out” in more ways than one.
Can shy bladder syndrome lead to other issues?
Yes, it can. Holding urine causes an increased risk for urinary tract infections and can weaken pelvic floor muscles. If you ward off trips to the restroom by limiting fluid intake, you could find yourself suffering from kidney stones, salivary gland stones, or gallstones. All, of which, are painful conditions and can ultimately result in time missed from work. The risk of dehydration exists as well.
Shy bladder and drug testing
DOT shy bladder protocol is followed when administering the urine drug tests unless a specific company policy is in place to do otherwise.
Lightly touched on above, that procedure is as follows:
- Even if the test subject announces to the collection specialist that he won’t be able to provide a specimen, the subject is asked to try.
- If unsuccessful in the first attempt to provide the required amount of urine, the specimen amount (if any) provided is discarded and the “shy bladder protocol” begins.
- The technician advised the employee of the shy bladder procedure. They’re given up to 40 ounces of fluids over the next 3-hours. If the employee refuses to drink, it is not considered a refusal to take the test. If the employee refuses to remain at the testing facility for up to 3 hours, it is recorded as a refusal to test.
- At any time during this period, the employee is free to use the restroom to try and provide the required specimen amount (about an ounce and a half). If successful, the test is complete. The employee is free to leave.
- If the specimen amount isn’t obtained, the test will be concluded. The employee is informed that they will have 5 days to obtain a medical evaluation from a licensed physician to give to their employer. At that time, it will be determined whether or not the employee will be retested or recording the initial test as a refusal.
How do employers handle shy bladder?
There is no doubt that people who suffer from paruresis have had difficulties producing the required specimen amount for a drug test. And, with approximately 21 million Americans suffering from a shy bladder, it stands to reason that a portion of them will be working for you.
The best-case scenario is for the employee to present a letter from their doctor stating their condition at the time of the required drug test. But, it’s a sensitive topic and many choose not to discuss it with anyone, not even a doctor.
The urine test is the most widely used employee drug testing method. However, the mouth swab drug test is gaining popularity. Safety-sensitive employers may soon be able to use the mouth swab test for any drug testing scenario. The DOT is working toward acknowledging it as an accepted method of employee drug testing.
If you’re not regulated by the government and are considering switching to the mouth swab test—or at least using it when cases of shy bladder syndrome arise—check to ensure your state hasn’t banned it. The hair follicle test is another possible alternative if you employ the general workforce, but again, check the drug testing laws in your state before proceeding.
Coming up with an alternative plan for those suffering from paruresis will afford them peace of mind. Who knows? It may even be the first step in breaking loose the mental block holding them back from free-flowing through life in general.
