Paruresis, also known as shy bladder syndrome, is a type of phobia in which a person is unable to urinate in the real or imaginary presence of others, such as in a public restroom. The analogous condition that affects bowel movement is called parcopresis or shy bowel. Signs and symptoms
Some people have brief, isolated episodes of urinary difficulty in situations where other people are in close proximity. Paruresis, however, goes beyond simple shyness, embarrassment, fear of exposure, or fear of being judged for not being able to urinate. Other people may find that they are unable to urinate while in moving vehicles, or are fixated on the sounds of their urination in quiet restrooms or residential settings. In severe cases, a person with paruresis can urinate only when alone at home or through the process of catheterization. Causes
A possible cause of paruresis is undergoing a voiding cystourethrography (VCUG) in the past. "Complications that can occur in both sexes include UTI, hematuria, cystitis as well as urinary dysfunction following a catheterization, phobia of urination, nocturia, and stopping urination. In the literature, psychological trauma resulting from VCUG was considered the same as from a violent rape, especially in girls." Pathophysiology
It appears that paruresis involves a tightening of the sphincter or bladder neck due to a sympathetic nervous system response. The adrenaline rush that produces the involuntary nervous system response probably has peripheral and central nervous system involvement.
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)