The internal urethral sphincter (smooth muscle tissue) or the external urethral sphincter (striated muscle), levator ani (especially the pubococcygeus) muscle area, or some combination of the above, may be involved. It is possible that there is an inhibition of the detrusor command through a reflex pathway as well. The pontine micturition center (Barringtons nucleus) also may be involved, as its inhibition results in relaxation of the detrusor and prevents the relaxation of the internal sphincter. Diagnosis
The condition is catered for in the rules for mandatory urine testing for drugs in UK prisons, and UK Incapacity Benefit tribunals also recognise it. It is listed in the NHS on-line encyclopaedia of conditions and disorders. It is now reported to have been accepted as a valid reason for jury service excusal. From 1 August 2005, the guidance on the rules relating to the testing of those on probation in the UK cites paruresis as a valid reason for inability to produce a sample which is not to be construed as a refusal.The condition is recognised by the American Urological Association, who include it in their on-line directory of conditions.Paruresis was described in section 300.23 of the DSM-IV-TR as "performance fears . . . using a public restroom" but it was not mentioned by name.
Alternatives to observed urine specimen collection for individuals who self-report paruresis include unobserved collections in a dry room, testing of hair specimens, sweat testing with a patch, and blood testing (Test for Drugs of Abuse 2002). These alternatives preclude the need for futile attempts to differentiate inmates with true paruresis from those who fabricate complaints." Popular culture
The condition has been occasionally portrayed in popular culture, sometimes for comedic effect or parody. Examples of this include:

In the 2005 comedy Waiting..., a nerdy character with paruresis is one of many bathroom jokes. In 2015, the International Paruresis Association protested a DirecTV ad starring Rob Lowe that portrayed a paruretic as goofy, wearing a fanny pack, and having his hair parted in the middle. In the American sitcom The Big Bang Theory the character Penny is revealed to suffer from bladder shyness. See also
The Sound Princess

References
External links
International Paruresis Association
United Kingdom Paruresis Trust (UKPT)