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Five things come up when paruresis is treated, and one check comes before all of them. The first of the five has the most behind it. After that the evidence thins out fast, and the order they come in below is not a ranking. Even the clinicians who publish here call the literature they are adding to "scarce".

[Hambrook 2017]

Where this page says that nothing was found, that is an account of our own search of the published literature, not a finding from a source.

Most of what follows was reported in men. Everyone in the controlled trial was male [Liang 2023], the NHS case is one man [Hambrook 2017], the drug report treated four men [Hatterer 1990], and both beta-blocker cases describe a man. [Zgourides 1991] [Zgourides 1990] The survey at the end of the page covers 59 men and 4 women. [Vythilingum 2002] Two of the reports here, the 101-person workshop study and the gabapentin case, say nothing about the sex of the people in them. That is what the literature holds rather than a finding that this is for men, and where a source says something about women, this page says so.

Nothing below is a recommendation; it is a description of what exists, so that you can ask for it by name.

The check that comes first

Paruresis is meant to be what is left once physical causes are ruled out:

Patients presenting with suspected paruresis or parcopresis should be examined for anatomic or physiologic abnormalities prior to a diagnosis of paruresis and/or parcopresis being made. Given the complexities of urinary and gastrointestinal functioning, collection of a thorough history, physical examination and use of appropriate investigative and diagnostic assessment should be conducted to rule out disorders of organic aetiology and allow for accurate diagnosis and initial management.

The same article names a condition that can look like this one: dysfunctional voiding. It tells the two apart by where the trouble happens. In its words, "unlike DV, paruresis is isolated to unfamiliar or busy public restrooms". [Kuoch 2019] Going normally when you are alone is part of what makes it this condition. Trouble that follows you into every toilet, your own included, is a different question. It is one for the examination.

It runs the other way too. An enlarged prostate is common in men and anyone else with a prostate over 50 [NHS inform 2026], and the health service that says so lists, first among the things it can do to urination, that it can "make it difficult for you to start urinating". [NHS inform 2026] A GP looking at one is expected to "rule out other conditions that cause similar symptoms". [NHS inform 2026] That example is male; the rule under it is not. For women and men both, this name arrives after the examination, not before it.

What that examination is made of is mostly not what people fear. The European urology guideline for women puts a thorough history and a physical examination first. They "should be the first step in the assessment of anyone with LUTS", its shorthand for lower urinary tract symptoms. [EAU 2026] The guideline for men says the history covers "current medication, lifestyle habits, emotional and psychological factors". [EAU 2026] A urine test "must be included in the primary evaluation of any patient presenting with LUTS". [EAU 2026] Then come three more things. A diary of when you go and how much. [EAU 2026] A flow test, which the men's guideline calls "a widely used non-invasive urodynamic test". [EAU 2026] And a measurement of what is left in the bladder afterwards, by catheter or by ultrasound; the guideline prefers ultrasound. [EAU 2026] The controlled trial further down kept the same tests in reserve for any man whose symptoms got worse: "ultrasound (kidney, ureter, bladder, residual urine), renal function tests, and urine analysis".

[Liang 2023]

A camera into the bladder is not routine. The men's guideline keeps it for when "the findings may change diagnosis or treatment". [EAU 2026] Nor are pressure tests routine: "a urodynamic investigation is generally only offered if conservative and medical treatment have failed". [EAU 2026]

The medicines you already take are part of that history for a reason. A review of drug-induced urinary retention puts it plainly: "many drugs can interact with the micturition pathway, all via different modes of action". It names the classes. First come drugs with anticholinergic activity, among them "antipsychotic drugs, antidepressant agents and anticholinergic respiratory agents". Then opioids, and benzodiazepines. [Verhamme 2008] A shy bladder that starts, or gets worse, after a new medicine is a question about the medicine first. It is a question about a phobia second, and it is one for whoever prescribed it.

Graduated exposure and CBT

This is the option that the one clinical article on the condition in an Australian GP journal puts first. The article is by three named authors, not by the college whose journal it is:

Given the psychogenic nature of paruresis and parcopresis, psychological interventions are likely to be the first line of treatment. Although clinical trials have yet to be undertaken, cognitive behavioural therapy (CBT) is likely to be helpful given its known efficacy in treating other anxiety-based conditions (eg SAD, specific phobias).

Graduated exposure means working up to harder situations a bit at a time, with a therapist. CBT is the wider course of work that carries it.

The biggest study we found put 101 people through it in weekend workshops:

This article explores the use of graduated exposure therapy during weekend-long workshops for the treatment of paruresis. One hundred one participants participated in workshops and were administered pretreatment, posttreatment, and 1-year follow-up treatment scales. [...] Findings suggest that graduated exposure therapy improves self-reported global severity of shy bladder symptoms and that these gains were maintained at 1-year follow up.

Everyone measured in it had been to a workshop. The abstract sets out no comparison with people who did not go, and it does not say how many of them were women. Nor does it say how many of them were still answering a year later. [Soifer 2010] So this is what happened to the people who went, as far as the abstract reports it.

A systematic review of the field reports this:

Over the 1418 studies screened, ten were found relating to at least one review question. [...] Paruresis symptoms were shown to reduce in one intervention study.

That is one good result in one study, and not a count of the studies that have been done.

A controlled trial has been published since. It tested a herbal medicine added to CBT, so the part that matters here is its comparison group:

The control group was assigned 10 weeks of CBT and systematic desensitisation.

In that group the trial recorded a total clinical efficacy rate of 62.5%. [Liang 2023] That is a headcount, not a measure of how far anyone's symptoms fell: a man was counted in it if he reached any of the paper's three grades of improvement [Liang 2023], and the lowest of the three is a partial drop in a symptom score, described as "moderate symptom improvement and patient satisfaction". [Liang 2023]

The men counted were 32 of the 35 the control group started with, three having been dropped from the analysis. [Liang 2023] Patients also chose their own group, which the authors give as their first limitation. [Liang 2023] So it is controlled, not randomised. And everyone in it was male, so the trial measured nothing about what that rate would be for women. [Liang 2023]

Table 2 sets out what that rate is made of. Twenty of those 32 men were counted as improved, and 16 of the 20 reached only the lowest band. [Liang 2023] Two of the 32 reached the highest band, the one the paper calls clinically controlled. [Liang 2023] Those counts were taken at the end of the ten weeks. The trial measured nobody afterwards, which its authors list among their limitations. [Liang 2023]

An NHS service has published a case of its own. One man had twelve sessions of CBT, and his scores "reduced over the course of his therapy, and were maintained at one month follow-up". [Hambrook 2017] That is one patient followed for one month, with no women in it.

What that therapy already includes

Two things get asked about as separate treatments: pelvic-floor relaxation, and breathing. In the published work they are parts of the therapy above.

In the controlled trial, relaxation was one part of the CBT:

A second component was to teach self-relaxation techniques, especially those involving the pelvic area.

That sentence is the whole of it: no exercise is named, and it was never tested on its own. A search for published work on pelvic-floor relaxation training or physiotherapy for paruresis found nothing, which is why this sits inside the therapy here rather than beside it. Relaxation is the trial's word. Exercises that tighten the pelvic floor are a different thing, and nothing here describes them.

Breathing turns up the same way, as one named part of a course of CBT: "stress/anxiety management (breathing retraining)". [Kuoch 2019] The same journal keeps the calming work alongside the treatment, not in place of it:

Other psychologically focused strategies such as stress management, including mindfulness, may also promote more adaptive emotion regulation and in turn a lessening of anxious arousal.

The breath-hold, which this page used to promise, is not here. The only thing our search turned up pairing it with paruresis is a preprint about a single patient that no journal has reviewed.

Clean intermittent self-catheterisation

The European nurses' guideline lists what intermittent catheterisation is prescribed for. Most of the list is about a bladder that is not emptying properly, and it starts here:

acute or chronic urinary retention due to nonneurogenic or neurogenic conditions

Paruresis is not on that list, and we went looking for a study that tests catheterisation as a treatment for paruresis and found none. Why someone with paruresis might still ask about it is this site's own reading rather than anybody's finding. What the guideline is for is a bladder that does not empty; paruresis is a bladder that will not start in company. A hospital sample or a long flight is where the two feel alike from the inside, which is why people ask. It is fair to ask a clinician about. It is not an established treatment for shy bladder.

It is also the kind of aid that the treatment literature calls a safety behaviour — the term comes up further down this page — something that gets you through the situation and can keep the fear in place. That is a reason to raise it with whoever treats the anxiety as well as with whoever would prescribe it, not a reason to keep quiet about it.

One thing is not a matter of asking. Not being able to go in a public toilet and then going at home is not an emergency. Being suddenly unable to pass any urine anywhere — at home too — with a bladder that is full and painful, is. That is acute urinary retention, and it needs emergency care whatever caused it, including this. [NIDDK 2019]

It is taught, and it is taught by a person: "IC should be taught by an appropriately experienced nurse". [EAUN 2025]

Even the version a health professional performs splits into a female sequence and a male sequence part-way through:

Some steps for urethral catheterisation by a health care professional according to the aseptic procedure are common to both male and female. The table separates through steps 14-22.

None of that is published here, on purpose. Neither the female version nor the male one is the default, and whoever teaches you teaches yours.

It has a cost as well as a use: "A UTI is the most common complication and is often associated with inflammation." [EAUN 2025] Most common is not the only one. The guideline's table of complications goes on. It lists urethritis, epididymo-orchitis, prostatitis and urethral bleeding. It lists a false passage, which "Occurs when an object passes through the wall of the urethra." And it lists a stricture, "A narrowing of the urethra." [EAUN 2025] Strictures, it adds, "are more common in men because the male urethra is longer than the female’s". [EAUN 2025] How to tell a real catheter from a dangerous one covers the equipment side and the signs that need same-day attention, and how supplies reach you once one is prescribed.

Who is authorised to prescribe it varies from place to place:

The practitioner authorised to prescribe IC will depend on the jurisdiction and local health care organisation policy.

Medication

This is the thinnest evidence on the site, and the section is short because of it.

We found no randomised trial of any drug for paruresis, in women or in men. The largest sample we found for a conventional drug was four men, in a report published in 1990. [Hatterer 1990] The herbal medicine in the controlled trial above is a drug too, by any fair reading; this page takes no position on it. This is the whole result of the four-man report:

Four men with paruresis received trials of atenolol or phenelzine or both. Atenolol was effective in one patient. Three patients had a poor response to phenelzine, and they all experienced troublesome side effects.

Atenolol, the beta blocker, helped one of the four. The three who tried phenelzine responded poorly to it, and all three had troublesome side effects.

After that come single cases. One reports a patient given gabapentin alone, and its author concludes only that the drug "should be studied further". [Kaufman 2005] The abstract does not say whether that patient was a woman or a man.

The other two go the other way, and they may be the same person twice. A beta blocker reduced the physical signs of anxiety, what the report calls "a decrease in ANS symptoms", and made no difference to being able to urinate in a public toilet; the report says it was given to a male patient after treatment with a different beta blocker had not worked. [Zgourides 1991] That earlier treatment has a case report of its own, published a year before by the same author, and it records the same null result. [Zgourides 1990] Neither abstract says whether the two are one patient, so this page counts them as one line of evidence rather than two. None of the drug reports we reached names a woman.

The GP journal puts drugs alongside the therapy, not in place of it: "Pharmacotherapy may also be appropriate as an adjunct." [Kuoch 2019] It ranks them plainly:

Despite the reported efficacy of medication, psychotherapy is considered the best intervention for paruresis and parcopresis until further clinical trials are investigated.

What a family doctor or a psychiatrist would usually reach for is not in any of those reports. England's clinical guideline on social anxiety disorder offers adults CBT first. For those who turn it down and want a medicine instead, it offers "a selective serotonin reuptake inhibitor (SSRI)". [NICE 2013] Every drug named on this page appears in the same guideline's account of what has been used for social anxiety:

Monoamine oxidase inhibitors (MAOIs), principally phenelzine and moclobemide, have been used for the treatment of social anxiety disorder as have the anticonvulsants gabapentin and pregabalin. Benzodiazepines have also been used, but their long-term use is actively discouraged. Beta-antagonists such as atenolol or propranolol have often been used to treat specific symptoms such as tremor.

And it is plain about the classes it does not want offered as a matter of course:

Do not routinely offer anticonvulsants, tricyclic antidepressants, benzodiazepines or antipsychotic medication to treat social anxiety disorder in adults.

That is evidence about social anxiety disorder, not about paruresis. The guideline never mentions this condition. Whether a drug that works for one works for the other is exactly what nobody has tested. A urologist may raise a different class again: the alpha blockers. The running-water paper below measures its own result against them, as the usual drug for prostate-type symptoms. [Kwon 2015] We found nothing testing one for paruresis.

No drug is named on this page as something to ask for. Where a guideline names one above, it is speaking about a different condition. No page on this site carries a dose.

Things people use

Everything above runs through somebody else — a referral, a prescriber, a nurse who teaches. This part does not, which is why people find it first, and why it is worth being straight about how thin the ground under it is.

Nothing here is a recommendation. This site sells nothing, earns nothing and links to no shop.

The sound of running water

This is the aid people ask about most, on this site's own reading, and the only one we found a trial for. The trial is smaller, and further from you, than most accounts of it suggest.

Eighteen men were enrolled. They were arriving at a urology department for the first time with lower urinary tract symptoms. [Kwon 2015] That is a broad label for urinary symptoms, not the name of a condition. These were men at a urology clinic, not people there for paruresis. Each was measured twice, a week apart, with and without the sound, in a randomised order:

Eighteen consecutive male patients with LUTS were prospectively enrolled between March and April 2014. Uroflowmetry with PVR measured by a bladder scan was randomly performed once weekly for two consecutive weeks with and without SRW in a completely sealed room…

"SRW" is the paper's shorthand for the sound of running water, and "LUTS" for those urinary symptoms.

The equipment has a name, and that is the only reason it is named here:

SRW was played using river water sound of the iPhone application Relax Melodies (iLBSoft, Ipnos Software Inc., Canada Montreal) during voiding, and a speaker system (Bose SoundLink Bluetooth Mobile speaker II) was used to regenerate real running water sound.

What the study found is that the stream ran faster at its peak with the sound playing. [Kwon 2015] That was not everyone's experience: flow went up in thirteen of the men and down in five. [Kwon 2015] Nothing else the study measured differed with the sound [Kwon 2015], and for those measures the authors say themselves that "the sample size was small". [Kwon 2015]

And the finding closest to what you actually want — being able to start — is the one the paper stands behind least:

All patients in this study indicated that they could easily initiate urination with SRW (data not presented).

Read the bracket at the end of it. That is the authors', not ours.

Two things about the study matter more than its result. It ran in "a completely sealed room" [Kwon 2015] — every man in it was voiding alone. The thing that defines paruresis, somebody else within earshot, is the one variable the design removed. And the conclusion the authors actually drew is about "male LUTS patients". [Kwon 2015] Paruresis appears once in the whole paper, in the discussion, as something expected rather than something found:

further studies that compensate for these limitations are warranted, and it is expected that similarly favorable outcomes would be obtained for helping patients with voiding problems in various ways, especially for those patients with paruresis

Every participant was a man, so nothing in it has been tested in women.

So: a real trial, a named app, a measured effect — in men who were not there for this condition, tested in the one setting where this condition does not bite. That is not nothing. It is also a long way from what a shopping page will tell you it is.

Everything else people use

We went looking for published evidence on the rest of it — earplugs and headphones, female urination devices, the timing and fluid habits people work out for themselves — and found nothing tying any of them to paruresis. No trial, no guideline, not even a case report.

That is a statement about what has been published, not about whether they help you. They may. This page cannot tell you so, and it will not imply it.

The question worth putting to a clinician

Aids of this kind have a name in the treatment literature. In the case report this page already draws on, "safety behaviours were also identified [...] and gradually eliminated based on a collaborative approach" as part of the therapy. [Kuoch 2019] The same report describes a man who "restricted fluid intake and altered his dietary habits". [Kuoch 2019]

That is one published course of treatment and not a verdict on anything you use. But it is why this is worth raising with whoever treats you rather than settling on your own: the thing that gets you through Tuesday and the thing that gets you better are not always the same thing.

What to avoid

Waiting it out. A survey of 63 people with paruresis, 59 men and 4 women, found a mean duration of symptoms of 24.5 years. [Vythilingum 2002] They reached that survey through an advocacy group, so it pictures people who waited rather than everybody. Its authors conclude that "paruresis can be a chronic and disabling symptom". [Vythilingum 2002] Can be, not must be — they hedged it, and so does this page.

Teaching yourself to catheterise. The nurses' guideline is short about it: "only properly trained nurses should provide teaching". [EAUN 2025] If you have already been ordering tubing online, how to tell a real catheter from a dangerous one is the page to read.

Cutting down on what you drink. This is here because a published case describes it, not because this page has a view on what anyone should drink. As a result of his anxiety, "the patient restricted fluid intake and altered his dietary habits to decrease the likelihood of needing to use the restroom in public". [Kuoch 2019] The same report says that in his therapy, "safety behaviours were also identified [...] and gradually eliminated based on a collaborative approach". [Kuoch 2019] Nothing about that is male or female, and it is worth saying out loud in an appointment.

Where this ends up

Every option here runs through somebody else: a referral, a nurse who teaches, a person who prescribes. The Doctor Brief is a sheet you can hand across a desk instead of finding the first sentence yourself.

No clinician has checked this page. Every claim on it is on the sources page with a link and the words behind it.