Last updated: November 27, 2023
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. This social anxiety disorder affects men and women from preschool age through adulthood. Because many suffer in silence and never report the condition to their doctors, the exact number of people who live with shy bladder syndrome is unknown. There are estimates, however, that approximately 7% of the United States population struggle with this condition.
After downing the specified fluid amount, the test subject sits in the designated waiting area passing the time scrolling on their phone. So far, intermittent trips to the assigned restroom in hopes of providing the ounce and a half necessary to send off for the test were unsuccessful. An audible sigh escapes them. The collection specialist glances over with a look of empathy. It’s going to be a long three hours.
What causes shy bladder?
A medical condition could be the underlying cause for a shy bladder. But, most people can pinpoint the moment it began. Most incidents occurred just before the age of puberty or during the early teen years. They felt harassed, teased, or even ridiculed in relation to urinating. The result, of course, being anxiety so severe they could not urinate.
Sadly, those feelings of anxiety and/or fear stuck with them. They may have even worsened with time.
Then, too, if a person is prone to having anxiety issues, shy bladder syndrome is an outlet for manifestation.
Can anything be done about it?
As paruresis could be related to an underlying medical issue, seeing a doctor will ensure that is not the case. Overall, though, medical professionals consider shy bladder as a social phobia, but it is not categorized as a mental illness.
Debilitating anxiety is an unhealthy mental condition. Anyone experiencing it is worthy of treatment and support. Therefore, the treatment for shy bladder syndrome involves mental health support and, at times, there is medication prescribed. Medication, however, has not been proven very effective in treating the condition to-date. The medications prescribed for treatment are often antidepressants and can pose problems with regard to passing an employee drug test, as well.
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 are able to 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 fluid intake is limited to ward off trips to the restroom, you can find yourself with kidney stones, salivary gland stones, or gallstones. All, of which, are painful conditions and can ultimately result in time missed from work.
How is shy bladder handled in a drug testing situation?
Commonly, the DOT shy bladder protocol is followed when administering the urine drug tests, unless a specific company policy is in place to do otherwise.
- Even if the test subject announces to the collection specialist that he will be unable 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 employee is advised of the shy bladder procedure. An amount of up to 40 ounces of fluids will be distributed to the employee over a 3 hour period. 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 considered a refusal to take the 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 and the employee will be free to leave.
- If during that time, the specimen amount is not 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 his previous test deemed a refusal.
How do non-DOT regulated employers handle shy bladder?
There is no doubt that people who suffer with 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 would be 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 very 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. If you are not regulated by the government regarding drug testing, you might consider choosing either the mouth swab or hair follicle test for employees that are affected by paruresis. This will protect them from being unjustly penalized for a condition they have not yet been able to get under control.
