Bashful bladders

Some people, mostly men, can't pee in public -- or even in their own homes.

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It is a warm May afternoon, and a man we will call Bob has been drinking. Like millions of Americans, Bob has a drinking problem. In Bob’s case, it doesn’t have to do with alcohol. Bob has been drinking tap water. The problem is that now Bob has to go to the bathroom, and when he does, I will be able to hear him.

Bob is a paruretic. To have paruresis is to have a hard time urinating in the presence of other people. For 15 million low-level paruretics, most of them men, this means pretty much what it sounds like it means: You can’t get going if there’s someone at the next urinal, or beside you at the trough. It’s the “shy kidneys” Niles Crane jokes about on “Frasier,” or Helen Hunt making Paul Reiser hide in the shower and sing loudly while she voids when they’re locked in their bathroom. An occasional annoyance; nothing to get catheterized over.

For 1 to 2 million Americans, paruresis means something else entirely. They can only pee if there’s no one else in the restroom. “It doesn’t matter if there’s a barrier or you’re in a stall,” says Bob. If someone can hear you, they can hear that you’re not doing anything. It’s a sort of performance anxiety that builds and feeds on itself. Bob again: “It’s a succession of failures that keeps reinforcing that you can’t do it.”

And soon, by God, you can’t. Extreme things start to happen. “There’s a man in solitary confinement in a New Hampshire prison because he couldn’t produce a sample,” says Steve Soifer, president of the International Paruresis Association. Some paruretics turn to self-catheterization, carrying “self-cath” kits on their belts like Walkmen. Others become functional agoraphobics, never going to clubs, eating in, avoiding plane travel. “One man’s marriage was falling apart because he’d refused to go on a vacation for 15 years,” Soifer told me. Many paruretics even have trouble urinating in their own homes. Witness the following entry from the paruresis Web site : “I keep a half-gallon pitcher in a closet and if my roommate is home, I urinate in the locked closet and empty the pitcher when he leaves.” According to Soifer, most paruretics can’t even urinate near their spouses. A third have difficulty relieving themselves even when no one else is home.



Bob’s problem has, for the past 10 years, kept him from having a relationship with a woman. “If my girlfriend was in bed with me and I had to get up and go to the bathroom I wouldn’t be able to go because the bathroom is right by the bedroom. She’d wonder what was wrong with me.” According to Soifer, other paruretics have gotten around this problem by “having their houses designed around their condition.” (Inventiveness seems to be a hallmark trait. Bob devised a hand-held white noise machine that he made by recording the sound of his sonic toothbrush.)

Bob doesn’t even like to have company over. “If the stereo is off and people are sitting right there where you’re sitting, on the sofa, they can hear me in the bathroom.”

But I am not company. I am — stay with me here — Bob’s “pee buddy.” A pee buddy is a component of graduated exposure therapy, one of the few techniques that seems to help paruretics. A therapist typically serves as the pee buddy the first time around, but from then on in, it’s anyone you can get: a fellow paruretic, a sympathetic friend, a curious reporter. The buddy’s job is simple. You are the stranger in the restroom, or the guest on the sofa, whatever is needed. Only instead of a stranger, you’re a supportive, nonjudgmental presence and/or curious reporter. As Bob puts it, “You’re basically showing yourself that yes, you can do it.”

Bob has downed three large glasses of water prior to my arrival. “Right now I have a light to moderate urgency level,” he tells me. As will happen numerous times this afternoon, I don’t seem to have a reply for what I’ve just been told. “I think a few more sips and I’ll be ready to try it.”

While Bob sips, he tells me what he thinks caused his condition: a series of traumatic experiences during toilet training. In a survey posted on the IPA Web site, 28 out of 64 respondents cited embarrassing incidents or parental behaviors as the cause. The number one response: “I don’t really know.”

Bob fills me in on our game plan. I will start out at the kitchen table, about 40 feet from the bathroom. Bob will attempt to pee, and if he can, he’ll then stop after three seconds, so as to conserve urine for the rest of the session. If all goes well, I will move to the sofa, then the hallway and so on.

Bob announces that he is ready. “So I’ll attempt to go, and then I’ll come tell you how I felt.”

I hear the lid bang against the toilet tank. Van Morrison is singing “Moondance” on the radio. Thirty seconds goes by. I’m rooting for the man. Go, Bob, go! He reappears in the kitchen. “I had a little apprehension,” he says, “but I was still able to go.”

Now I’m on the sofa; now the chair with a view of the bathroom door. Another victory, and another. We take a break to allow Bob to refuel. He puts on a “Seinfeld” episode he taped, wherein George has elimination issues owing to the proximity of his new girlfriend’s bathroom to her bed. (“It’s like, right there. There’s no buffer zone.”) “See?” Bob frowns. “A loser. Always a loser.”

Maybe not losers, but a certain personality type does come up over and over. Christopher McCullough, a San Francisco therapist who specializes in social phobias and often treats paruretics, says low self-worth is common among paruretics. “Some of these men see their condition as an indictment against their whole worth as a person,” he says. “They seem to suffer from a generalized feeling of inadequacy and this, in their minds, is evidence of that.”

Only about one in 10 paruretics is a woman. Soifer attributes the disparity to the simple reason that women don’t have to deal with urinals. Over the years, American urinals have become less and less private. “Economics have driven the urinal companies to cut down on the amount of porcelain they use,” says Soifer, “and to get rid of dividers.” (Same reason phone booths are no longer booths.) Soifer goes on to say that the morally conservative climate in the United States has also contributed to the problem. “Starting in the ’50s and ’60s, men began using restrooms to pick other men up. If you look at rest stops along interstates, they’ve even taken the doors off the stalls. Whereas in Europe, there are stalls with doors and locks on them. I’m told Paris is a paruretic’s dream.”

As is Tokyo. Soifer reports that men’s rooms there sometimes have TV sets, which are turned up high so that no one can tell whether you’re pissing or simply standing there feeling like an idiot. I once, by accident, pushed a button in a Tokyo toilet stall that triggered a loud recording of a toilet flushing. I later learned that so many people flush first to mask their sound (or lack thereof) that millions of gallons of water were being wasted. The toilet company was recruited to come up with an ecologically sound, if somewhat bizarre, alternative.

Bob has been using his stereo for just such a purpose. “Now I’m going to turn the music off,” he says. “This is going to be tough, but I’m going to give it a shot.” He walks over to the receiver and cuts off “Moondance,” which will forever after remind me of men trying to urinate in my presence.

“Good luck.”

“Thank you.”

Success. Now Bob has the bathroom door partway open. He’s feeling pretty cocky. “If I get a flow going, I’m going to ask you to come closer.” A moment passes. There is silence, and nothing golden. I am wondering what, as a pee buddy, I am expected to do when Bob hits his porcelain ceiling. Do I encourage him to keep trying? Do we go back to square one? Then I hear it: a hesitant trickle.

“Look at that!” I do not. “Not a real good stream, but still.” At Bob’s bidding, I move down the hallway, keeping my eyes on the carpet, which is beige and of a medium nap. I’m three feet from the bathroom door. Perhaps as much as Bob doesn’t like people listening to him urinate, I don’t like listening to Bob urinate. I try to imagine that it is a mountain stream, or one of those mall fountains that calm countless husbands sitting and waiting on benches. Oh, for a sonic toothbrush recording.

“That’s major,” exclaims Bob from inside the bathroom. “That is major. It’s incredible!” At this point in graduated exposure therapy sessions, I imagine, men are hugging their pee buddies. I do not hug Bob, partly because he’s still fiddling with his zipper, partly because I’m not a stranger-hugger. I pat him on the back as he emerges from the bathroom, the way baseball players will as a teammate crosses home plate. I tell him he did really great, which he did. And now, I’m afraid, I’m going to have to steal his thunder.

“Hey, Bob?”

“Yes?”

“I need to use the bathroom.” I take Bob’s place at the toilet. The water is blue, and Bob has left the seat up. I close the door. I don’t have to, but I want to.

Former Salon columnist Mary Roach is the author most recently of "Gulp: Adventures on the Alimentary Canal." Her previous books include "Stiff," "Spook" and "Packing for Mars."

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