Sources
Every claim this site makes about the condition is listed here with a link to its source and the exact words that back it. Open the original and judge for yourself whether it says what the page says it does.
How to tell a real catheter from a dangerous one
A urinary catheter is a regulated medical device with a definition in law, not a generic length of tubing.
What the source says
A urological catheter and accessories is a flexible tubular device that is inserted through the urethra and used to pass fluids to or from the urinary tract.
21 CFR § 876.5130 — Urological catheter and accessories — US Code of Federal Regulations, Title 21, Chapter I, Subchapter H, Part 876, Subpart F; 2024 annual edition, revised as of 1 April 2024. Source 48 FR 53023, as amended at 61 FR 1122 and 66 FR 38801. Paragraph (a), Identification.
The publisher's own page for this source
Read on 2026-09-08
A US device that may be sold only on a practitioner's order has to carry one of a fixed set of phrases on its label.
What the source says
The symbol statement “Rx only” or “℞ only” or the statement “Caution: Federal law restricts this device to sale by or on the order of a ___”, the blank to be filled with the word “physician”, “dentist”, “veterinarian”, or with the descriptive designation of any other practitioner licensed by the law of the State in which the practitioner practices to use or order the use of the device
21 CFR § 801.109 — Prescription devices — US Code of Federal Regulations, Title 21, Chapter I, Subchapter C, Part 801, Subpart D; 2024 annual edition, revised as of 1 April 2024. Source 41 FR 6896, as amended at 81 FR 38930. Paragraph (b)(1).
The publisher's own page for this source
Read on 2026-09-08
GREAT BRITAIN ONLY. The UK regulator states that a medical device placed on the Great Britain market must carry a UKCA marking or a CE marking.
What the source says
Medical devices placed on the Great Britain market must have a UKCA marking or a CE marking, depending on which legislation the device has been certified under.
Regulating medical devices in the UK — Medicines and Healthcare products Regulatory Agency · GOV.UK guidance, Medicines and Healthcare products Regulatory Agency. Published 31 December 2020, last updated 20 February 2026. Section "Labelling requirements", first sentence. · 2026
Read on 2026-09-11
The ready-to-use intermittent catheters described by the European nurses' guideline are sterile and carry their own coating or gel.
What the source says
Sterile catheters with hydrophilic coatings are a ready-to-use solution, with gel on the surface of the catheter or in the wrapping.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Table 7, Summary of catheter types — row "Single-use catheter with coating or gel", Description column. · 2025
The publisher's own page for this source
Read on 2026-09-08
The guideline's recommendation on reuse is a sterile catheter used once.
What the source says
Use a sterile single-use intermittent catheter to prevent cross-contamination in clinical, rehabilitation, and long-term care settings
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Procedures for IC, recommendations table; reference 60, level of evidence 1, grade B. · 2025
The publisher's own page for this source
Read on 2026-09-08
The guideline singles out the plastic PVC as a material to avoid in a catheter.
What the source says
PVC-free catheters should be used for IC to reduce pain and burning
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Complications, recommendations table; reference 54, level of evidence 1b, grade A. · 2025
The publisher's own page for this source
Read on 2026-09-08
Sterile lubricant is single use, and an opened package is not used again.
What the source says
Sterile lubricants are always for single use. An open package should not be used again.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Figure 1 sidebar, "Catheter lubrications/coating". · 2025
The publisher's own page for this source
Read on 2026-09-08
The guideline's lubricant recommendation names women and men together.
What the source says
Use lubricant in both women and men when using a non-coated catheter
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Procedures for IC, recommendations table; reference 95, level of evidence 4, grade C. · 2025
The publisher's own page for this source
Read on 2026-09-08
Who may prescribe intermittent catheterisation depends on the jurisdiction and on local policy.
What the source says
The practitioner authorised to prescribe IC will depend on the jurisdiction and local health care organisation policy.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Principles of management of nursing intervention, opening sentence. · 2025
The publisher's own page for this source
Read on 2026-09-08
Choosing a catheter is an assessment of the person, not a purchase decision made from a listing.
What the source says
The choice of catheter should consider the patient assessment, patient preference, limitations or disabilities, cost-benefit, cost effectiveness, ease of use, and storage issues. The patient should be given guidance on selecting the best product for their needs, recognising that their needs may change over time.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Catheter material, types of catheters, and equipment, opening paragraph. · 2025
The publisher's own page for this source
Read on 2026-09-08
The guideline routes persisting problems and complications to a medical consultation.
What the source says
If problems persist or complications occur, a medical consultation should be made.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Troubleshooting IC, closing line under Table 10. · 2025
The publisher's own page for this source
Read on 2026-09-08
The guideline tells staff to confirm a catheter's size from its packaging rather than from a connector colour.
What the source says
Note, while the colours are international, not every manufacturer uses the colour coding; so, it is necessary to check the packaging and connector for size confirmation.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Catheter diameter, length, and connectors — "Catheter connectors" paragraph. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline's recommendation is that a catheter's size is chosen for the person, balancing free drainage against the risk of trauma.
What the source says
Choose a catheter size large enough to allow free drainage but small enough to reduce risk of trauma
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Procedures for IC, recommendations table; no reference, level of evidence 4, grade C. · 2025
The publisher's own page for this source
Read on 2026-09-11
When someone starts catheterisation the guideline requires the catheter type, tip, length and size to be recorded.
What the source says
catheter type, tip, length, and size
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Documentation section — list of data that "must be collected and documented" when a patient starts catheterisation, fifth item. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline recommends hydrophilic-coated or pre-lubricated catheters for intermittent catheterisation — a recommendation, not a mark of a genuine device.
What the source says
Hydrophilic-coated or pre-lubricated catheters should be used for IC
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Complications, recommendations table; references 30, 31, 52, 53, level of evidence 1a, grade A. · 2025
The publisher's own page for this source
Read on 2026-09-11
When a catheter cannot be passed, the guideline's recommendation is to seek a urologist's advice.
What the source says
In the event of inability to catheterise, seek advice of a urologist
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Complications, recommendations table; no reference, level of evidence 4, grade A. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline lists significant visible blood in the urine among the contraindications to intermittent catheterisation.
What the source says
significant visible haematuria
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Table 2, Contraindications to IC, "Relative" column, sixth item. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline treats the single-use catheter as the default and allows a reusable catheter where single-use ones are not available.
What the source says
If single-use catheters are not available, use reusable catheter.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Figure 7, "IC technique – simplified", footnote. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline's hygiene recommendation for intermittent catheterisation is water and pH-neutral soap.
What the source says
Clean the urethral meatus with water and pH-neutral soap
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Procedures for IC, recommendations table; references 96–99, level of evidence 1a, grade A. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline recommends against routine use of antiseptic lubricants for intermittent catheterisation.
What the source says
Do not use antiseptic lubricants for IC routinely
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Procedures for IC, recommendations table; reference 95, level of evidence 4, grade C. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline names urinary tract infection as the most common complication of intermittent catheterisation.
What the source says
A UTI is the most common complication and is often associated with inflammation.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Complications, "Infection", second sentence. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline's complications table gives the share of intermittent catheter users affected by infection: 62%–77% among users with a neurogenic disorder and 38%–42% among users with a non-neurogenic disorder.
What the source says
62%–77% among IC users with a neurogenic disorder and 38%–42% among IC users with a non-neurogenic disorder.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Table 5, Complications experienced by IC users, "Infection and/or inflammation" group, first row, Frequency column; references 11, 36, 37. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline's complications table lists urethritis, inflammation of the urethra, among the complications of intermittent catheterisation.
What the source says
Inflammation of the urethra, which may or may not be infectious.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Table 5, Complications experienced by IC users, row "Urethritis", Description column. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline's complications table lists epididymo-orchitis, inflammation of the epididymis and/or testicle, among the complications of intermittent catheterisation.
What the source says
Inflammation of the epididymis and/or testicle, which may or may not be infectious.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Table 5, Complications experienced by IC users, row "Epididymo-orchitis", Description column. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline's complications table lists urethral stricture, a narrowing of the urethra, and records it as occurring mostly in men and rarely in women.
What the source says
A narrowing of the urethra. Incidence of 4.2%–25% in men. Rare in women.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Table 5, Complications experienced by IC users, "Urethral trauma/haematuria" group, row "Urethral stricture", Description and Frequency columns. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline recommends hydrophilic-coated catheters to prevent urethral strictures.
What the source says
Hydrophilic-coated catheters to prevent urethral strictures should be used
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Complications, recommendations table; reference 53, level of evidence 1a, grade A. The row wraps onto two lines in the PDF ("...should / be used"). · 2025
The publisher's own page for this source
Read on 2026-09-11
Bacteria in the urine are acquired at a rate of 1%–3% per catheterisation, and asymptomatic bacteriuria does not require treatment.
What the source says
Bacteriuria is acquired at the rate of 1%–3% per catheterisation. Asymptomatic bacteriuria does not require treatment.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Infection prevention, first paragraph, sentences three and four; reference 7 on the first. · 2025
The publisher's own page for this source
Read on 2026-09-11
The guideline's recommendation is that in all intermittent catheter users only symptomatic urinary tract infection is treated.
What the source says
In all IC users, only treat symptomatic UTI
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Complications, recommendations table, first row; references 14, 51, level of evidence 1b, grade A. · 2025
The publisher's own page for this source
Read on 2026-09-11
The EPA-accepted label for Metrex CaviWipes states what the product is for: hard, non-porous inanimate surfaces.
What the source says
CaviWipes is a multi-purpose [disinfectant] [cleaning product] [cleaner] for use on hard, non-porous inanimate surfaces.
Pesticide Product Label — CaviWipes, EPA Reg. No. 46781-8, accepted 03/24/2021 — US Environmental Protection Agency, Office of Pesticide Programs, Pesticide Product and Label System. Master label version 03/2021, page 5, DISINFECTION section. Registrant Metrex Research. · 2021
Read on 2026-09-08
The same label's precautionary statement addresses contact with skin.
What the source says
Harmful if absorbed through skin. Causes moderate eye irritation. Avoid contact with eyes, skin or clothing.
Pesticide Product Label — CaviWipes, EPA Reg. No. 46781-8, accepted 03/24/2021 — US Environmental Protection Agency, Office of Pesticide Programs, Pesticide Product and Label System. Master label version 03/2021, page 2, PRECAUTIONARY STATEMENTS — Hazards to Humans and Domestic Animals, under the signal word CAUTION. Registrant Metrex Research. · 2021
Read on 2026-09-08
The same label addresses instruments that go into the body.
What the source says
This product is not to be used as a terminal sterilant/ high-level disinfectant on any surface or instrument that (1) is introduced directly into the human body, either into or in contact with the bloodstream or normally sterile areas of the body, or (2) contacts intact mucous membranes but which does not ordinarily penetrate the blood barrier or otherwise enter normally sterile areas of the body. This product may be used to preclean or decontaminate critical or semi-critical medical devices prior to sterilization/high-level disinfection.
Pesticide Product Label — CaviWipes, EPA Reg. No. 46781-8, accepted 03/24/2021 — US Environmental Protection Agency, Office of Pesticide Programs, Pesticide Product and Label System. Master label version 03/2021, page 5, the paragraph carried in full on production labels that reference health care use and applications on medical devices. Registrant Metrex Research. · 2021
Read on 2026-09-08
Fever with flank pain suggests pyelonephritis, an infection of the upper urinary tract.
What the source says
Pyelonephritis is suggested in case of fever (> 38°C), chills, flank pain, nausea, vomiting or costovertebral angle tenderness, with or without the typical symptoms of cystitis
EAU Guidelines on Urological Infections — G. Bonkat (Chair); J. Kranz (Vice chair); T. Cai; S.E. Geerlings; B. Koves; M.M.C. Lambregts; G. Mantica; A. Pilatz; J. Medina-Polo; L. Schneidewind; S. Schubert; M. Vallee; R. Veeratterapillay; F. Wagenlehner · European Association of Urology, limited update March 2026; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Section 3.6.1.a. · 2026
The publisher's own page for this source
Read on 2026-09-08
Guidelines say the obstructive form of pyelonephritis must be told apart from the rest as soon as possible, because it can lead rapidly to sepsis.
What the source says
It is vital to differentiate as soon as possible between pyelonephritis with or without risk factors, such as obstructive pyelonephritis, as the latter can rapidly lead to urosepsis.
EAU Guidelines on Urological Infections — G. Bonkat (Chair); J. Kranz (Vice chair); T. Cai; S.E. Geerlings; B. Koves; M.M.C. Lambregts; G. Mantica; A. Pilatz; J. Medina-Polo; L. Schneidewind; S. Schubert; M. Vallee; R. Veeratterapillay; F. Wagenlehner · European Association of Urology, limited update March 2026; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Section 3.6.1.b. · 2026
The publisher's own page for this source
Read on 2026-09-08
Acute urinary retention is the sudden inability to urinate with a full bladder; it can be severely painful and life threatening, and needs emergency care right away.
What the source says
People with acute urinary retention are unable to urinate even though they have a full bladder. Acute urinary retention can cause severe pain and be life threatening. If you are suddenly unable to urinate, it’s important that you seek emergency medical treatment right away.
Definition & Facts of Urinary Retention — NIDDK (US National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health). Page last reviewed December 2019. · 2019
Read on 2026-09-11
Repeat prescriptions can be ordered online through the NHS App or website, with a pharmacy chosen to collect from; some pharmacies deliver.
What the source says
You can order repeat prescriptions online by logging into the NHS App or the NHS website. You can choose a high-street pharmacy to collect your prescription from. Some pharmacies may offer delivery.
How to order a repeat prescription — nhs.uk, NHS services — Prescriptions. Page last reviewed 17 October 2023; next review due 17 October 2026. · 2023
Read on 2026-09-10
A GP surgery may be able to send the prescription to a pharmacy of the patient's choice, which may then deliver.
What the source says
When your prescription is ready you can pick it up in person, or your GP surgery may be able to send it to a pharmacy of your choice. If you choose a pharmacy, the pharmacy may be able to deliver your medicine to you or let you know when it's ready for you to collect.
How to order a repeat prescription — nhs.uk, NHS services — Prescriptions. Page last reviewed 17 October 2023; next review due 17 October 2026. · 2023
Read on 2026-09-10
The NHS prescription charge in England is a flat amount per item.
What the source says
The current prescription charge is £9.90 per item.
NHS prescription charges — nhs.uk, NHS services — Prescriptions. · 2026
Read on 2026-09-10
Most prescriptions are valid for six months from signing.
What the source says
Most prescriptions are valid for 6 months from the date they are signed by a doctor or nurse.
NHS prescription charges — nhs.uk, NHS services — Prescriptions. · 2026
Read on 2026-09-10
A prescription prepayment certificate covers all of a person's NHS prescriptions regardless of how many items.
What the source says
A PPC covers all your NHS prescriptions, including NHS dental prescriptions, no matter how many items you need.
Save money with a prescription prepayment certificate (PPC) — nhs.uk, NHS services — Prescriptions. Page last reviewed 27 November 2023; next review due 27 November 2026. · 2023
Read on 2026-09-10
The NHS tells people to check whether they are entitled to free prescriptions before buying a prepayment certificate.
What the source says
Check if you can get free prescriptions before you apply for a PPC.
Save money with a prescription prepayment certificate (PPC) — nhs.uk, NHS services — Prescriptions. Page last reviewed 27 November 2023; next review due 27 November 2026. · 2023
Read on 2026-09-10
Medicare covers intermittent catheterisation where the patient meets its basic coverage criteria and the patient or a carer can perform it.
What the source says
We cover intermittent catheterization when the patient meets basic coverage criteria, and the patient or caregiver can do the procedure.
Urological Supplies — Medicare Provider Compliance Tips — Centers for Medicare & Medicaid Services, Medicare Learning Network. Page last modified 12 February 2026. · 2026
Read on 2026-09-10
Coverage turns on what the medical record shows.
What the source says
The patient’s medical records must support the medical necessity for the urological supplies and must be available, if asked, for us to consider them reasonable and necessary.
Urological Supplies — Medicare Provider Compliance Tips — Centers for Medicare & Medicaid Services, Medicare Learning Network. Page last modified 12 February 2026. · 2026
Read on 2026-09-10
US ONLY. Medicare's urological-supplies policy covers urinary catheters for a beneficiary who has permanent urinary incontinence or permanent urinary retention, and requires a permanent impairment of urination.
What the source says
Urinary catheters and external urinary collection devices are covered to drain or collect urine for a beneficiary who has permanent urinary incontinence or permanent urinary retention. The beneficiary must have a permanent impairment of urination.
Urological Supplies — Policy Article (A52521) — Centers for Medicare & Medicaid Services, Medicare Coverage Database. Local Coverage Article A52521, the Policy Article attached to LCD L33803 (Urological Supplies). Revision effective 1 April 2026. Article Text, "Non-medical necessity coverage and payment rules", heading "GENERAL", first two sentences. · 2026
Read on 2026-09-11
For my doctor: shy bladder syndrome (paruresis)
Paruresis "refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others."
What the source says
Paruresis refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others.
A systematic review of paruresis: Clinical implications and future directions — Kenley L J Kuoch; Denny Meyer; David W Austin; Simon R Knowles · Journal of Psychosomatic Research 98:122-129. doi:10.1016/j.jpsychores.2017.05.015. PMID 28554367 · 2017
The publisher's own page for this source
Read on 2026-09-07
"As a result of stigma and a perception that symptoms are embarrassing, patients hesitate to raise paruresis and parcopresis issues with their clinicians and may choose not to disclose."
What the source says
As a result of stigma and a perception that symptoms are embarrassing, patients hesitate to raise paruresis and parcopresis issues with their clinicians and may choose not to disclose.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-07
"The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1-22.2% of individuals with paruresis also had Social Anxiety Disorder."
What the source says
RESULTS: The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1-22.2% of individuals with paruresis also had Social Anxiety Disorder.
A systematic review of paruresis: Clinical implications and future directions — Kenley L J Kuoch; Denny Meyer; David W Austin; Simon R Knowles · Journal of Psychosomatic Research 98:122-129. doi:10.1016/j.jpsychores.2017.05.015. PMID 28554367 · 2017
The publisher's own page for this source
Read on 2026-09-07
That review adds: "Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required."
What the source says
CONCLUSION: Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required.
A systematic review of paruresis: Clinical implications and future directions — Kenley L J Kuoch; Denny Meyer; David W Austin; Simon R Knowles · Journal of Psychosomatic Research 98:122-129. doi:10.1016/j.jpsychores.2017.05.015 · 2017
The publisher's own page for this source
Read on 2026-09-07
A 2024 survey of 356 university staff and students - "221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders".
What the source says
We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18-30 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open. doi:10.1136/bmjopen-2024-086097. PMC11574405 · 2024
The publisher's own page for this source
Read on 2026-09-07
The survey found the adjusted odds of 'mild' paruresis "higher for men than women (OR 3.39; 95% CI 1.90 to 6.06)".
What the source says
The adjusted odds of 'mild' paruresis were higher for men than women (OR 3.39; 95% CI 1.90 to 6.06)
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-07
Its authors note: "The sample may be motivated and may not be generalisable to the wider population."
What the source says
The sample may be motivated and may not be generalisable to the wider population.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-07
"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."
What the source says
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).
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-07
In a study of 101 people who did graduated exposure therapy in weekend workshops: "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."
What the source says
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.
Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach — Steven Soifer; Joseph Himle; Kathleen Walsh · Social Work in Health Care 49(5):494-507. doi:10.1080/00981381003684898 · 2010
The publisher's own page for this source
Read on 2026-09-07
CISC is taught, not self-taught: "IC should be taught by an appropriately experienced nurse."
What the source says
IC should be taught by an appropriately experienced nurse [and, in the same document] There is a lack of agreed standards for patient and caregiver education on IC, and only properly trained nurses should provide teaching.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025 · 2025
The publisher's own page for this source
Read on 2026-09-07
The only statement I have is "Pharmacotherapy may also be appropriate as an adjunct."
What the source says
Pharmacotherapy may also be appropriate as an adjunct.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-07
"Patients presenting with suspected paruresis or parcopresis should be examined for anatomic or physiologic abnormalities prior to a diagnosis."
What the source says
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.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-07
49 CFR Sec. 40.193 sends the employee to a physician who "must recommend that the MRO make one of the following determinations", the first being that "a medical condition has, or with a high degree of probability could have, precluded the employee from providing a sufficient amount of specimen." The medical review officer decides whether to "accept this recommendation".
What the source says
(c) As the DER, if the collector informs you that the employee has not provided a sufficient amount of specimen (see paragraph (b) of this section), you must, after consulting with the MRO, direct the employee to obtain, within five days, an evaluation from a licensed physician, acceptable to the MRO, who has expertise in the medical issues raised by the employee's failure to provide a urine (see paragraph (b)(1) of this section) or oral fluid (see paragraph (b)(2) of this section) sufficient specimen, but not both. [...] (d) As the referral physician conducting this evaluation, you must recommend that the MRO make one of the following determinations: (1) A medical condition has, or with a high degree of probability could have, precluded the employee from providing a sufficient amount of specimen. As the MRO, if you accept this recommendation, you must: (i) Check "Test Cancelled" (Step 6) on the CCF; and (ii) Sign and date the CCF.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. Source note in text - [88 FR 27647, May 2, 2023]. Published by the US Government Publishing Office (govinfo.gov). · 2023
The publisher's own page for this source
Read on 2026-09-07
It adds that a medical condition includes "a medically documented pre-existing psychological disorder, but does not include unsupported assertions of 'situational anxiety' or dehydration."
What the source says
(e) For purposes of this paragraph, a medical condition includes an ascertainable physiological condition (e.g., a urinary system dysfunction in the case of a urine test or autoimmune disorder in the case of an oral fluid test), or a medically documented pre-existing psychological disorder, but does not include unsupported assertions of "situational anxiety" or dehydration.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Part 40, Subpart I (govinfo.gov) · 2023
The publisher's own page for this source
Read on 2026-09-07
Fever with flank pain suggests pyelonephritis, an infection of the upper urinary tract.
What the source says
Pyelonephritis is suggested in case of fever (> 38°C), chills, flank pain, nausea, vomiting or costovertebral angle tenderness, with or without the typical symptoms of cystitis
EAU Guidelines on Urological Infections — G. Bonkat (Chair); J. Kranz (Vice chair); T. Cai; S.E. Geerlings; B. Koves; M.M.C. Lambregts; G. Mantica; A. Pilatz; J. Medina-Polo; L. Schneidewind; S. Schubert; M. Vallee; R. Veeratterapillay; F. Wagenlehner · European Association of Urology, limited update March 2026; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Section 3.6.1.a, p. 26. · 2026
The publisher's own page for this source
Read on 2026-09-08
Acute urinary retention, the sudden inability to pass any urine, is treated as a medical emergency.
What the source says
Acute urinary retention (AUR) is the sudden inability to pass any urine. AUR should be treated as a medical emergency, because without prompt treatment urine may be passed back up into the kidneys, which can damage them.
Benign prostate enlargement — NHS inform (NHS 24, Scotland's national health information service). Page last updated 1 June 2026. · 2026
Read on 2026-09-08
Guidelines say the obstructive form of pyelonephritis must be told apart from the rest as soon as possible, because it can lead rapidly to sepsis.
What the source says
It is vital to differentiate as soon as possible between pyelonephritis with or without risk factors, such as obstructive pyelonephritis, as the latter can rapidly lead to urosepsis.
EAU Guidelines on Urological Infections — G. Bonkat (Chair); J. Kranz (Vice chair); T. Cai; S.E. Geerlings; B. Koves; M.M.C. Lambregts; G. Mantica; A. Pilatz; J. Medina-Polo; L. Schneidewind; S. Schubert; M. Vallee; R. Veeratterapillay; F. Wagenlehner · European Association of Urology, limited update March 2026; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Section 3.6.1.b, p. 26. · 2026
The publisher's own page for this source
Read on 2026-09-08
Acute urinary retention is the sudden inability to urinate with a full bladder; it can be severely painful and life threatening, and needs emergency care right away.
What the source says
People with acute urinary retention are unable to urinate even though they have a full bladder. Acute urinary retention can cause severe pain and be life threatening. If you are suddenly unable to urinate, it’s important that you seek emergency medical treatment right away.
Definition & Facts of Urinary Retention — NIDDK (US National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health). Page last reviewed December 2019. · 2019
Read on 2026-09-11
The discriminator: paruresis "is isolated to unfamiliar or busy public restrooms", unlike dysfunctional voiding, which shares its symptoms.
What the source says
For instance, dysfunctional voiding (DV) has been noted to share similar symptoms with paruresis as both conditions involve urinary retention in the absence of anatomic, obstructive, infectious or neurologic pathology. However, unlike DV, paruresis is isolated to unfamiliar or busy public restrooms.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-11
Urinary retention "is common after anesthesia and surgery".
What the source says
Urinary retention is common after anesthesia and surgery, reported incidence of between 5% and 70%. Comorbidities, type of surgery, and type of anesthesia influence the development of postoperative urinary retention (POUR).
Postoperative urinary retention: anesthetic and perioperative considerations — Gabriele Baldini; Hema Bagry; Armen Aprikian; Franco Carli · Anesthesiology 110(5):1139-57. doi:10.1097/ALN.0b013e31819f7aea. PMID 19352147 · 2009
The publisher's own page for this source
Read on 2026-09-11
Urinary retention "has been described with the use of drugs with anticholinergic activity", among them "antidepressant agents", and with opioids.
What the source says
Urinary retention has been described with the use of drugs with anticholinergic activity (e.g. antipsychotic drugs, antidepressant agents and anticholinergic respiratory agents), opioids and anaesthetics, alpha-adrenoceptor agonists, benzodiazepines, NSAIDs, detrusor relaxants and calcium channel antagonists.
Drug-induced urinary retention: incidence, management and prevention — Katia M C Verhamme; Miriam C J M Sturkenboom; Bruno H Ch Stricker; Ruud Bosch · Drug Safety 31(5):373-88. doi:10.2165/00002018-200831050-00002. PMID 18422378 · 2008
The publisher's own page for this source
Read on 2026-09-11
Parcopresis is the same problem for the bowel: it "refers to the difficulty or inability to defecate in public restrooms because of overwhelming fear of perceived scrutiny."
What the source says
A closely related condition is parcopresis, which refers to the difficulty or inability to defecate in public restrooms because of overwhelming fear of perceived scrutiny.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-11
The European nurses' guideline's list of what intermittent catheterisation is for starts at "acute or chronic urinary retention due to nonneurogenic or neurogenic conditions"; paruresis is not on it.
What the source says
acute or chronic urinary retention due to nonneurogenic or neurogenic conditions
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Indications, contraindications, and alternatives for IC", first bullet under Indications. · 2025
The publisher's own page for this source
Read on 2026-09-11
Workplace drug testing when you cannot produce a sample
The US Department of Transportation drug-testing procedure described on this page applies to transportation employers, safety-sensitive transportation employees and service agents. It is not a general rule for US workplaces, and it is not a rule anywhere outside the United States.
What the source says
(b) This part concerns the activities of transportation employers, safety-sensitive transportation employees (including self-employed individuals, contractors and volunteers as covered by DOT agency regulations), and service agents.
49 CFR Sec. 40.1 - Who does this regulation cover? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart A. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The regulation defines the three roles by name: the collector, the designated employer representative (DER), and the medical review officer (MRO), who is a licensed physician. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
Collector. A person who instructs and assists employees at a collection site, who receives and makes an initial inspection of the specimen provided by those employees, and who initiates and completes the CCF. [...] Designated employer representative (DER). An employee authorized by the employer to take immediate action(s) to remove employees from safety-sensitive duties, or cause employees to be removed from these covered duties, and to make required decisions in the testing and evaluation processes. The DER also receives test results and other communications for the employer, consistent with the requirements of this part. Service agents cannot act as DERs. [...] Medical Review Officer (MRO). A person who is a licensed physician and who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for certain drug test results.
49 CFR Sec. 40.3 - What do the terms used in this part mean? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart A. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
An ordinary DOT urine collection is not watched. The preferred facility is a single-toilet room with a full-length privacy door, and no one but the employee may be in the room - unless the collection is a directly observed one. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(e) The first, and preferred, type of facility for urination that a collection site may include is a single-toilet room, having a full-length privacy door, within which urination can occur. (1) No one but the employee may be present in the room during the collection, except for the observer in the event of a directly observed collection.
49 CFR Sec. 40.42 - Where does a urine collection for a DOT drug test take place? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart D. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
A directly observed collection is one the employer must direct in listed circumstances - an invalid result with no adequate medical explanation, a split specimen that could not be tested, a narrowly dilute negative, or a missed observation - and always for a return-to-duty or a follow-up test. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(a) As an employer, you must direct an immediate collection under direct observation with no advance notice to the employee, if: (1) The laboratory reported to the MRO that a specimen is invalid, and the MRO reported to you that there was not an adequate medical explanation for the result; (2) The MRO reported to you that the original positive, adulterated, or substituted result had to be cancelled because the test of the split specimen could not be performed; or (3) The laboratory reported to the MRO that the specimen was negative-dilute with a creatinine concentration greater than or equal to 2 mg/dL but less than or equal to 5 mg/dL, and the MRO reported the specimen to you as negative-dilute and that a second collection must take place under direct observation (see § 40.197(b)(1)). (4) You realize a collection under direct observation was required but was not conducted or the service agent informs you that a direct observation should have been collected but was not (see paragraph (n) of this section). (b) As an employer, you must direct a collection under direct observation of an employee if the drug test is a return-to-duty test or a follow-up test.
49 CFR Sec. 40.67 - When and how is a directly observed urine collection conducted? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart E. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The collector must conduct a directly observed collection when the DER directs one, or on evidence of tampering, or when the specimen was out of temperature range, or when the test reason is return-to-duty or follow-up. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(c) As a collector, you must immediately conduct a collection under direct observation if: (1) You are directed by the DER to do so (see paragraph (a) of this section); or (2) You observed materials brought to the collection site or the employee's conduct clearly indicates an attempt to tamper with a specimen (see §§ 40.61(f)(5)(i) and 40.63(e)); or (3) The temperature on the original specimen was out of range (see § 40.65(b)(5)); (4) The original specimen appeared to have been tampered with (see § 40.65(c)(1)); or (5) The test reason is return-to-duty or follow-up.
49 CFR Sec. 40.67 - When and how is a directly observed urine collection conducted? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart E. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The collector must tell the employee the reason for a directly observed collection, if it is known. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(2) As the collector, you must explain to the employee the reason, if known, under this part for a directly observed collection.
49 CFR Sec. 40.67 - When and how is a directly observed urine collection conducted? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart E. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
Declining to allow a directly observed collection is itself a refusal to test. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(m) As the employee, if you decline to allow a directly observed collection required or permitted under this section to occur, this is a refusal to test.
49 CFR Sec. 40.67 - When and how is a directly observed urine collection conducted? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart E. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
A monitored collection - where someone is in the room but does not watch - is a different thing from a directly observed one, and the regulation names exactly one circumstance that requires it: a multi-stall restroom where the water sources cannot be secured. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(a) As stated in § 40.42(f)(2), if you are conducting a urine collection in a multi-stall restroom and you cannot secure all sources of water and other substances that could be used for adulteration and substitution, you must conduct a monitored collection. This is the only circumstance in which you must conduct a monitored collection.
49 CFR Sec. 40.69 - How is a monitored urine collection conducted? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart E. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
Declining to allow a monitored collection is also a refusal to test. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(h) As the employee being tested, if you decline to permit a collection authorized under this section to be monitored, it is a refusal to test.
49 CFR Sec. 40.69 - How is a monitored urine collection conducted? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart E. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
A sufficient specimen for a DOT drug test is 45 mL of urine in a single void, or 2 mL of oral fluid in a single sampling. If the employee does not provide it, the collector must give another opportunity, and - if the employer's instructions allow it - that second attempt may be an alternate specimen type rather than urine again. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(a) If an employee does not provide a sufficient amount of specimen to permit a drug test (i.e., 45 mL of urine in a single void, or 2mL oral fluid in a single sampling, as applicable) you, as the collector, must provide another opportunity to the employee to do so. In accordance with the employer's instructions, this can be done using the same specimen type as the original collection or this can be done by a collector qualified to use an alternate specimen collection for this purpose.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
For a urine collection, the collector urges the employee to drink up to 40 ounces of fluid spread over up to three hours, or until a sufficient specimen is given. Declining to drink is not a refusal to test, and the employee must be told when the three-hour period begins and ends. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(ii) Urge the employee to drink up to 40 ounces of fluid, distributed reasonably through a period of up to three hours, or until the individual has provided a sufficient urine specimen, whichever occurs first. It is not a refusal to test if the employee declines to drink. Document on the Remarks line of the CCF (Step 2), and inform the employee of the time at which the three-hour period begins and ends.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
If no sufficient urine specimen is given within three hours of the first unsuccessful attempt, the collector stops the collection, records it, and notifies the DER. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(iv) If the employee has not provided a sufficient specimen within three hours of the first unsuccessful attempt to provide the specimen, you must discontinue the collection, note the fact on the “Remarks” line of the CCF (Step 2), and immediately notify the DER. You must also discard any specimen the employee previously provided, including any specimen that is “out of temperature range” or shows signs of tampering. In the remarks section of the CCF that you will distribute to the MRO and DER, note the fact that the employee provided an “out of temperature range specimen” or “specimen that shows signs of tampering” and that it was discarded because the employee did not provide a second sufficient specimen.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
For oral fluid, the collection is discontinued and the DER notified if no sufficient specimen is given within one hour of the first unsuccessful attempt. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(ii) If the employee has not provided a sufficient specimen within one hour of the first unsuccessful attempt to provide the specimen, you must discontinue the collection, note the fact on the “Remarks” line of the CCF (Step 2), and immediately notify the DER.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
Refusing to attempt a second specimen, or leaving the collection site before the collection is finished, is handled differently from being unable to go: the collector records it and notifies the DER, and the employer decides whether it counts as a refusal. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(iii) If the employee refuses to make the attempt to provide a new urine specimen or leaves the collection site before the collection process is complete, you must discontinue the collection, note that fact on the “Remarks” line of the CCF (Step 2), and immediately notify the DER of the conduct as provided in § 40.191(e)(1); the employer decides whether the situation is deemed to be a refusal.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
After the collector reports an insufficient specimen, it is the DER - the employer's designated representative - who, after consulting the MRO, directs the employee to obtain an evaluation within five days from a licensed physician who is acceptable to the MRO and has expertise in the medical issues raised. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(c) As the DER, if the collector informs you that the employee has not provided a sufficient amount of specimen (see paragraph (b) of this section), you must, after consulting with the MRO, direct the employee to obtain, within five days, an evaluation from a licensed physician, acceptable to the MRO, who has expertise in the medical issues raised by the employee's failure to provide a urine (see paragraph (b)(1) of this section) or oral fluid (see paragraph (b)(2) of this section) sufficient specimen, but not both. The evaluation and MRO determination required by this section only applies to the oral fluid or the urine insufficient specimen that was the final methodology at the collection site. (The MRO may perform this evaluation if the MRO has appropriate expertise.)
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The licensed physician who conducts the evaluation does not decide the outcome. That physician RECOMMENDS one of two determinations to the MRO: that a medical condition precluded the employee from providing enough specimen, or that there is not an adequate basis for so determining. The MRO is the one who accepts a recommendation and marks the form. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(d) As the referral physician conducting this evaluation, you must recommend that the MRO make one of the following determinations: (1) A medical condition has, or with a high degree of probability could have, precluded the employee from providing a sufficient amount of specimen. As the MRO, if you accept this recommendation, you must: (i) Check “Test Cancelled” (Step 6) on the CCF; and (ii) Sign and date the CCF. (2) There is not an adequate basis for determining that a medical condition has, or with a high degree of probability could have, precluded the employee from providing a sufficient amount of specimen. As the MRO, if you accept this recommendation, you must: (i) Check the “Refusal to Test” box and “Other” box in Step 6 on Copy 2 of the CCF and note the reason next to the “Other” box and on the “Remarks” lines, as needed. (ii) Sign and date the CCF.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The evaluating physician must give the MRO a written statement of the recommendation and the basis for it, and must not include detail about the employee's medical condition beyond what is needed to explain the conclusion. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(f) As the referral physician making the evaluation, after completing your evaluation, you must provide a written statement of your recommendations and the basis for them to the MRO. You must not include in this statement detailed information on the employee's medical condition beyond what is necessary to explain your conclusion.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The MRO makes the determination. The MRO must seriously consider and assess the referral physician's recommendations, decide whether a medical condition precluded the employee from providing enough specimen, and report that determination to the DER in writing. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(h) As the MRO, you must seriously consider and assess the referral physician's recommendations in making your determination about whether the employee has a medical condition that has, or with a high degree of probability could have, precluded the employee from providing a sufficient amount of specimen. You must report your determination to the DER in writing as soon as you make it.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The regulation says what counts as a medical condition for this purpose: an ascertainable physiological condition, or a medically documented pre-existing psychological disorder - but not an unsupported assertion of "situational anxiety" or dehydration. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(e) For purposes of this paragraph, a medical condition includes an ascertainable physiological condition (e.g., a urinary system dysfunction in the case of a urine test or autoimmune disorder in the case of an oral fluid test), or a medically documented pre-existing psychological disorder, but does not include unsupported assertions of “situational anxiety” or dehydration.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
If the MRO reports that the test is cancelled on medical grounds, the employer takes no further action against the employee, and an employee tested at random stays in the random pool. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(i) As the employer, when you receive a report from the MRO indicating that a test is cancelled as provided in paragraph (d)(1) of this section, you take no further action with respect to the employee. If the test reason was 'random', the employee remains in the random testing pool.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
Failing to provide enough specimen is a refusal to test only once it has been determined, through the required medical evaluation, that there was no adequate medical explanation. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(5) Fail to provide a sufficient amount of specimen when directed, and it has been determined, through a required medical evaluation, that there was no adequate medical explanation for the failure (see § 40.193(d)(2));
49 CFR Sec. 40.191 - What is a refusal to take a DOT drug test, and what are the consequences? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
Failing to undergo the medical evaluation the DER directs is itself a refusal to test. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(7) Fail to undergo a medical examination or evaluation, as directed by the MRO as part of the verification process, or as directed by the DER under § 40.193(c). In the case of a pre-employment drug test, the employee is deemed to have refused to test on this basis only if the pre-employment test is conducted following a contingent offer of employment. If there was no contingent offer of employment, the MRO will cancel the test;
49 CFR Sec. 40.191 - What is a refusal to take a DOT drug test, and what are the consequences? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The regulation uses the phrase "shy bladder" itself, in the paragraph on notifying a refusal to test: a referral physician - given as an example, one evaluating a "shy bladder" condition - notifies the MRO, and the MRO in turn notifies the DER. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(d) As a collector or an MRO, when an employee refuses to participate in the part of the testing process in which you are involved, you must terminate the portion of the testing process in which you are involved, document the refusal on the CCF (including, in the case of the collector, printing the employee's name on Copy 2 of the CCF), immediately notify the DER by any means (e.g., telephone or secure fax machine) that ensures that the refusal notification is immediately received. As a referral physician (e.g., physician evaluating a “shy bladder” condition or a claim of a legitimate medical explanation in a validity testing situation), you must notify the MRO, who in turn will notify the DER.
49 CFR Sec. 40.191 - What is a refusal to take a DOT drug test, and what are the consequences? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The collector does not decide anything. Where conduct is in question, the employer has the sole responsibility to decide whether a refusal occurred, and the regulation calls that duty non-delegable. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(1) As the collector, you must note the actions that may constitute a refusal in the “Remarks” line (Step 2), and sign and date the CCF. The collector does not make the final decision about whether the employee's conduct constitutes a refusal to test; the employer has the sole responsibility to decide whether a refusal occurred, as stated in § 40.355(i), the employer has a non-delegable duty to make the decision about whether the employee has refused to test.
49 CFR Sec. 40.191 - What is a refusal to take a DOT drug test, and what are the consequences? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
A service agent - the collection company, the laboratory, the third-party administrator - must not make the determination that an employee refused a test. That is a non-delegable duty of the actual employer. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(i) Except as provided in paragraph (j) of this section, you must not make a determination that an employee has refused a drug or alcohol test. This is a non-delegable duty of the actual employer. You may, however, provide advice and information to employers regarding refusal-to-test issues.
49 CFR Sec. 40.355 - What limitations apply to the activities of service agents? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart Q. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
A refusal carries the consequences the relevant DOT agency regulation sets, and those consequences cannot be overturned by an arbitration, a grievance, a state court or any other non-federal forum. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(c) As an employee, if you refuse to take a drug test, you incur the consequences specified under DOT agency regulations for a violation of those DOT agency regulations. The consequences specified under DOT agency regulations for a refusal cannot be overturned or set aside by an arbitration, grievance, State court or other non-Federal forum that adjudicates the personnel decisions the employer has taken against the employee.
49 CFR Sec. 40.191 - What is a refusal to take a DOT drug test, and what are the consequences? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
Outside the United States, one national regulator - the Canadian Nuclear Safety Commission - expects the licensees it regulates to have a shy-bladder protocol, but as guidance rather than a requirement, and it does not publish the protocol itself.
What the source says
Procedures for the administration of drug-testing collection and transportation of specimens should include or make reference to the following: [...] protocols for shy bladder and dry mouth [...]
REGDOC-2.2.4, Fitness for Duty, Volume II: Managing Alcohol and Drug Use, Version 3 — Canadian Nuclear Safety Commission · Canadian Nuclear Safety Commission regulatory document series (human performance management). Section 6.2, "Drug-testing process", under the heading "Guidance".
Read on 2026-09-09
Where the test is a pre-employment, return-to-duty or follow-up test and the referral physician finds a serious and permanent or long-term disability, the physician must say so in writing to the MRO, and the MRO must then follow Sec. 40.195 instead of stopping at the cancellation in Sec. 40.193. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(g) If, as the referral physician making this evaluation in the case of a pre-employment, return-to-duty, or follow-up test, you determine that the employee's medical condition is a serious and permanent or long-term disability that is highly likely to prevent the employee from providing a sufficient amount of specimen for a very long or indefinite period of time, you must set forth your determination and the reasons for it in your written statement to the MRO. As the MRO, upon receiving such a report, you must follow the requirements of § 40.195, where applicable.
49 CFR Sec. 40.193 - What happens when an employee does not provide a sufficient amount of specimen for a drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
On that route the MRO must determine whether there is clinical evidence that the individual is an illicit drug user, through a medical evaluation, and the MRO or the evaluating physician may use an alternative test such as blood to do it. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(a) This section concerns a situation in which an employee has a medical condition that precludes him or her from providing a sufficient specimen for a pre-employment follow-up or return-to-duty test and the condition involves a permanent or long-term disability. As the MRO in this situation, you must do the following: (1) You must determine if there is clinical evidence that the individual is an illicit drug user. You must make this determination by personally conducting, or causing to be conducted, a medical evaluation and through consultation with the employee's physician and/or the physician who conducted the evaluation under § 40.193(d). [...] (3) For purposes of this section, the MRO or the physician conducting the evaluation may conduct an alternative test (e.g., blood) as part of the medically appropriate procedures in determining clinical evidence of drug use.
49 CFR Sec. 40.195 - What happens when an individual is unable to provide a sufficient amount of urine for a pre-employment follow-up or return-to-duty test because of a permanent or long-term medical condition? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
If that evaluation finds no clinical evidence of drug use, the MRO reports a negative test. If it finds clinical evidence, the MRO reports a cancelled test, and the regulation states that a cancelled test does not serve the purposes of a negative one - the employer is not authorised to let the employee begin or resume safety-sensitive work on it. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(b) If the medical evaluation reveals no clinical evidence of drug use, as the MRO, you must report the result to the employer as a negative test with written notations regarding results of both the evaluation conducted under § 40.193(d) and any further medical examination. This report must state the basis for the determination that a permanent or long-term medical condition exists, making provision of a sufficient urine specimen impossible, and for the determination that no signs and symptoms of drug use exist. [...] (c) If the medical evaluation reveals clinical evidence of drug use, as the MRO, you must report the result to the employer as a cancelled test with written notations regarding results of both the evaluation conducted under § 40.193(d) and any further medical examination. This report must state that a permanent or long-term medical condition exists, making provision of a sufficient urine specimen impossible, and state the reason for the determination that signs and symptoms of drug use exist. Because this is a cancelled test, it does not serve the purposes of a negative test (i.e., the employer is not authorized to allow the employee to begin or resume performing safety-sensitive functions, because a negative test is needed for that purpose).
49 CFR Sec. 40.195 - What happens when an individual is unable to provide a sufficient amount of urine for a pre-employment follow-up or return-to-duty test because of a permanent or long-term medical condition? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
For that section a permanent or long-term condition means a physiological, anatomic or psychological abnormality documented as being present before the collection was attempted, and its own examples include a severe psychiatric disorder focused on genito-urinary matters. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(d) For purposes of this section, permanent or long-term medical conditions are those physiological, anatomic, or psychological abnormalities documented as being present prior to the attempted collection, and considered not amenable to correction or cure for an extended period of time, if ever. (1) Examples would include destruction (any cause) of the glomerular filtration system leading to renal failure; unrepaired traumatic disruption of the urinary tract; or a severe psychiatric disorder focused on genito-urinary matters.
49 CFR Sec. 40.195 - What happens when an individual is unable to provide a sufficient amount of urine for a pre-employment follow-up or return-to-duty test because of a permanent or long-term medical condition? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The collector checks the temperature of whatever is produced. Following shy-bladder procedures the original specimen is discarded unless another problem, such as a temperature out of range, also exists - and a temperature outside the acceptable range means the collector must immediately conduct a new urine collection under direct observation, or an oral fluid collection. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(a) Sufficiency of specimen. You must check to ensure that the specimen contains at least 45 mL of urine. (1) If it does not, you must follow “shy bladder” procedures (see § 40.193(b)). (2) When you follow “shy bladder” procedures, you must discard the original specimen, unless another problem (i.e., temperature out of range, signs of tampering) also exists. [...] (b) Temperature. You must check the temperature of the specimen no later than four minutes after the employee has given you the specimen. (1) The acceptable temperature range is 32-38 °C/90-100 °F. [...] (5) If the specimen temperature is outside the acceptable range, you must immediately conduct a new urine collection using direct observation procedures (see § 40.67) or an oral fluid collection.
49 CFR Sec. 40.65 - What does the collector check for when the employee presents a specimen? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart E. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
Where a directly observed collection is one the employer directed or one required because the test is return-to-duty or follow-up, the employer must explain the reason to the employee. The duty is unqualified. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(d)(1) As the employer, you must explain to the employee the reason for a directly observed collection under paragraph (a) or (b) of this section.
49 CFR Sec. 40.67 - When and how is a directly observed urine collection conducted? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart E. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
The exception the service-agent rule opens with is a short one: a self-employed person or owner-operator who fails to appear for a scheduled test without a legitimate reason, and an MRO determining a refusal on the basis of adulteration or substitution. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(j) As an exception to paragraph (i) of this section, you may make a determination that an employee has refused a drug or alcohol test, if: (1) You schedule a required test for an owner-operator or other self-employed individual, and the individual fails to appear for the test without a legitimate reason; or (2) As an MRO, you determine that an individual has refused to test on the basis of adulteration or substitution.
49 CFR Sec. 40.355 - What limitations apply to the activities of service agents? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart Q. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-09
A cancelled test is neither positive nor negative. On a pre-employment, return-to-duty or follow-up test the employer must not treat it as the negative result needed to let the employee start or return to safety-sensitive work, and may direct another collection in exactly that case. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(a) A cancelled drug test is neither positive nor negative. (1) As an employer, you must not attach to a cancelled test the consequences of a positive test or other violation of a DOT drug testing regulation (e.g., removal from a safety-sensitive position). (2) As an employer, you must not use a cancelled test for the purposes of a negative test to authorize the employee to perform safety-sensitive functions (i.e., in the case of a pre-employment, return-to-duty, or follow-up test). (3) However, as an employer, you must not direct a recollection for an employee because a test has been cancelled, except in the situations cited in paragraph (a)(2) of this section or other provisions of this part that require another test to be conducted (e.g., §§ 40.159(a)(5) and 40.187(b)(2), (c)(1), and (e).
49 CFR Sec. 40.207 - What is the effect of a cancelled drug test? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-11
Under the US Department of Health and Human Services' own list of certified drug-testing laboratories, no laboratory was certified to test oral fluid specimens at the date of the notice, so oral fluid testing under 49 CFR part 40 could not yet be conducted by any DOT-regulated employer. Whether that has since changed must be checked, not assumed. (United States only.)
What the source says
In accordance with the Mandatory Guidelines using Oral Fluid effective October 10, 2023 (88 FR 70814), the following HHS-certified laboratories meet the minimum standards to conduct drug and specimen validity tests on oral fluid specimens: At this time, there are no laboratories certified to conduct drug and specimen validity tests on oral fluid specimens.
Current List of HHS-Certified Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum Standards To Engage in Urine and Oral Fluid Drug Testing for Federal Agencies — US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration · Federal Register, vol. 91, p. 56152 (91 FR 56152), notice, published September 1, 2026. FR Doc. 2026-17852. · 2026
The publisher's own page for this source
Read on 2026-09-11
A second published United States procedure, the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs, covers federal agency employees rather than DOT-regulated transportation workers, and its collection section for a donor who cannot provide a urine specimen is built on the same pattern as 49 CFR part 40: fluid offered, capped at the same total over the same three hours, with the choice not to drink left to the donor. This page names it and does not walk through it. (United States only, and federal agency testing only.)
What the source says
(1) If the donor states that they could provide a specimen after drinking some fluids, the collector gives the donor a reasonable amount of liquid to drink for this purpose (e.g., an 8 ounce glass of water every 30 minutes, but not to exceed a maximum of 40 ounces over a period of 3 hours or until the donor has provided a sufficient urine specimen). If the donor simply needs more time before attempting to provide a urine specimen, the donor may choose not to drink any fluids during the 3 hour wait time. (2) If the donor states that they are unable to provide a urine specimen, the collector records the reason for not collecting a urine specimen on the Federal CCF, notifies the Federal agency's designated representative for authorization to collect an alternate specimen, and sends the appropriate copies of the Federal CCF to the MRO and to the Federal agency's designated representative. The Federal agency may choose to provide the collection site with a standard protocol to follow in lieu of requiring the collector to notify the agency's designated representative for authorization in each case. If an alternate specimen is authorized, the collector may begin the collection procedure for the alternate specimen (see Section 8.7) in accordance with the Mandatory Guidelines for Federal Workplace Drug Testing Programs using the alternate specimen.
Mandatory Guidelines for Federal Workplace Drug Testing Programs — US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration · Federal Register, vol. 88, p. 70768 (88 FR 70768), issuance of mandatory guidelines, published October 12, 2023, effective February 1, 2024. FR Doc. 2023-21734. Subpart H, Section 8.6, "What procedure is used when the donor states that they are unable to provide a urine specimen?", paragraphs (b)(1) and (b)(2). · 2023
The publisher's own page for this source
Read on 2026-09-11
A third published United States procedure, the Nuclear Regulatory Commission's fitness-for-duty rule for its licensees, has a section of its own headed "Determining 'shy' bladder", on the same pattern: a three-hour urine collection window, then a referral within days to a licensed physician with expertise in the question, acceptable to the MRO. This page names it and does not walk through it. (United States only, and NRC-regulated fitness-for-duty programmes only.)
What the source says
(a) When a donor has not provided a specimen of at least 30 mL within the 3 hours permitted for urine collection, FFD program personnel shall direct the donor to obtain, within 5 business days, an evaluation from a licensed physician who is acceptable to the MRO and has expertise in the medical issues raised by the donor's failure to provide a sufficient specimen. The MRO may perform this evaluation if the MRO has the appropriate expertise.
10 CFR Sec. 26.119 - Determining "shy" bladder. — US Nuclear Regulatory Commission · Code of Federal Regulations, Title 10, Chapter I, Part 26 (Fitness for Duty Programs), Subpart E (Collecting Specimens for Testing). 2025 annual edition, revised as of January 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-11
A laboratory must report a urine specimen as dilute when its creatinine and its specific gravity both fall inside the band the regulation sets - two laboratory measures, not a judgement about the donor. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(a) As a laboratory, you must consider the primary specimen to be dilute when: (1) The creatinine concentration is greater than or equal to 2 mg/dL but less than 20 mg/dL, and (2) The specific gravity is greater than 1.0010 but less than 1.0030 on a single aliquot.
49 CFR Sec. 40.88 - What criteria do laboratories use to establish that a urine specimen is dilute or substituted? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart F. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-11
When a negative test is also dilute, the employer's duty depends on where the creatinine fell: at the low end of the dilute band the MRO directs an immediate recollection under direct observation and the employer must carry it out; above that the employer may, but need not, direct another test, and that one must not be observed unless some other ground for observation exists. (United States only: 49 CFR part 40, which binds DOT-regulated transportation employers and their safety-sensitive employees, and nobody else.)
What the source says
(b) As an employer, if the MRO informs you that a negative test was dilute, take the following action: (1) If the MRO directs you to conduct a recollection under direct observation (i.e., because the creatinine concentration of the specimen was equal to or greater than 2mg/dL, but less than or equal to 5 mg/dL (see § 40.155(c)), you must do so immediately. (2) Otherwise (i.e., if the creatinine concentration of the dilute specimen is greater than 5 mg/dL), you may, but are not required to, direct the employee to take another test immediately. (i) Such recollections must not be collected under direct observation, unless there is another basis for use of direct observation (see § 40.67 (b) and (c)).
49 CFR Sec. 40.197 - What happens when an employer receives a report of a dilute urine specimen? — US Office of the Secretary of Transportation (Department of Transportation) · Code of Federal Regulations, Title 49, Subtitle A, Part 40, Subpart I. 2025 annual edition, revised as of October 1, 2025. Published by the US Government Publishing Office (govinfo.gov). · 2025
The publisher's own page for this source
Read on 2026-09-11
A published case report describes acute water intoxication as a complication of workplace urine drug testing, and its authors conclude that for workers undergoing such testing the risk factors are intake of more than a litre of water and impaired urine dilution. One case and a literature review of seven others; not a rate, and not a statement about how often this happens.
What the source says
Urine drug testing is now mandatory in many industries. We report the first case, to our knowledge, of an adverse consequence of drug testing in the workplace: acute water intoxication. We discuss normal water metabolism and the adverse effects of water loading and impaired renal function on free water clearance. We present a literature review of seven other cases of acute voluntary water intoxication in patients without chronic psychiatric or neurologic illness. For workers undergoing urine drug testing we conclude that risk factors for acute water intoxication include (1) intake of more than 1 L of water and (2) impaired urine dilution. In a recently drug-tested worker, symptoms of cerebral dysfunction should suggest the possibility of water intoxication.
Acute water intoxication as a complication of urine drug testing in the workplace — David C. Klonoff; Arthur H. Jurow · JAMA 265(1):84-85, January 2, 1991. PMID 1984128. Department of Medicine, Peninsula Hospital, Burlingame, California. · 1991
The publisher's own page for this source
Read on 2026-09-11
Flying
UK ONLY. The UK government's published hand luggage rules state that at most UK airports liquids in containers larger than 100ml cannot be taken through security, and that the limit applies to the container, not to how full it is.
What the source says
At most airports, you cannot take liquids in containers larger than 100ml through security. This still applies if the container is only part full.
Hand luggage restrictions at UK airports: Liquids — GOV.UK guide "Hand luggage restrictions at UK airports", section 2, Liquids, under the heading "How much liquid you can take".
Read on 2026-09-09
UK ONLY. The same rules list essential medicines of more than 100ml among the items a passenger is allowed to carry in hand luggage.
What the source says
essential medicines of more than 100ml, including liquid dietary foodstuffs and inhalers
Hand luggage restrictions at UK airports: Medicines, medical equipment and dietary requirements — GOV.UK guide "Hand luggage restrictions at UK airports", section 5, Medicines, medical equipment and dietary requirements, first list.
Read on 2026-09-09
UK ONLY. The same list allows medical equipment in hand luggage where it is essential for the journey.
What the source says
medical equipment, if it’s essential for your journey
Hand luggage restrictions at UK airports: Medicines, medical equipment and dietary requirements — GOV.UK guide "Hand luggage restrictions at UK airports", section 5, Medicines, medical equipment and dietary requirements, first list.
Read on 2026-09-09
UK ONLY, and liquid medicine only. The same rules state that a passenger must carry proof of prescription for medication that is both in liquid form and in a container larger than 100ml. The requirement is about medication, not about medical equipment.
What the source says
You’ll need to carry proof that the medication is prescribed to you (for example a letter from your doctor or a copy of your prescription) if it’s both:
Hand luggage restrictions at UK airports: Medicines, medical equipment and dietary requirements — GOV.UK guide "Hand luggage restrictions at UK airports", section 5, Medicines, medical equipment and dietary requirements, the paragraph after the first list.
Read on 2026-09-09
UK ONLY. The same rules say that airport staff may open containers to screen liquids at the security point, and that medical equipment is screened separately from the rest of a passenger's bag.
What the source says
Airport staff might need to open the containers to screen the liquids at the security point. Medical equipment is screened separately.
Hand luggage restrictions at UK airports: Medicines, medical equipment and dietary requirements — GOV.UK guide "Hand luggage restrictions at UK airports", section 5, Medicines, medical equipment and dietary requirements, closing paragraph before the allowances table.
Read on 2026-09-09
UK ONLY. The same rules state that airport security staff can refuse any item they consider dangerous even when it is normally allowed, so the medical allowance is not a guarantee.
What the source says
Airport security staff will not let anything through that they consider dangerous - even if it’s normally allowed in hand luggage.
Hand luggage restrictions at UK airports: Liquids — GOV.UK guide "Hand luggage restrictions at UK airports". The sentence appears in section 1 (Overview) and again in section 2 (Liquids).
Read on 2026-09-09
US ONLY, and only for the operations Part 121 covers (US domestic, flag and supplemental air carriers). Federal regulation requires the "Fasten Seat Belt" sign to be lit for surface movement, every take-off and every landing, and at any other time the pilot in command considers necessary.
What the source says
Except as provided in paragraph (l) of this section, the “Fasten Seat Belt” sign shall be turned on during any movement on the surface, for each takeoff, for each landing, and at any other time considered necessary by the pilot in command.
14 CFR § 121.317 — Passenger information requirements, smoking prohibitions, and additional seat belt requirements — Federal Aviation Administration, Department of Transportation · Code of Federal Regulations, Title 14, Chapter I, Subchapter G, Part 121, Subpart K, paragraph (b). 2024 annual edition (govinfo.gov). · 2024
The publisher's own page for this source
Read on 2026-09-09
US ONLY, Part 121 operations. The same regulation puts the obligation on the passenger: while the sign is lit, the belt stays fastened.
What the source says
Each passenger required by § 121.311(b) to occupy a seat or berth shall fasten his or her safety belt about him or her and keep it fastened while the “Fasten Seat Belt” sign is lighted.
14 CFR § 121.317 — Passenger information requirements, smoking prohibitions, and additional seat belt requirements — Federal Aviation Administration, Department of Transportation · Code of Federal Regulations, Title 14, Chapter I, Subchapter G, Part 121, Subpart K, paragraph (f). 2024 annual edition (govinfo.gov). · 2024
The publisher's own page for this source
Read on 2026-09-09
US ONLY, Part 121 operations. The same regulation requires passengers to comply with a crew member's instructions about the seat belt requirement, so a crew member's word governs in the cabin.
What the source says
Each passenger shall comply with instructions given him or her by a crewmember regarding compliance with paragraphs (f), (g), (h), and (l) of this section.
14 CFR § 121.317 — Passenger information requirements, smoking prohibitions, and additional seat belt requirements — Federal Aviation Administration, Department of Transportation · Code of Federal Regulations, Title 14, Chapter I, Subchapter G, Part 121, Subpart K, paragraph (k). 2024 annual edition (govinfo.gov). · 2024
The publisher's own page for this source
Read on 2026-09-09
The UK Paruresis Trust's own published position on flying is that plane journeys make many people with paruresis very nervous and that flying in comfort is possible with planning. This is a statement of what UKPT tells people. It is not a clinical finding and no study is cited for it.
What the source says
Many people with Paruresis are very nervous about making plane journeys, particularly coping with long flights. However, it is possible to fly in comfort with some forward planning and an understanding of what triggers your anxiety.
Paruresis and Flying: Coping With Long Flights — United Kingdom Paruresis Trust (UKPT), "Living with Paruresis" section
Read on 2026-09-09
The NHS's own medicines page on pseudoephedrine, the common over-the-counter decongestant, tells people to check with a pharmacist or doctor before taking it if they have an enlarged prostate, a condition the page itself describes as causing difficulty peeing. This is a caution about peeing attached to a medicine people take for ear pressure on flights. The page does not mention paruresis.
What the source says
Pseudoephedrine is not suitable for some people. To make sure it's safe for you, tell a pharmacist or doctor before taking it if you have: [...] an enlarged prostate (this causes difficulty peeing or needing to pee often)
Who can and cannot take pseudoephedrine — NHS website (nhs.uk), Medicines A to Z, "Pseudoephedrine (Sudafed)", section "Who can and cannot take pseudoephedrine", under the heading "Who may not be able to take pseudoephedrine". Page last reviewed 2 November 2022; next review due 2 November 2025. · 2022
Read on 2026-09-11
The NHS's own medicines page on chlorphenamine, a sedating antihistamine, tells people who have problems peeing or emptying their bladder to check with a doctor or pharmacist before taking it. This is a caution about peeing attached to a medicine people take to sleep on flights. The page does not mention paruresis.
What the source says
Chlorphenamine is not suitable for some people. To make sure it's safe for you, tell your doctor or pharmacist if you: [...] have problems peeing or emptying your bladder
Who can and cannot take chlorphenamine — NHS website (nhs.uk), Medicines A to Z, "Chlorphenamine (Piriton)", section "Who can and cannot take chlorphenamine", under the heading "Who may not be able to take chlorphenamine". Page last reviewed 14 May 2025; next review due 14 May 2028. · 2025
Read on 2026-09-11
The NHS's own overview of antihistamines lists difficulty peeing among the side effects of the antihistamines that make you drowsy - the class people take to sleep on a flight. The page does not mention paruresis.
What the source says
Side effects of antihistamines that make you drowsy can include: [...] difficulty peeing
Antihistamines — NHS website (nhs.uk), Health A to Z, "Antihistamines", section "Side effects of antihistamines". Page last reviewed 16 May 2023; next review due 16 May 2026. · 2023
Read on 2026-09-11
The NHS's own page on deep vein thrombosis says that on a journey of four hours or more by plane, train or car there are things a traveller can do during the journey to lower the chance of DVT, and lists them: wearing loose clothing, drinking plenty of water, avoiding alcohol, and walking around when possible. This is general travel advice; the page does not mention paruresis or the bladder.
What the source says
If you're travelling for 4 hours or more by plane, train or car, there are things you can do during the journey to lower your chances of getting DVT. These include:
DVT (deep vein thrombosis) — NHS website (nhs.uk), Health A to Z, "DVT (deep vein thrombosis)", section "How to prevent DVT (deep vein thrombosis)", subsection "Going on a long journey". Page last reviewed 30 April 2026; next review due 30 April 2029. · 2026
Read on 2026-09-11
The World Health Organization's WRIGHT project report lists low humidity and dehydration among the POSSIBLE cabin-related risk factors for venous thromboembolism that reports and studies have proposed - alongside prolonged immobility, cramped sitting, low air pressure and relative hypoxia. Proposed, in the report's own framing; not established.
What the source says
Possible cabin–related risk factors include prolonged immobility, cramped sitting position, low air pressure, relative hypoxia, low humidity and dehydration due to the consumption of alcohol and other diuretics such as tea and coffee.
WHO Research Into Global Hazards of Travel (WRIGHT) Project: final report of phase I — World Health Organization · World Health Organization, Geneva, 2007. ISBN 978 92 4 159553 7. Section 3, "Background", in the review of cabin-related and passenger-related risk factors. PDF, 20 pages, served from the WHO IRIS repository. · 2007
The publisher's own page for this source
Read on 2026-09-11
The same WHO report concludes that the increased risk of venous thromboembolism seen in long-haul travellers is due mainly to prolonged immobility. That is the finding the page sets against the dehydration item: sitting still is the established factor, dehydration a proposed one.
What the source says
Nonetheless, the findings of Phase I of the WRIGHT project demonstrated that the increased risk of VTE observed in long–haul travellers is due mainly to prolonged immobility.
WHO Research Into Global Hazards of Travel (WRIGHT) Project: final report of phase I — World Health Organization · World Health Organization, Geneva, 2007. ISBN 978 92 4 159553 7. Section 5, "Conclusions", final paragraph. PDF, 20 pages, served from the WHO IRIS repository. · 2007
The publisher's own page for this source
Read on 2026-09-11
Getting help
Urology is the surgical specialty for the urinary system, and the British Association of Urological Surgeons defines its scope as covering women and men alike.
What the source says
Urology is the branch of surgery relating to the management of conditions affecting the urinary system, including the kidneys, ureters, bladder and urethra, and the male and female external genitalia.
A Student Guide to Urology — British Association of Urological Surgeons · The British Association of Urological Surgeons Limited (BAUS), medical students' education section. Page 1, "What is Urology?". · 2014
The publisher's own page for this source
Read on 2026-09-09
The American Urological Association defines the same specialty for the United States in slightly different terms: the male and female urinary tract and the male reproductive organs, where BAUS names the male and female external genitalia.
What the source says
Urology is a surgical specialty which deals with diseases of the male and female urinary tract and the male reproductive organs.
Why Urology? — American Urological Association · American Urological Association (AUA), "About Us" section.
Read on 2026-09-09
The Royal Australian College of General Practitioners' journal puts the GP at the start of the route: "GPs play a part in identifying these conditions ... and enabling access to psychological interventions."
What the source says
GPs play a part in identifying these conditions, defusing feelings of shame and embarrassment, and enabling access to psychological interventions, which are likely to provide significant benefits to individuals living with paruresis and/or parcopresis.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-09
The article puts psychological intervention first and names CBT, keeping its own hedges: no clinical trials have been undertaken, and the reasoning is by analogy with other anxiety-based conditions.
What the source says
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).
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-09
Before a paruresis diagnosis is made, the same article says a physical cause has to be looked for: patients "should be examined for anatomic or physiologic abnormalities prior to a diagnosis of paruresis and/or parcopresis being made".
What the source says
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.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-09
In the case the article itself presents, the referral went to a psychologist: "The patient was referred to a psychologist who provided 20 sessions of cognitive behavioural therapy."
What the source says
The patient was referred to a psychologist who provided 20 sessions of cognitive behavioural therapy.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. "Case: Presentation of paruresis and parcopresis", Management. · 2019
Read on 2026-09-09
The same journal says why the appointment is hard to start: "patients hesitate to raise paruresis and parcopresis issues with their clinicians and may choose not to disclose."
What the source says
As a result of stigma and a perception that symptoms are embarrassing, patients hesitate to raise paruresis and parcopresis issues with their clinicians and may choose not to disclose.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-09
In England, the NHS lists CBT as a recommended treatment for anxiety conditions including social anxiety and phobias — the two categories the literature places paruresis in.
What the source says
Cognitive behavioural therapy (CBT) is a recommended treatment for many mental health problems, such as: [...] anxiety, including social anxiety, phobias and obsessive compulsive disorder (OCD)
Cognitive behavioural therapy (CBT) — NHS website (nhs.uk), Tests and treatments A to Z. Section "What CBT is for". Page last reviewed 28 March 2025; next review due 28 March 2028. · 2025
Read on 2026-09-09
In England, an adult can self-refer to NHS talking therapies without seeing a GP first, subject to being registered with a GP and an age threshold the NHS states as 18, or 16 in some areas.
What the source says
For many mental health problems, such as anxiety and depression, you can refer yourself to NHS talking therapies without speaking to a GP. To use this service, you need to be registered with a GP and must be aged 18 or over (or 16 or over in some areas).
Talking therapies — NHS website (nhs.uk), Tests and treatments A to Z. Section "Refer yourself for talking therapies on the NHS". Page last reviewed 5 November 2025; next review due 5 November 2028. · 2025
Read on 2026-09-09
For social anxiety specifically, the NHS in England describes two routes side by side: the GP refers on to a mental health specialist, or the person refers themselves.
What the source says
If they think you could have social anxiety, you'll be referred to a mental health specialist to have a full assessment and talk about treatments. You can also refer yourself directly to an NHS talking therapies service without a referral from a GP.
Social anxiety (social phobia) — NHS website (nhs.uk), Mental health conditions. Section "Getting help for social anxiety". Page last reviewed 17 May 2023; next review due 17 May 2026. · 2023
Read on 2026-09-09
The NHS in England describes what happens after the referral: an assessment first, then a recommendation of a therapy type.
What the source says
Once you've been referred for cognitive behavioural therapy (CBT), you'll have an assessment with a therapist to decide what the best treatment is for you. This may be done in person, online or on the phone. The therapist will ask about your symptoms and what you hope to get from treatment. They'll then recommend a type of therapy, which may be CBT or another type of therapy, depending on what you need it for.
Cognitive behavioural therapy (CBT) — NHS website (nhs.uk), Tests and treatments A to Z. Section "Before you have CBT". Page last reviewed 28 March 2025. · 2025
Read on 2026-09-09
For anyone paying privately in the UK, the NHS names the check to make: that the therapist is registered with a body accredited by the Professional Standards Authority.
What the source says
Before choosing a private therapist, make sure they’re registered with a professional organisation that’s been accredited by the Professional Standards Authority (PSA).
Talking therapies — NHS website (nhs.uk), Tests and treatments A to Z. Section "Other ways to get talking therapies". Page last reviewed 5 November 2025. · 2025
Read on 2026-09-09
In Australia, healthdirect describes the same journey differently: the referral is a letter, it usually goes from a GP to a specialist and lasts 12 months, and the GP advises which kind of specialist is needed.
What the source says
A referral is a letter from your doctor or health professional to another health professional or health service. Referrals are made to get expert help with the diagnosis or treatment of your health problem. [...] Most referrals from GPs to specialists last for 12 months. [...] Make an appointment with your doctor to talk about your health issues. You can ask your doctor to write you a referral. They will be able to advise you on which type of specialist you need to see.
What is a referral? — healthdirect Australia (a government-funded health information service). Sections "Key facts" and "How do I get a referral?". Last reviewed September 2023. · 2023
Read on 2026-09-09
In Australia, healthdirect describes a mental health treatment plan which "can help with the cost of seeing a mental health professional", available to people diagnosed with a mental health condition "such as anxiety or depression".
What the source says
If you're struggling with your mental health, a mental health treatment plan can help with the cost of seeing a mental health professional. [...] You can only get a mental health treatment plan if you've been diagnosed with a mental health condition, such as anxiety or depression.
Mental health treatment plan — healthdirect Australia (a government-funded health information service). Sections "How can a mental health treatment plan help me?" and "Am I eligible for a mental health treatment plan?". Last reviewed July 2025. · 2025
Read on 2026-09-11
Under that plan, healthdirect says, a doctor can refer for 6 sessions to start with and for further sessions if needed; the plan lets a person claim 10 individual and 10 group sessions each calendar year through Medicare.
What the source says
To start with, your doctor can refer you to a mental health professional for 6 sessions. If you need more support, they can refer you for further sessions. A mental health treatment plan lets you claim 10 individual and 10 group sessions with a mental health professional each calendar year through Medicare.
Mental health treatment plan — healthdirect Australia. Section "What does a mental health treatment plan cover?". Last reviewed July 2025. · 2025
Read on 2026-09-11
IC — the wider term, of which CISC is the self-performed form — is taught, not self-taught: "IC should be taught by an appropriately experienced nurse".
What the source says
IC should be taught by an appropriately experienced nurse
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Summary of recommendations, "Principles of management of nursing intervention", graded LE 4 / GR C. · 2025
The publisher's own page for this source
Read on 2026-09-09
The full European nurses' guideline is blunt about the state of teaching standards: there are none agreed, and "only properly trained nurses should provide teaching."
What the source says
There is a lack of agreed standards for patient and caregiver education on IC, and only properly trained nurses should provide teaching.
Urethral intermittent catheterisation in adults, including urethral intermittent dilatation: Evidence-based Guidelines for Best Practice in Urological Health Care — S. Vahr Lauridsen; S. Chagani; A. Daniels; T. Kelly; H. Lurvink; I. Pearce; M. Popiński; B. Thoft Jensen; G. Villa; S. Wildeman; V. Geng · European Association of Urology Nurses (EAUN), 2024 update. ISBN 978-94-92-671-25-7. Section 8.4, "Patient and caregiver education — why, who, when, where, how and what". · 2024
The publisher's own page for this source
Read on 2026-09-09
The same guideline says where the teaching happens: "Teaching IC may be carried out in the patient's home or in hospital. The patient's privacy is paramount in either location."
What the source says
Teaching IC may be carried out in the patient’s home or in hospital. The patient’s privacy is paramount in either location.
Urethral intermittent catheterisation in adults, including urethral intermittent dilatation: Evidence-based Guidelines for Best Practice in Urological Health Care — S. Vahr Lauridsen; S. Chagani; A. Daniels; T. Kelly; H. Lurvink; I. Pearce; M. Popiński; B. Thoft Jensen; G. Villa; S. Wildeman; V. Geng · European Association of Urology Nurses (EAUN), 2024 update. ISBN 978-94-92-671-25-7. Section 8.4, subsection "Where". · 2024
The publisher's own page for this source
Read on 2026-09-09
Who is allowed to prescribe intermittent catheterisation is not the same everywhere: it "will depend on the jurisdiction and local health care organisation policy."
What the source says
The practitioner authorised to prescribe IC will depend on the jurisdiction and local health care organisation policy.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Section "Principles of management of nursing intervention", opening sentence. · 2025
The publisher's own page for this source
Read on 2026-09-09
The teaching recommendation quoted as GH14 carries the guideline's own lowest level of evidence, which its table defines as evidence from "expert committee reports or opinions or clinical experience of respected authorities".
What the source says
Evidence obtained from expert committee reports or opinions or clinical experience of respected authorities
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Table 1, "Level of evidence and grade of recommendation", the last row of the level column. · 2025
The publisher's own page for this source
Read on 2026-09-09
In England, the NHS states a second opinion is something a patient can ask for: "If you think you have an underlying condition that's been missed by your doctor, you can ask for a second opinion."
What the source says
If you think you have an underlying condition that's been missed by your doctor, you can ask for a second opinion.
Medically unexplained symptoms — NHS website (nhs.uk), Conditions A to Z. Section "How a GP can help". Page last reviewed 5 June 2024; next review due 5 June 2027. · 2024
Read on 2026-09-09
healthdirect, Australia's government-funded health information service, puts it more strongly: "You have the right to ask for as many opinions or referrals as you want."
What the source says
Sometimes you may be unhappy with a diagnosis or feel there might be better treatment choices. Do not be afraid to ask your doctor to refer you to another specialist for a second opinion. A second opinion can help you have peace of mind or give you another point of view. You have the right to ask for as many opinions or referrals as you want.
What is a referral? — healthdirect Australia. Section "How do I get a second opinion?". Last reviewed September 2023. · 2023
Read on 2026-09-09
Relaxation-style approaches appear in the article's account as an additional strategy, after CBT and graded exposure, not as the first thing to try.
What the source says
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.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. Section "Management". · 2019
Read on 2026-09-09
For CBT in the UK, one PSA-accredited register is the BABCP's, which says of itself: "Our CBT Register is accredited by the Professional Standards Authority."
What the source says
Our CBT Register is accredited by the Professional Standards Authority.
Check the CBT Register — British Association for Behavioural and Cognitive Psychotherapies (BABCP), CBT Register UK & Ireland, "Check the CBT Register" page, closing sentence of the introduction. · 2026
The publisher's own page for this source
Read on 2026-09-11
Hospital samples
UK ONLY. An NHS pathology service's own patient leaflet states that many laboratory tests can be done on blood, and that urine is asked for where the condition is best diagnosed that way.
What the source says
Although many laboratory tests can be carried out on blood samples, some conditions are best diagnosed by analysing a small amount of urine.
Collecting a Random Urine Sample — Information for patients, relatives and carers — Scarborough, York and Hull Pathology Services (SHYPS), Department of Clinical Biochemistry, for York and Scarborough Teaching Hospitals NHS Foundation Trust and Hull University Teaching Hospitals NHS Trust. Document reference PIL1185 v5 (Y&S), HEY1448-2024 (Hull), version 5 issued November 2024, review date November 2027. Page 2, "Why is a Urine Sample needed?". · 2024
Read on 2026-09-09
UK ONLY. The same leaflet says what urine is tested for: kidney function, infection, metabolic problems and conditions involving raised hormone levels.
What the source says
For example, levels of protein and electrolytes (salts) in the urine may be used to investigate kidney function. Other tests can be used to diagnose infections, problems with metabolism and conditions associated with raised hormone levels.
Collecting a Random Urine Sample — Information for patients, relatives and carers — Scarborough, York and Hull Pathology Services (SHYPS), Department of Clinical Biochemistry. Version 5, November 2024. Page 2, "Why is a Urine Sample needed?", second and third sentences. · 2024
Read on 2026-09-09
UK ONLY. The same leaflet states that the clinician asking for the sample should explain why it is needed.
What the source says
Your GP or another healthcare professional, such as a nurse, should explain why a urine sample is required and how to collect it.
Collecting a Random Urine Sample — Information for patients, relatives and carers — Scarborough, York and Hull Pathology Services (SHYPS), Department of Clinical Biochemistry. Version 5, November 2024. Page 2, closing sentence of "Why is a Urine Sample needed?". · 2024
Read on 2026-09-09
UK ONLY. The same leaflet's storage instructions describe a sample collected away from the clinic and handed in afterwards, within about a day of collection.
What the source says
Urine samples should be handed in as soon as possible. If you can't hand the sample in immediately, you should store it in a fridge in a plastic bag, ready to hand in to your GP at the earliest opportunity (ideally within 24 hours of collecting it).
Collecting a Random Urine Sample — Information for patients, relatives and carers — Scarborough, York and Hull Pathology Services (SHYPS), Department of Clinical Biochemistry. Version 5, November 2024. Page 6, "Storing a Urine Sample". · 2024
Read on 2026-09-09
UK ONLY. The same leaflet states that what is done with the sample follows the requesting doctor's instructions.
What the source says
The laboratory will arrange for the sample to be tested according to the instructions provided by your doctor.
Collecting a Random Urine Sample — Information for patients, relatives and carers — Scarborough, York and Hull Pathology Services (SHYPS), Department of Clinical Biochemistry. Version 5, November 2024. Page 6, "What will happen afterwards?". · 2024
Read on 2026-09-09
AUSTRALIA. healthdirect, Australia's national health information service, states in its own words what urine tests are for.
What the source says
Urine tests can give your doctor or nurse useful information about your general health. They can also help find health issues early.
Urine tests — healthdirect Australia, "Urine tests", section "What are urine tests?". Page last reviewed July 2025. · 2025
Read on 2026-09-09
AUSTRALIA, and true of one test only. The same health information service states that the hCG test — the pregnancy test — can be run on blood as well as on urine.
What the source says
hCG tests can use blood or urine samples.
hCG test - pregnancy — healthdirect Australia, "hCG test", Key facts. Page last reviewed March 2025. · 2025
Read on 2026-09-09
UK ONLY. The UK national microbiology standard states that voided midstream and clean-catch urines are the most commonly collected specimens and are the ones recommended for routine use.
What the source says
MSU and clean catch urines are the most commonly collected specimens and are recommended for routine use.
UK Standards for Microbiology Investigations. B 41: Investigation of urine — Standards Unit, UK Health Security Agency · UK Standards for Microbiology Investigations, Bacteriology B 41, issue 8.8, issue date 05.12.25. Section 4.5, "Types of urine specimen and collection", under "Midstream urine (MSU) and clean-catch urine". · 2025
The publisher's own page for this source
Read on 2026-09-09
UK ONLY. The same standard records a catheter specimen — an "in and out" catheterisation — as one of the specimen types laboratories occasionally receive, collected to ensure the sample is free of contamination.
What the source says
‘In and out’, or intermittent self-catheterisation, samples are occasionally collected to ensure that they are contamination free.
UK Standards for Microbiology Investigations. B 41: Investigation of urine — Standards Unit, UK Health Security Agency · UK Standards for Microbiology Investigations, Bacteriology B 41, issue 8.8, issue date 05.12.25. Section 4.5, "Types of urine specimen and collection", under "Catheter urine (CSU)". · 2025
The publisher's own page for this source
Read on 2026-09-09
NOT COUNTRY-SPECIFIC, but true only of typical cystitis symptoms. The European Association of Urology's guideline states that in patients with typical cystitis symptoms, urine analysis adds only a minimal amount of diagnostic accuracy.
What the source says
In patients presenting with typical symptoms of cystitis urine analysis (i.e. urine culture, dip stick testing, etc.) leads only to a minimal increase in diagnostic accuracy
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.4.3.c, "Laboratory diagnosis". · 2026
The publisher's own page for this source
Read on 2026-09-09
NOT COUNTRY-SPECIFIC. The same guideline names when a urine culture is recommended: atypical symptoms, and failure to respond to treatment.
What the source says
Taking a urine culture is recommended in patients with atypical symptoms, as well as those who fail to respond to appropriate antimicrobial therapy
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.4.3.c, "Laboratory diagnosis", closing sentence. · 2026
The publisher's own page for this source
Read on 2026-09-09
WOMEN ONLY, and cystitis only. The same guideline's summary of evidence states that an accurate diagnosis of cystitis in women can be based on history rather than on a sample.
What the source says
An accurate diagnosis of cystitis in women can be based on a focused history of lower urinary tract symptoms and the absence of vaginal discharge or irritation.
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.4.3.d, Summary of evidence table, level of evidence 2b. · 2026
The publisher's own page for this source
Read on 2026-09-09
NOT COUNTRY-SPECIFIC. The same guideline states that where the diagnosis of cystitis is unclear, dipstick analysis can increase the likelihood of that diagnosis.
What the source says
However, if the diagnosis is unclear, dipstick analysis can increase the likelihood of a cystitis diagnosis
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.4.3.c, "Laboratory diagnosis", second sentence — the sentence immediately after HS10. · 2026
The publisher's own page for this source
Read on 2026-09-09
NOT COUNTRY-SPECIFIC, and acute cystitis only. The same guideline's recommendation table recommends urine dipstick testing for the diagnosis of acute cystitis, at its "Weak" strength rating.
What the source says
Use urine dipstick testing for diagnosis of acute cystitis.
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.4.3.d, Recommendations table, second row. The strength rating "Weak" is the adjacent cell of the same row. · 2026
The publisher's own page for this source
Read on 2026-09-09
WOMEN ONLY, cystitis only, and only where there are no other risk factors. The same guideline's recommendation on diagnosing cystitis from history is limited to women who have no other risk factors for systemic urinary tract infections.
What the source says
Diagnose cystitis in women who have no other risk factors for systemic urinary tract infections based on:
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.4.3.d, Recommendations table, first row, strength rating "Strong". · 2026
The publisher's own page for this source
Read on 2026-09-09
WOMEN ONLY, and elderly women specifically. The same guideline states that in elderly women genitourinary symptoms are not necessarily related to cystitis.
What the source says
In elderly women, genitourinary symptoms are not necessarily related to cystitis
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.4.3.a, "Clinical diagnosis", second sentence. · 2026
The publisher's own page for this source
Read on 2026-09-09
WOMEN ONLY. The European guideline's cystitis section is titled "Cystitis in women" and defines its subject as a bladder infection without systemic signs such as fever, chills or flank pain.
What the source says
Cystitis in women is defined as a symptomatic lower urinary tract infection limited to the bladder, in the absence of systemic symptoms or signs such as fever, chills, flank pain, or malaise.
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.4, "Cystitis in women", 3.4.1 Introduction, opening sentence. · 2026
The publisher's own page for this source
Read on 2026-09-11
NOT COUNTRY-SPECIFIC. The same guideline asks for a urine culture where a systemic urinary tract infection is suspected.
What the source says
For patients with suspected systemic UTI, urine should be collected for both urinalysis and culture with antimicrobial susceptibility testing.
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.7.2.b, "Urinalysis and urine culture", the section's single sentence. · 2026
The publisher's own page for this source
Read on 2026-09-11
NOT COUNTRY-SPECIFIC. The same guideline's recommendation table lists pregnant women among the situations in which a urine culture should be done.
What the source says
Pregnant women.
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.4.3.d, Recommendations table, third row ("Urine cultures should be done in the following situations:"), fifth bullet; strength rating "Strong". · 2026
The publisher's own page for this source
Read on 2026-09-11
NOT COUNTRY-SPECIFIC. The same guideline asks for a urine culture before a presumed catheter-associated urinary tract infection is treated.
What the source says
A urine specimen for culture should be obtained prior to initiating antimicrobial therapy for presumed CA-UTI due to the wide spectrum of potential infecting organisms and the increased likelihood of antimicrobial resistance.
EAU Guidelines on Urological Infections — EAU Guidelines Panel on Urological Infections · European Association of Urology, EAU Guidelines on Urological Infections, 2026 edition. Section 3.8.4.g, "Antimicrobial treatment for suspected CAUTI", opening sentence. · 2026
The publisher's own page for this source
Read on 2026-09-11
UK ONLY. The UK national microbiology standard states that most urinary infections in adult men are complicated and related to abnormalities of the urinary tract.
What the source says
Most infections in adult men are complicated and related to abnormalities of the urinary tract, although a low incidence occurs spontaneously in otherwise healthy young men.
UK Standards for Microbiology Investigations. B 41: Investigation of urine — Standards Unit, UK Health Security Agency · UK Standards for Microbiology Investigations, Bacteriology B 41, issue 8.8, issue date 05.12.25. Section 4.3, "Incidence of UTI", under "Men". · 2025
The publisher's own page for this source
Read on 2026-09-11
ENGLAND. NICE's guideline on lower urinary tract infection asks for a midstream urine sample from pregnant women and from men, sent for culture and susceptibility testing before antibiotics are taken.
What the source says
Obtain a midstream urine sample from pregnant women and men before antibiotics are taken, and send for culture and susceptibility testing.
Urinary tract infection (lower): antimicrobial prescribing — Recommendations — National Institute for Health and Care Excellence · NICE guideline NG109, published 31 October 2018. Section 1.1 "Managing lower urinary tract infection", "Treatment for pregnant women and men with lower UTI", recommendation 1.1.6. · 2018
The publisher's own page for this source
Read on 2026-09-11
ENGLAND. NICE's guideline on routine tests before elective surgery says not to routinely offer urine dipstick tests before surgery.
What the source says
Do not routinely offer urine dipstick tests before surgery.
Preoperative Tests (Update): Routine Preoperative Tests for Elective Surgery — 1, Guideline summary — National Guideline Centre (UK) · NICE Guideline No. 45, London: National Institute for Health and Care Excellence, April 2016. NCBI Bookshelf copy (Bookshelf ID NBK367919), chapter 1, "Guideline summary", 1.1 "Full list of recommendations", heading "Urinalysis", recommendation 20. · 2016
The publisher's own page for this source
Read on 2026-09-11
ENGLAND. The same guideline says to consider microscopy and culture of a midstream urine sample before surgery only if a urinary tract infection would influence the decision to operate.
What the source says
Consider microscopy and culture of midstream urine sample before surgery if the presence of a urinary tract infection would influence the decision to operate.
Preoperative Tests (Update): Routine Preoperative Tests for Elective Surgery — 1, Guideline summary — National Guideline Centre (UK) · NICE Guideline No. 45, London: National Institute for Health and Care Excellence, April 2016. NCBI Bookshelf copy (Bookshelf ID NBK367919), chapter 1, "Guideline summary", 1.1 "Full list of recommendations", heading "Urinalysis", recommendation 21. · 2016
The publisher's own page for this source
Read on 2026-09-11
ENGLAND. The same guideline says a pregnancy test is carried out with the woman's consent if there is any doubt about whether she could be pregnant.
What the source says
Carry out a pregnancy test with the woman’s consent if there is any doubt about whether she could be pregnant.
Preoperative Tests (Update): Routine Preoperative Tests for Elective Surgery — 1, Guideline summary — National Guideline Centre (UK) · NICE Guideline No. 45, London: National Institute for Health and Care Excellence, April 2016. NCBI Bookshelf copy (Bookshelf ID NBK367919), chapter 1, "Guideline summary", 1.1 "Full list of recommendations", heading "Pregnancy testing", recommendation 25. · 2016
The publisher's own page for this source
Read on 2026-09-11
NOT COUNTRY-SPECIFIC. The guideline's evidence chapter on pregnancy testing states that the test is usually performed on urine but a venous blood test may also be used.
What the source says
Pregnancy testing is usually performed using a urine test, but a venous blood test may also be used.
Preoperative Tests (Update): Routine Preoperative Tests for Elective Surgery — 17, Pregnancy testing — National Guideline Centre (UK) · NICE Guideline No. 45, London: National Institute for Health and Care Excellence, April 2016. NCBI Bookshelf copy (Bookshelf ID NBK367900), chapter 17, "Pregnancy testing", 17.1 "Introduction", second sentence. · 2016
The publisher's own page for this source
Read on 2026-09-11
NOT COUNTRY-SPECIFIC. Urinary retention is common after anaesthesia and surgery, with a reported incidence of between 5% and 70%.
What the source says
Urinary retention is common after anesthesia and surgery, reported incidence of between 5% and 70%.
Postoperative urinary retention: anesthetic and perioperative considerations — Gabriele Baldini; Hema Bagry; Armen Aprikian; Franco Carli · Anesthesiology 2009;110(5):1139-57. doi:10.1097/ALN.0b013e31819f7aea. PMID 19352147. Abstract only. · 2009
The publisher's own page for this source
Read on 2026-09-11
NOT COUNTRY-SPECIFIC. An educational review for anaesthetists on day-case spinal anaesthesia says high-risk patients should be required to pass urine before discharge.
What the source says
High-risk patients should be required to void prior to discharge.
Spinal anaesthesia for ambulatory surgery — W. Rattenberry; A. Hertling; R. Erskine · BJA Education 2019;19(10):321-328. doi:10.1016/j.bjae.2019.06.001. PMID 33456853, PMCID PMC7807930. Open access (CC BY-NC-ND); full text read through Europe PMC. Section "Potential complications of ambulatory spinal anaesthesia", subsection "Postoperative urinary retention". · 2019
The publisher's own page for this source
Read on 2026-09-11
NOT COUNTRY-SPECIFIC. The same review says that discharging low-risk patients before they have passed urine requires a robust local support framework and thorough patient education.
What the source says
Discharging low-risk patients before voiding requires a robust local support framework and thorough education of patients.
Spinal anaesthesia for ambulatory surgery — W. Rattenberry; A. Hertling; R. Erskine · BJA Education 2019;19(10):321-328. doi:10.1016/j.bjae.2019.06.001. PMID 33456853, PMCID PMC7807930. Open access (CC BY-NC-ND); full text read through Europe PMC. Section "Potential complications of ambulatory spinal anaesthesia", subsection "Postoperative urinary retention". · 2019
The publisher's own page for this source
Read on 2026-09-11
UK ONLY. A day procedure unit's own leaflet for patients who have not passed urine before leaving says most people in that position pass urine normally in due course.
What the source says
After your operation you may not want to pass urine before you are ready to leave the day procedure unit. The large majority of people in these circumstances pass urine quite normally in due course.
Day Procedure Unit — Not Passed Urine? — Rachel Morris, Sister, Day Procedure Unit · Norfolk and Norwich University Hospitals NHS Foundation Trust, patient information leaflet, Trust Docs ID 29, version 8. Approved by the Patient Information Forum, further one-year review given 12 February 2024, review date 12 February 2025. One page; opening paragraph. · 2024
Read on 2026-09-11
UK ONLY. An NHS urology leaflet describes an ultrasound bladder scan as measuring the amount of urine in the bladder, before and/or after passing urine, to check how well the bladder has emptied.
What the source says
An ultrasound bladder scan measures the amount of urine stored in the bladder. It can be carried out before passing urine and/or after passing urine to check how well the bladder has emptied.
Tests for urinary flow rate with ultrasound bladder scan — Gloucestershire Hospitals NHS Foundation Trust, Urology department, patient information leaflet GHPI0680_11_24, review due November 2027. · 2024
Read on 2026-09-11
UK ONLY. The same leaflet says ultrasound scans are painless and take only a few minutes.
What the source says
Ultrasound scans are painless and will only take a few minutes.
Tests for urinary flow rate with ultrasound bladder scan — Gloucestershire Hospitals NHS Foundation Trust, Urology department, patient information leaflet GHPI0680_11_24, review due November 2027. · 2024
Read on 2026-09-11
NOT COUNTRY-SPECIFIC. The European nurses' guideline lists ultrasound bladder scans for residual urine among the ordinary inputs to planning intermittent catheterisation.
What the source says
Individualised care plans help identify appropriate catheterisation frequency, based on discussion of voiding dysfunction and impact on QoL, voiding diary, functional bladder capacity, and ultrasound bladder scans for residual urine.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Principles of management of nursing intervention, "Frequency of catheterisation", first sentence. · 2025
The publisher's own page for this source
Read on 2026-09-11
NOT COUNTRY-SPECIFIC. Ultrasound provides an accurate assessment of bladder volume and a guide to the management of post-operative urinary retention.
What the source says
Ultrasound has been shown to provide an accurate assessment of urinary bladder volume and a guide to the management of POUR.
Postoperative urinary retention: anesthetic and perioperative considerations — Gabriele Baldini; Hema Bagry; Armen Aprikian; Franco Carli · Anesthesiology 2009;110(5):1139-57. doi:10.1097/ALN.0b013e31819f7aea. PMID 19352147. Abstract only. · 2009
The publisher's own page for this source
Read on 2026-09-11
Acute urinary retention is the sudden inability to urinate with a full bladder; it can be severely painful and life threatening, and needs emergency care right away.
What the source says
People with acute urinary retention are unable to urinate even though they have a full bladder. Acute urinary retention can cause severe pain and be life threatening. If you are suddenly unable to urinate, it’s important that you seek emergency medical treatment right away.
Definition & Facts of Urinary Retention — NIDDK (US National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health). Page last reviewed December 2019. · 2019
Read on 2026-09-11
UK ONLY. The UK national microbiology standard says urine specimens should be transported and processed within four hours if possible, unless a boric acid preservative is used.
What the source says
Specimens should be transported and processed within 4hr if possible, unless boric acid preservative is used
UK Standards for Microbiology Investigations. B 41: Investigation of urine — Standards Unit, UK Health Security Agency · UK Standards for Microbiology Investigations, Bacteriology B 41, issue 8.8, issue date 05.12.25. Section 8, "Specimen transport and storage", 8.1 "Optimal transport and storage conditions", second sentence. · 2025
The publisher's own page for this source
Read on 2026-09-11
UK ONLY. The same standard explains why: delay and room-temperature storage let organisms multiply until the result no longer reflects the true clinical situation.
What the source says
Delays and storage at room temperature allow organisms to multiply, which generate results that do not reflect the true clinical situation.
UK Standards for Microbiology Investigations. B 41: Investigation of urine — Standards Unit, UK Health Security Agency · UK Standards for Microbiology Investigations, Bacteriology B 41, issue 8.8, issue date 05.12.25. Specimen collection, "Transport of urine specimens", second sentence. · 2025
The publisher's own page for this source
Read on 2026-09-11
UK ONLY. The same standard provides for collecting the specimen in a container with boric acid preservative as the alternative to refrigeration.
What the source says
Alternatively, the specimen may be collected in a CE marked leak proof container with boric acid preservative
UK Standards for Microbiology Investigations. B 41: Investigation of urine — Standards Unit, UK Health Security Agency · UK Standards for Microbiology Investigations, Bacteriology B 41, issue 8.8, issue date 05.12.25. Section 8.1 "Optimal transport and storage conditions", fourth sentence. · 2025
The publisher's own page for this source
Read on 2026-09-11
Your options
"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."
What the source says
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).
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-07
In a study of 101 people who did graduated exposure therapy in weekend workshops: "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."
What the source says
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.
Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach — Steven Soifer; Joseph Himle; Kathleen Walsh · Social Work in Health Care 49(5):494-507. doi:10.1080/00981381003684898 · 2010
The publisher's own page for this source
Read on 2026-09-07
The 2017 systematic review of paruresis reports that "Paruresis symptoms were shown to reduce in one intervention study."
What the source says
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.
A systematic review of paruresis: Clinical implications and future directions — Kenley L J Kuoch; Denny Meyer; David W Austin; Simon R Knowles · Journal of Psychosomatic Research 98:122-129. doi:10.1016/j.jpsychores.2017.05.015. PMID 28554367 · 2017
The publisher's own page for this source
Read on 2026-09-09
In a controlled trial of avoidant paruresis, the comparison group was given ten weeks of CBT and systematic desensitisation: "The control group was assigned 10 weeks of CBT and systematic desensitisation."
What the source says
The control group was assigned 10 weeks of CBT and systematic desensitisation.
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. PMC10582859 · 2023
The publisher's own page for this source
Read on 2026-09-09
In that trial, the group given CBT and systematic desensitisation alone had a "total clinical efficacy rate" of 62.5%.
What the source says
The total clinical efficacy rate was 80.0% and 62.5% in the treatment and control groups, respectively.
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Results, "Comparison of clinical efficacy". · 2023
The publisher's own page for this source
Read on 2026-09-09
The trial's own first stated limitation is that patients chose which group they joined.
What the source says
First, patients self-selecting which group they joined created selection bias. In future research, randomised controlled trials can be employed to enhance the credibility of the studies.
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Discussion, "Limitations". · 2023
The publisher's own page for this source
Read on 2026-09-09
In a published NHS case study, 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."
What the source says
Peter attended 12 sessions of CBT including one follow-up session a month after treatment had ended. [...] Peter subjectively found the intervention helpful and his scores on all of the outcome measures reduced over the course of his therapy, and were maintained at one month follow-up.
Cognitive Behavioural Therapy for Paruresis or "Shy Bladder Syndrome": A Case Study — David Hambrook; Tanya Taylor; Victoria Bream · Behavioural and Cognitive Psychotherapy 45(1):79-84. doi:10.1017/S1352465816000321. PMID 27439900 · 2017
The publisher's own page for this source
Read on 2026-09-09
The same authors describe the literature they were adding to as "scarce".
What the source says
This report adds to the scarce literature regarding effective treatments for individuals suffering with paruresis.
Cognitive Behavioural Therapy for Paruresis or "Shy Bladder Syndrome": A Case Study — David Hambrook; Tanya Taylor; Victoria Bream · Behavioural and Cognitive Psychotherapy 45(1):79-84. doi:10.1017/S1352465816000321 · 2017
The publisher's own page for this source
Read on 2026-09-09
In that trial, teaching relaxation of the pelvic area was one part of the CBT, not a treatment on its own.
What the source says
A second component was to teach self-relaxation techniques, especially those involving the pelvic area.
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Methods, "Study design and procedure". · 2023
The publisher's own page for this source
Read on 2026-09-09
In the RACGP's own case, breathing retraining was part of the CBT the patient was given, alongside psychoeducation and cognitive restructuring.
What the source says
The focus of these sessions included psychoeducation (educating the patient about how anxiety influences bladder and bowel function), stress/anxiety management (breathing retraining) and cognitive restructuring (reappraising unhelpful thoughts the patient may have regarding voiding and defecation).
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. "Case: Presentation of paruresis and parcopresis", treatment paragraph. · 2019
Read on 2026-09-09
The same article puts stress management and mindfulness in the same place - as things that may help with the anxiety, alongside the main treatment.
What the source says
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.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. "Treatment recommendations". · 2019
Read on 2026-09-09
The European nurses' guideline lists what intermittent catheterisation is for, beginning with "acute or chronic urinary retention due to nonneurogenic or neurogenic conditions".
What the source says
acute or chronic urinary retention due to nonneurogenic or neurogenic conditions
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Indications, contraindications, and alternatives for IC", first bullet under Indications. · 2025
The publisher's own page for this source
Read on 2026-09-09
The guideline's own recommendation on who teaches intermittent catheterisation: "IC should be taught by an appropriately experienced nurse".
What the source says
IC should be taught by an appropriately experienced nurse
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Principles of management of nursing intervention, recommendations table, "Patient and caregiver education". · 2025
The publisher's own page for this source
Read on 2026-09-09
Even catheterisation by a health care professional follows the guideline's steps in common only in part, and then separates into a female sequence and a male sequence.
What the source says
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.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Procedures for IC", preamble to the procedure table. · 2025
The publisher's own page for this source
Read on 2026-09-09
Urinary tract infection is the most common complication of intermittent catheterisation.
What the source says
A UTI is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney. A UTI is the most common complication and is often associated with inflammation.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Complications", Infection. · 2025
The publisher's own page for this source
Read on 2026-09-09
Who may prescribe intermittent catheterisation depends on the jurisdiction and on local policy.
What the source says
The practitioner authorised to prescribe IC will depend on the jurisdiction and local health care organisation policy.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. Principles of management of nursing intervention, opening sentence. · 2025
The publisher's own page for this source
Read on 2026-09-08
A 1990 report treated four men with paruresis: "Atenolol was effective in one patient. Three patients had a poor response to phenelzine, and they all experienced troublesome side effects."
What the source says
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.
Pharmacotherapy of four men with paruresis — James A Hatterer; Jack M Gorman; Abby J Fyer; Raphael B Campeas; Franklin R Schneier; Eric Hollander; Laszlo A Papp; Michael R Liebowitz · American Journal of Psychiatry 147(1):109-111. doi:10.1176/ajp.147.1.109. PMID 2403470 · 1990
The publisher's own page for this source
Read on 2026-09-09
The gabapentin result that gets repeated is a single case report, and its author's own conclusion is that the drug "should be studied further".
What the source says
This case report presents the first instance of successful monotherapy treatment of paruresis with gabapentin. [...] Gabapentin should be studied further for its potential use in the treatment of paruresis.
Monotherapy treatment of paruresis with gabapentin — Kenneth R Kaufman · International Clinical Psychopharmacology 20(1):53-55. doi:10.1097/00004850-200501000-00011. PMID 15602118 · 2005
The publisher's own page for this source
Read on 2026-09-09
In a published case, atenolol was given to a male patient after treatment with propranolol had not worked; it reduced the physical symptoms of anxiety and did not change his ability to urinate in a public toilet.
What the source says
Atenolol, a cardioselective beta blocker, was administered following unsuccessful treatment with propranolol to a male with a significant history of paruresis. During atenolol therapy, the client reported a decrease in ANS symptoms but no increase in ability to urinate in public restrooms.
Atenolol treatment of paruresis — George Zgourides · Psychological Reports 68(3 Pt 1):766. doi:10.2466/pr0.1991.68.3.766. PMID 1891538 · 1991
The publisher's own page for this source
Read on 2026-09-09
In the earlier propranolol case, "The client did not report a significant increase in his ability to urinate in public facilities during subsequent exposures."
What the source says
The client did not report a significant increase in his ability to urinate in public facilities during subsequent exposures.
Propranolol treatment of paruresis (psychogenic urinary retention): a brief case report — George D Zgourides; Ricks Warren · Perceptual and Motor Skills 71(3 Pt 1):885-886. doi:10.2466/pms.1990.71.3.885. PMID 1981391 · 1990
The publisher's own page for this source
Read on 2026-09-09
The Australian GP journal article puts medication as an addition rather than the treatment: "Pharmacotherapy may also be appropriate as an adjunct."
What the source says
Pharmacotherapy may also be appropriate as an adjunct.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. "Treatment recommendations". · 2019
Read on 2026-09-09
"Despite the reported efficacy of medication, psychotherapy is considered the best intervention for paruresis and parcopresis until further clinical trials are investigated."
What the source says
Despite the reported efficacy of medication, psychotherapy is considered the best intervention for paruresis and parcopresis until further clinical trials are investigated.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. "Treatment recommendations", closing sentence. · 2019
Read on 2026-09-09
Before paruresis is diagnosed, physical causes are meant to be ruled out.
What the source says
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.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. "Diagnostic challenges", opening sentences. · 2019
Read on 2026-09-09
Benign prostate enlargement is particularly common in men and anyone with a prostate over 50.
What the source says
Benign prostate enlargement (BPE), also known as benign prostatic hyperplasia (BPH), is a condition that affects older men and anyone with a prostate. It’s particularly common in men and anyone with a prostate over 50 years of age and isn’t usually a serious threat to health.
Benign prostate enlargement — NHS inform (NHS 24, Scotland's national health information service). Page last updated 1 June 2026. · 2026
Read on 2026-09-09
A GP assessing an enlarged prostate is expected to "rule out other conditions that cause similar symptoms".
What the source says
Your GP will also want to rule out other conditions that cause similar symptoms to prostate enlargement.
Benign prostate enlargement — NHS inform (NHS 24, Scotland's national health information service). Page last updated 1 June 2026. "How is benign prostate enlargement diagnosed?" · 2026
Read on 2026-09-09
In a survey of 63 people with paruresis, the mean duration of symptoms was 24.5 years.
What the source says
Sixty-three patients (59 M, 4 F) completed the questionnaire. The mean age of the subjects was 38.1+/-12 years, with the mean duration of symptoms being 24.5+/-13 years.
Is "shy bladder syndrome" a subtype of social anxiety disorder? A survey of people with paruresis — Bavanisha Vythilingum; Dan J Stein; Steven Soifer · Depression and Anxiety 16(2):84-87. doi:10.1002/da.10061. PMID 12219340 · 2002
The publisher's own page for this source
Read on 2026-09-09
That survey's own conclusion: "paruresis can be a chronic and disabling symptom".
What the source says
Thus, paruresis can be a chronic and disabling symptom, and there seems to be an association between paruresis and other performance anxieties.
Is "shy bladder syndrome" a subtype of social anxiety disorder? A survey of people with paruresis — Bavanisha Vythilingum; Dan J Stein; Steven Soifer · Depression and Anxiety 16(2):84-87. doi:10.1002/da.10061 · 2002
The publisher's own page for this source
Read on 2026-09-09
In the case this journal published, one patient restricted his fluid intake because of his anxiety.
What the source says
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.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. "Case: Presentation of paruresis and parcopresis". · 2019
Read on 2026-09-09
The guideline on who may teach intermittent catheterisation: "There is a lack of agreed standards for patient and caregiver education on IC, and only properly trained nurses should provide teaching."
What the source says
There is a lack of agreed standards for patient and caregiver education on IC, and only properly trained nurses should provide teaching.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Patient and caregiver education", opening sentence. · 2025
The publisher's own page for this source
Read on 2026-09-09
The trial's "total clinical efficacy rate" is a headcount of the patients who reached any of its three grades of improvement, not a measure of how far symptoms fell.
What the source says
total effective rate=(number of clinical control cases+number of apparent effective cases+number of effective cases)/total cases×100%
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Methods, "Scales and efficacy rating". · 2023
The publisher's own page for this source
Read on 2026-09-09
The trial's control group was analysed as 32 patients, three of the 35 enrolled having been excluded.
What the source says
Of the 35 enrollees in the control group, three were excluded for failure to meet the standardised psychotherapy requirements. In total, 32 subjects were included in the outcome analysis, with an exclusion rate of 8.6%.
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Results, opening paragraph. · 2023
The publisher's own page for this source
Read on 2026-09-09
Everyone in the trial was male: "All participants were young males."
What the source says
All participants were young males.
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Results, opening paragraph. · 2023
The publisher's own page for this source
Read on 2026-09-09
The lowest of the trial's three grades of improvement is a partial fall in symptom score: "moderate symptom improvement and patient satisfaction".
What the source says
effective: moderate symptom improvement and patient satisfaction, ≥30% and <60% reduction in symptom rating scale score compared with that before treatment
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Methods, "Scales and efficacy rating", criterion 3. · 2023
The publisher's own page for this source
Read on 2026-09-09
An enlarged prostate can "make it difficult for you to start urinating".
What the source says
make it difficult for you to start urinating
Benign prostate enlargement — NHS inform (NHS 24, Scotland's national health information service). Page last updated 1 June 2026. "Symptoms of benign prostate enlargement", first item of the list of effects on urination. · 2026
Read on 2026-09-09
In the same case, the patient's safety behaviours were identified in therapy and gradually eliminated.
What the source says
In addition, safety behaviours were also identified [...] and gradually eliminated based on a collaborative approach.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. "Case: Presentation of paruresis and parcopresis", treatment paragraph. · 2019
Read on 2026-09-09
Table 2's control-group row: of the 20 men the 62.5% counts, 16 reached only the lowest of the three graded bands.
What the source says
Table 2 Comparison of clinical efficacy between two male groups with avoidant paruresis | Group | n | Clinically controlled | Significantly effective | Effective | Ineffective | Total effectiveness rate (%) | [...] | Control group | 32 | 2 | 2 | 16 | 12 | 62.50
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Table 2, control-group row. · 2023
The publisher's own page for this source
Read on 2026-09-09
Table 2's control-group row: 2 of the 32 reached the highest band, clinically controlled.
What the source says
Table 2 Comparison of clinical efficacy between two male groups with avoidant paruresis | Group | n | Clinically controlled | Significantly effective | Effective | Ineffective | Total effectiveness rate (%) | [...] | Control group | 32 | 2 | 2 | 16 | 12 | 62.50
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Table 2, control-group row. · 2023
The publisher's own page for this source
Read on 2026-09-09
The running-water trial enrolled 18 men, measured them twice a week apart in randomised order with and without the sound, in a completely sealed room.
What the source says
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 after pre-checked bladder volume was scanned to be more than 150 cc.
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798. PMID 25978725 · 2015
The publisher's own page for this source
Read on 2026-09-10
The trial names the application and the speaker it used to play the sound.
What the source says
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.
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798 · 2015
The publisher's own page for this source
Read on 2026-09-10
Peak flow rate was significantly higher with the sound of running water than without it.
What the source says
Mean PFR values with SRW were significantly higher than were those without SRW (15.7 ± 6.2 mL/s vs. 12.3 ± 4.1 mL/s, p = 0.013).
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798 · 2015
The publisher's own page for this source
Read on 2026-09-10
Peak flow rose in 13 participants and fell in 5.
What the source says
PFR with SRW increased in 13 (72%) and decreased in 5 (28%) participants
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798 · 2015
The publisher's own page for this source
Read on 2026-09-10
No other voiding measure differed with the sound.
What the source says
However, no differences were observed in other voiding parameters of UFM and PVR, including average flow rate, voided volume, and voiding time
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798 · 2015
The publisher's own page for this source
Read on 2026-09-10
Participants reported starting more easily with the sound, and the paper marks that report "data not presented".
What the source says
All patients in this study indicated that they could easily initiate urination with SRW (data not presented).
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798 · 2015
The publisher's own page for this source
Read on 2026-09-10
Paruresis appears in the paper as an expectation for future study, not as a finding.
What the source says
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
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798 · 2015
The publisher's own page for this source
Read on 2026-09-10
The paper's own conclusion is about men with lower urinary tract symptoms.
What the source says
The study showed that SRW from a mobile phone application may be helpful in facilitating voiding functions by increasing PFR in male LUTS patients.
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798 · 2015
The publisher's own page for this source
Read on 2026-09-10
Participants were men attending a urology department for the first time with lower urinary tract symptoms.
What the source says
Participants were those who presented with LUTS in the urology department for the first time.
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798 · 2015
The publisher's own page for this source
Read on 2026-09-10
The trial's outcomes were measured immediately after treatment and never again, which its authors give as their third limitation.
What the source says
Third, we only took measures immediately post-treatment. In future research, we can increase the frequency of follow-up measurements to determine the duration of treatment effectiveness.
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Discussion, "Limitations". · 2023
The publisher's own page for this source
Read on 2026-09-11
Being suddenly unable to pass any urine, with a full bladder, is acute urinary retention and needs emergency care whatever the cause.
What the source says
People with acute urinary retention are unable to urinate even though they have a full bladder. Acute urinary retention can cause severe pain and be life threatening. If you are suddenly unable to urinate, it’s important that you seek emergency medical treatment right away.
Definition & Facts of Urinary Retention — NIDDK (US National Institute of Diabetes and Digestive and Kidney Diseases), "Urinary Retention", Definition & Facts, "What are the types of urinary retention?", acute. Page marked "Last Reviewed December 2019". · 2019
Read on 2026-09-11
The Australian GP journal article separates paruresis from dysfunctional voiding by where it happens: "unlike DV, paruresis is isolated to unfamiliar or busy public restrooms".
What the source says
For instance, dysfunctional voiding (DV) has been noted to share similar symptoms with paruresis as both conditions involve urinary retention in the absence of anatomic, obstructive, infectious or neurologic pathology. However, unlike DV, paruresis is isolated to unfamiliar or busy public restrooms.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700. "Diagnostic challenges", second paragraph. · 2019
Read on 2026-09-11
The EAU guideline on female lower urinary tract symptoms says a thorough history and a focused physical examination "should be the first step in the assessment of anyone with LUTS".
What the source says
Taking a thorough clinical history and carrying out a focussed physical examination are fundamental to the process of clinical evaluation. Despite the lack of supportive high-level evidence, there is universal agreement that they should be the first step in the assessment of anyone with LUTS.
EAU Guidelines on Non-neurogenic Female LUTS — European Association of Urology; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Chapter 3, Diagnosis, section 3.1 "History and physical examination", opening paragraph. · 2026
The publisher's own page for this source
Read on 2026-09-11
The EAU guideline on male lower urinary tract symptoms says the history must review "current medication, lifestyle habits, emotional and psychological factors".
What the source says
In addition, current medication, lifestyle habits, emotional and psychological factors must be reviewed.
EAU Guidelines on the Management of Non-neurogenic Male LUTS — European Association of Urology; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Chapter 4, Diagnostic evaluation, section 4.1 "Medical history", first paragraph. · 2026
The publisher's own page for this source
Read on 2026-09-11
The men's guideline says a urine test "must be included in the primary evaluation of any patient presenting with LUTS".
What the source says
Urinalysis (dipstick or microscopy) must be included in the primary evaluation of any patient presenting with LUTS to identify conditions such as urinary tract infections (UTI), microhaematuria and diabetes mellitus.
EAU Guidelines on the Management of Non-neurogenic Male LUTS — European Association of Urology; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Chapter 4, section 4.5 "Urinalysis", opening sentence. · 2026
The publisher's own page for this source
Read on 2026-09-11
The women's guideline asks for a bladder diary as part of the initial assessment.
What the source says
Ask patients with LUTS to complete a bladder diary as part of the standardised initial assessment and follow-up of female LUTS.
EAU Guidelines on Non-neurogenic Female LUTS — European Association of Urology; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Chapter 3, section 3.3.1 "Summary of evidence and recommendations for bladder diaries", recommendations table, first row. · 2026
The publisher's own page for this source
Read on 2026-09-11
The men's guideline calls the flow test "a widely used non-invasive urodynamic test".
What the source says
Urinary flow rate assessment is a widely used non-invasive urodynamic test.
EAU Guidelines on the Management of Non-neurogenic Male LUTS — European Association of Urology; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Chapter 4, section 4.9 "Uroflowmetry", opening sentence. · 2026
The publisher's own page for this source
Read on 2026-09-11
What is left in the bladder after voiding is measured by ultrasound or by catheter, and the women's guideline prefers ultrasound.
What the source says
Post-void residual volume can be measured by catheterisation or ultrasound (US). [...] US measurement of PVR volume is preferable to catheterisation, due to its favourable risk-benefit profile.
EAU Guidelines on Non-neurogenic Female LUTS — European Association of Urology; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Chapter 3, section 3.5 "Post-void residual volume", first and second paragraphs. · 2026
The publisher's own page for this source
Read on 2026-09-11
The controlled trial's own safety protocol was the same set of tests: "ultrasound (kidney, ureter, bladder, residual urine), renal function tests, and urine analysis", to be run if any man's symptoms worsened.
What the source says
If there had been a significant worsening of symptoms accompanied by other urinary system symptoms, our hospital’s doctors would have promptly conducted urinary system examinations, such as ultrasound (kidney, ureter, bladder, residual urine), renal function tests, and urine analysis, and provided appropriate treatment, based on the findings.
Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial — Shengjing Liang; Ying Zhou; Chao Yu; Xiang Gao; Feng Ji; Qi Fang; Zhen Zhang; Lei Yang; Yong Zhao; Yi Zhao; Rui Yin; Kai Chen; Zheng Lu · General Psychiatry 36(5):e101014. doi:10.1136/gpsych-2023-101014. Methods, "Safety-related treatment". · 2023
The publisher's own page for this source
Read on 2026-09-11
The men's guideline does not make a camera examination of the bladder routine: it is for cases where "the findings may change diagnosis or treatment".
What the source says
Perform urethrocystoscopy in men with LUTS if the findings may change diagnosis or treatment.
EAU Guidelines on the Management of Non-neurogenic Male LUTS — European Association of Urology; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Chapter 4, section 4.11 "Urethrocystoscopy", recommendation row (strength rating: weak). · 2026
The publisher's own page for this source
Read on 2026-09-11
Pressure testing of the bladder is not routine: "a urodynamic investigation is generally only offered if conservative and medical treatment have failed".
What the source says
Due to the invasive nature of the test, a urodynamic investigation is generally only offered if conservative and medical treatment have failed.
EAU Guidelines on the Management of Non-neurogenic Male LUTS — European Association of Urology; edition presented at the EAU Annual Congress, London 2026. ISBN 978-94-92671-32-5. Chapter 4, section 4.12 "Urodynamics", paragraph on indications. · 2026
The publisher's own page for this source
Read on 2026-09-11
A review of drug-induced urinary retention says "many drugs can interact with the micturition pathway" and names the classes reported to do so, beginning with drugs that have anticholinergic activity, "antipsychotic drugs, antidepressant agents and anticholinergic respiratory agents" among them, then opioids and benzodiazepines.
What the source says
Because of the complex mechanism of micturition, many drugs can interact with the micturition pathway, all via different modes of action. [...] Urinary retention has been described with the use of drugs with anticholinergic activity (e.g. antipsychotic drugs, antidepressant agents and anticholinergic respiratory agents), opioids and anaesthetics, alpha-adrenoceptor agonists, benzodiazepines, NSAIDs, detrusor relaxants and calcium channel antagonists.
Drug-induced urinary retention: incidence, management and prevention — K M Verhamme; M C Sturkenboom; B H Stricker; R Bosch · Drug Safety 31(5):373-388. doi:10.2165/00002018-200831050-00002. PMID 18422378 · 2008
The publisher's own page for this source
Read on 2026-09-11
England's clinical guideline on social anxiety disorder offers adults CBT first and, for those who decline it and want a medicine, "a selective serotonin reuptake inhibitor (SSRI)".
What the source says
For adults who decline cognitive behavioural interventions and express a preference for a pharmacological intervention, discuss their reasons for declining cognitive behavioural interventions and address any concerns. If the person wishes to proceed with a pharmacological intervention, offer a selective serotonin reuptake inhibitor (SSRI) (escitalopram or sertraline).
Social Anxiety Disorder: Recognition, Assessment and Treatment — National Collaborating Centre for Mental Health (UK) · NICE Clinical Guidelines, No. 159. Leicester (UK): British Psychological Society; 2013. NCBI Bookshelf copy of the full guideline, chapter 9 "Summary of recommendations", 9.3.2.4 and 9.3.2.5. · 2013
The publisher's own page for this source
Read on 2026-09-11
The same guideline: "Do not routinely offer anticonvulsants, tricyclic antidepressants, benzodiazepines or antipsychotic medication to treat social anxiety disorder in adults."
What the source says
Do not routinely offer anticonvulsants, tricyclic antidepressants, benzodiazepines or antipsychotic medication to treat social anxiety disorder in adults.
Social Anxiety Disorder: Recognition, Assessment and Treatment — National Collaborating Centre for Mental Health (UK) · NICE Clinical Guidelines, No. 159. Leicester (UK): British Psychological Society; 2013. NCBI Bookshelf copy of the full guideline, chapter 9, section 9.6 "Interventions that are not recommended to treat social anxiety disorder", 9.6.1.2. · 2013
The publisher's own page for this source
Read on 2026-09-11
The guideline's account of what has been used for social anxiety disorder names every drug on this page: phenelzine among the MAOIs, gabapentin among the anticonvulsants, and atenolol and propranolol as beta-antagonists "used to treat specific symptoms such as tremor".
What the source says
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.
Social Anxiety Disorder: Recognition, Assessment and Treatment — National Collaborating Centre for Mental Health (UK) · NICE Clinical Guidelines, No. 159. Leicester (UK): British Psychological Society; 2013. NCBI Bookshelf copy of the full guideline, chapter 6 "Interventions for adults", section 6.2.1 "Pharmacological interventions". · 2013
The publisher's own page for this source
Read on 2026-09-11
The running-water paper measures its own result against alpha blockers, the usual drug treatment in the LUTS trials it cites.
What the source says
Several meta-analyses and an international randomized controlled trial to evaluate the efficacy of alpha blockers to treat LUTS showed a significant PFR increase of 2.2 mL/s compared with the control group.
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798. Discussion. · 2015
The publisher's own page for this source
Read on 2026-09-11
The guideline's table of complications of intermittent catheterisation goes beyond infection to urethritis, epididymo-orchitis, prostatitis, urethral bleeding, false passage and urethral stricture, and defines a false passage as one that "Occurs when an object passes through the wall of the urethra."
What the source says
Occurs when an object passes through the wall of the urethra. [...] A narrowing of the urethra.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Complications", Table 5 "Complications experienced by IC users", Description column, rows "False passage" and "Urethral stricture". · 2025
The publisher's own page for this source
Read on 2026-09-11
The same guideline: strictures "are more common in men because the male urethra is longer than the female’s".
What the source says
Strictures are more common in men because the male urethra is longer than the female’s and the female urethra is straighter than the male’s.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Intermittent urethral dilatation", opening sentence. · 2025
The publisher's own page for this source
Read on 2026-09-11
For the measures that did not change, the authors say "the sample size was small".
What the source says
To evaluate differences in other voiding parameters of UFM and PVR and differences according to timing of the sound application, the sample size was small.
Changes in Urination According to the Sound of Running Water Using a Mobile Phone Application — Whi-An Kwon; Sung Han Kim; Sohee Kim; Jae Young Joung; Jinsoo Chung; Kang Hyun Lee; Sang-Jin Lee; Ho Kyung Seo · PLOS ONE 10(5):e0126798. doi:10.1371/journal.pone.0126798. Discussion, limitations paragraph. · 2015
The publisher's own page for this source
Read on 2026-09-11
Paruresis in women
Researchers who studied how women use public toilets open their own discussion by saying the subject has barely been looked at: "Toileting behaviors are often considered to be a private matter, and therefore, barriers to restroom use at work and in public are frequently not discussed and have been minimally studied."
What the source says
Toileting behaviors are often considered to be a private matter, and therefore, barriers to restroom use at work and in public are frequently not discussed and have been minimally studied.
Why Do Women Not Use the Bathroom? Women's Attitudes and Beliefs on Using Public Restrooms — Siobhan M Hartigan; Kemberlee Bonnet; Leah Chisholm; Casey Kowalik; Roger R Dmochowski; David Schlundt; W Stuart Reynolds · International Journal of Environmental Research and Public Health 17(6):2053. doi:10.3390/ijerph17062053. PMID 32244871. PMC7142493. Discussion, opening sentence. · 2020
The publisher's own page for this source
Read on 2026-09-09
The one study that asked whether the condition looks different in women found little difference — in a sample that was 87.7% male: "most of participants were male (87.7%; N=57). Although gender differences in the clinical manifestations of the disorder appear limited..."
What the source says
RESULTS: 65 participants showed clinically relevant symptoms of paruresis, as suggested by a PCL score above the threshold. Mean age was 28 ys (SD= ± 7.75 ys); most of participants were male (87.7%; N=57). Although gender differences in the clinical manifestations of the disorder appear limited, the variable mostly connected to the severity of paruresis is the presence of a further diagnosis of generalized social phobia.
[Shy bladder syndrome] — Antonio Prunas · Rivista di Psichiatria 48(4):345-353. doi:10.1708/1319.14632. PMID 24056834. Article in Italian; English abstract. · 2013
The publisher's own page for this source
Read on 2026-09-09
The same paper's conclusion about who knows about this condition: "Paruresis is a clinical condition associated with high level of distress on which, however, there is limited knowledge among mental health professionals."
What the source says
DISCUSSION: Paruresis is a clinical condition associated with high level of distress on which, however, there is limited knowledge among mental health professionals.
[Shy bladder syndrome] — Antonio Prunas · Rivista di Psichiatria 48(4):345-353. doi:10.1708/1319.14632. PMID 24056834. Article in Italian; English abstract, DISCUSSION. · 2013
The publisher's own page for this source
Read on 2026-09-09
Who the older studies studied: "Sixty-three patients (59 M, 4 F) completed the questionnaire."
What the source says
A survey of people affiliated with the "International Paruresis Association" was undertaken using a self-report questionnaire with items that addressed demographic variables, the phenomenology of paruresis, comorbid disorders, and the impact of symptoms on quality of life. Sixty-three patients (59 M, 4 F) completed the questionnaire. The mean age of the subjects was 38.1+/-12 years, with the mean duration of symptoms being 24.5+/-13 years.
Is "shy bladder syndrome" a subtype of social anxiety disorder? A survey of people with paruresis — Bavanisha Vythilingum; Dan J Stein; Steven Soifer · Depression and Anxiety 16(2):84-7. doi:10.1002/da.10061 · 2002
The publisher's own page for this source
Read on 2026-09-09
What was actually asked, and of how many women: "There were 5397 participants who entered free-text responses that contributed to the qualitative analysis."
What the source says
There were 5397 participants who entered free-text responses that contributed to the qualitative analysis.
Why Do Women Not Use the Bathroom? Women's Attitudes and Beliefs on Using Public Restrooms — Siobhan M Hartigan; Kemberlee Bonnet; Leah Chisholm; Casey Kowalik; Roger R Dmochowski; David Schlundt; W Stuart Reynolds · International Journal of Environmental Research and Public Health 17(6):2053. doi:10.3390/ijerph17062053. PMC7142493. Results, Cohort/data Description. · 2020
The publisher's own page for this source
Read on 2026-09-09
What privacy means to the women surveyed is not a lockable door: "Privacy can mean using a restroom alone so that others cannot see, hear, or smell what you are doing."
What the source says
Privacy is a very important aspect of a restroom that is considered when deciding whether to use a specific facility. Privacy can mean using a restroom alone so that others cannot see, hear, or smell what you are doing. Some women only truly feel comfortable and private at home and do not like to use any public restrooms.
Why Do Women Not Use the Bathroom? Women's Attitudes and Beliefs on Using Public Restrooms — Siobhan M Hartigan; Kemberlee Bonnet; Leah Chisholm; Casey Kowalik; Roger R Dmochowski; David Schlundt; W Stuart Reynolds · International Journal of Environmental Research and Public Health 17(6):2053. doi:10.3390/ijerph17062053. PMC7142493. Results, Situational Influences, privacy. · 2020
The publisher's own page for this source
Read on 2026-09-09
The 2024 UK survey's own recommendation to employers and institutions is for single-occupancy toilets, not more cubicles: "Organisations should consider building single gender, single occupancy toilets and locating toilets in quiet non-communal areas to limit anxiety associated with shy bladder syndrome."
What the source says
This work has important implications for all organisations in relation to layout of buildings and support for staff. Organisations should consider building single gender, single occupancy toilets and locating toilets in quiet non-communal areas to limit anxiety associated with shy bladder syndrome.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097. PMC11574405. Discussion, implications. · 2024
The publisher's own page for this source
Read on 2026-09-09
"Like other social phobias, individuals with paruresis demonstrate anticipatory anxiety and fear of negative evaluation, with urinary difficulties that increase as the level of privacy decreases."
What the source says
Like other social phobias, individuals with paruresis demonstrate anticipatory anxiety and fear of negative evaluation, with urinary difficulties that increase as the level of privacy decreases.
Development and validation of the Shy Bladder and Bowel Scale (SBBS) — Simon R Knowles; Jason Skues · Cognitive Behaviour Therapy 45(4):324-338. doi:10.1080/16506073.2016.1178800. PMC4960499 · 2016
The publisher's own page for this source
Read on 2026-09-09
The European nurses' guideline lists what intermittent catheterisation is for, beginning with "acute or chronic urinary retention due to nonneurogenic or neurogenic conditions".
What the source says
acute or chronic urinary retention due to nonneurogenic or neurogenic conditions
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Indications, contraindications, and alternatives for IC", first bullet under Indications. · 2025
The publisher's own page for this source
Read on 2026-09-09
CISC is taught, not self-taught: "IC should be taught by an appropriately experienced nurse."
What the source says
IC should be taught by an appropriately experienced nurse [and, in the same document] There is a lack of agreed standards for patient and caregiver education on IC, and only properly trained nurses should provide teaching.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025 · 2025
The publisher's own page for this source
Read on 2026-09-09
Catheterisation in women and in men are not the same procedure: the guideline's steps are common to both only in part, and then separate.
What the source says
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.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Procedures for IC", preamble to the procedure table. · 2025
The publisher's own page for this source
Read on 2026-09-09
The guideline gives the anatomical reason the two cases differ, and the complication that follows from it: "Strictures are more common in men because the male urethra is longer than the female's and the female urethra is straighter than the male's."
What the source says
Strictures are more common in men because the male urethra is longer than the female’s and the female urethra is straighter than the male’s.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Intermittent urethral dilatation", opening sentence. · 2025
The publisher's own page for this source
Read on 2026-09-09
Urinary tract infection is the most common complication of intermittent catheterisation.
What the source says
A UTI is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney. A UTI is the most common complication and is often associated with inflammation.
A Summary of the EAUN Guidelines on Urethral Intermittent Catheterisation in Adults: Evidence-based Guidelines for Best Practices in Urological Health Care — Susanne Vahr Lauridsen; Veronika Geng; Hanneke Lurvink; EAUN Guidelines Working Group · European Association of Urology Nurses (EAUN), March 2025. "Complications", Infection. · 2025
The publisher's own page for this source
Read on 2026-09-09
The guideline's table of what raises the risk of infection in intermittent catheterisation lists being female as one of the factors, with a level of evidence of 1b.
What the source says
Table 10. Factors increasing the risk of infection in IC | Risk factor | LE [...] Female [48, 69] | 1b [...]
Urethral intermittent catheterisation in adults, including urethral intermittent dilatation: Evidence-based Guidelines for Best Practice in Urological Health Care — S. Vahr Lauridsen; S. Chagani; A. Daniels; T. Kelly; H. Lurvink; I. Pearce; M. Popiński; B. Thoft Jensen; G. Villa; S. Wildeman; V. Geng · European Association of Urology Nurses (EAUN), 2024. FULL guideline, not the March 2025 summary. Section 6.1, Table 10. · 2024
The publisher's own page for this source
Read on 2026-09-09
The guideline's own scale defines a level of evidence of 1b as "Evidence obtained from at least one randomised trial".
What the source says
Table 1. Level of evidence (LE) | LE | Type of evidence [...] 1b | Evidence obtained from at least one randomised trial [...]
Urethral intermittent catheterisation in adults, including urethral intermittent dilatation: Evidence-based Guidelines for Best Practice in Urological Health Care — S. Vahr Lauridsen; S. Chagani; A. Daniels; T. Kelly; H. Lurvink; I. Pearce; M. Popiński; B. Thoft Jensen; G. Villa; S. Wildeman; V. Geng · European Association of Urology Nurses (EAUN), 2024. FULL guideline, Table 1. · 2024
The publisher's own page for this source
Read on 2026-09-09
Dysfunctional voiding in women is a flow that starts and stops because of involuntary contractions of the muscles around the urethra during voiding, "in neurologically normal women".
What the source says
This is characterized by an intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the peri-urethral striated or levator muscles during voiding in neurologically normal women. This type of voiding may also be the result of an acontractile detrusor (abdominal voiding) with electromyography (EMG) or video-urodynamics required to distinguish between the two entities.
ICS Glossary: Dysfunctional voiding (female) — International Continence Society, carrying the definition from Haylen BT; de Ridder D; Freeman RM; Swift SE; Berghmans B; Lee J; Monga A; Petri E; Rizk DE; Sand PK; Schaer GN · ICS Glossary entry "Dysfunctional voiding (female)", which the glossary references to: An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics 29(1):4-20. doi:10.1002/nau.20798 · 2010
The publisher's own page for this source
Read on 2026-09-11
Dysfunctional voiding "has been noted to share similar symptoms with paruresis", and the two are told apart by setting: paruresis "is isolated to unfamiliar or busy public restrooms".
What the source says
For instance, dysfunctional voiding (DV) has been noted to share similar symptoms with paruresis as both conditions involve urinary retention in the absence of anatomic, obstructive, infectious or neurologic pathology. However, unlike DV, paruresis is isolated to unfamiliar or busy public restrooms.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-11
Urinary retention in women "is an uncommon and poorly understood condition"; in Fowler's syndrome the underlying abnormality is "a poorly relaxing external urethral sphincter" that on electromyography shows "a distinct abnormal pattern".
What the source says
Urinary retention in women is an uncommon and poorly understood condition. In 1986, Fowler and colleagues described a syndrome in young women with unexplained urinary retention associated with polycystic ovary syndrome. The underlying abnormality was a poorly relaxing external urethral sphincter that when studied using concentric needle electromyography showed a distinct abnormal pattern suggesting direct spread of impulses between muscle fibres.
Fowler's syndrome--a cause of unexplained urinary retention in young women? — Nadir I Osman; Christopher R Chapple · Nature Reviews Urology 11(2):87-98. doi:10.1038/nrurol.2013.277. PMID 24323131 · 2014
The publisher's own page for this source
Read on 2026-09-11
Understanding paruresis
Paruresis "refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others."
What the source says
Paruresis refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others.
A systematic review of paruresis: Clinical implications and future directions — Kenley L J Kuoch; Denny Meyer; David W Austin; Simon R Knowles · Journal of Psychosomatic Research 98:122-129. doi:10.1016/j.jpsychores.2017.05.015. PMID 28554367 · 2017
The publisher's own page for this source
Read on 2026-09-09
"Paruresis is a condition characterized by difficulty or inability to urinate in situations where others are present, or may soon be present."
What the source says
Paruresis is a condition characterized by difficulty or inability to urinate in situations where others are present, or may soon be present.
Paruresis (psychogenic inhibition of micturition): cognitive behavioral formulation and treatment — Mark J Boschen · Depression and Anxiety 25(11):903-12. doi:10.1002/da.20367. PMID 17932976 · 2008
The publisher's own page for this source
Read on 2026-09-09
Comparing people with paruresis against people with social phobia: "The paruretic group differs significantly in all symptom variables from both the non-generalized and the generalized social phobia groups."
What the source says
A sample of N = 226 subjects completed different questionnaires concerning paruresis, social phobic symptoms, lower urinary tract symptoms and depressive symptoms. These individuals were divided into four groups: no symptoms, suffering primarily from paruresis, non-generalized social phobia and generalized social phobia. The paruretic group differs significantly in all symptom variables from both the non-generalized and the generalized social phobia groups.
Is "shy bladder syndrome" (paruresis) correctly classified as social phobia? — Philipp Hammelstein; Steven Soifer · Journal of Anxiety Disorders 20(3):296-311. doi:10.1016/j.janxdis.2005.02.008. PMID 16564434 · 2006
The publisher's own page for this source
Read on 2026-09-09
The same study concludes: "These results question the classification of paruresis as simply being a form of social phobia."
What the source says
These results question the classification of paruresis as simply being a form of social phobia.
Is "shy bladder syndrome" (paruresis) correctly classified as social phobia? — Philipp Hammelstein; Steven Soifer · Journal of Anxiety Disorders 20(3):296-311. doi:10.1016/j.janxdis.2005.02.008 · 2006
The publisher's own page for this source
Read on 2026-09-09
"In contrast to other forms of social phobia, paruresis is not associated with a lower educational or occupational level."
What the source says
In contrast to other forms of social phobia, paruresis is not associated with a lower educational or occupational level.
Psychogenic urinary retention ('paruresis'): diagnosis and epidemiology in a representative male sample — Philipp Hammelstein; Reinhard Pietrowsky; Martin Merbach; Elmar Brähler · Psychotherapy and Psychosomatics 74(5):308-14. doi:10.1159/000086322. PMID 16088269 · 2005
The publisher's own page for this source
Read on 2026-09-09
"Like other social phobias, individuals with paruresis demonstrate anticipatory anxiety and fear of negative evaluation, with urinary difficulties that increase as the level of privacy decreases."
What the source says
Like other social phobias, individuals with paruresis demonstrate anticipatory anxiety and fear of negative evaluation, with urinary difficulties that increase as the level of privacy decreases.
Development and validation of the Shy Bladder and Bowel Scale (SBBS) — Simon R Knowles; Jason Skues · Cognitive Behaviour Therapy 45(4):324-338. doi:10.1080/16506073.2016.1178800. PMC4960499 · 2016
The publisher's own page for this source
Read on 2026-09-09
"The severity of paruresis can range from slight hesitancy of using public toilets to chronic urinary retention."
What the source says
The severity of paruresis can range from slight hesitancy of using public toilets to chronic urinary retention.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
In urology, chronic urinary retention means being able to urinate but unable to empty the bladder completely - "can urinate but cannot completely empty the urine from their bladders."
What the source says
Chronic urinary retention develops over time. People with chronic urinary retention can urinate but cannot completely empty the urine from their bladders.
Definition & Facts of Urinary Retention — NIDDK (US National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health). Page last reviewed December 2019. · 2019
Read on 2026-09-11
"The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1-22.2% of individuals with paruresis also had Social Anxiety Disorder."
What the source says
RESULTS: The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1-22.2% of individuals with paruresis also had Social Anxiety Disorder.
A systematic review of paruresis: Clinical implications and future directions — Kenley L J Kuoch; Denny Meyer; David W Austin; Simon R Knowles · Journal of Psychosomatic Research 98:122-129. doi:10.1016/j.jpsychores.2017.05.015 · 2017
The publisher's own page for this source
Read on 2026-09-09
The low end of that range comes from a representative male sample: "Using the empirically based cutoff score of the PCL, 2.8% of the sample was diagnosed as suffering from paruresis."
What the source says
The aim of the present study was to achieve for the first time an estimation of point prevalence in a representative male sample (n = 1,105). [...] RESULTS: Reliability of the PCL seemed to be sufficient, and adequate evidence for validity was found. Using the empirically based cutoff score of the PCL, 2.8% of the sample was diagnosed as suffering from paruresis.
Psychogenic urinary retention ('paruresis'): diagnosis and epidemiology in a representative male sample — Philipp Hammelstein; Reinhard Pietrowsky; Martin Merbach; Elmar Brähler · Psychotherapy and Psychosomatics 74(5):308-14. doi:10.1159/000086322 · 2005
The publisher's own page for this source
Read on 2026-09-09
A 2024 survey of 356 university staff and students - "221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders".
What the source says
We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18–30 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097. PMC11574405 · 2024
The publisher's own page for this source
Read on 2026-09-09
What those bands mean: "We defined 'mild' and 'severe' paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40."
What the source says
We defined ‘mild’ and ‘severe’ paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
The survey found the adjusted odds of 'mild' paruresis "higher for men than women (OR 3.39; 95% CI 1.90 to 6.06)".
What the source says
The adjusted odds of ‘mild’ paruresis were higher for men than women (OR 3.39; 95% CI 1.90 to 6.06)
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
And for 'severe' paruresis: "The adjusted odds of 'severe' paruresis were higher for men than women (OR 2.60; 95% CI 1.32 to 5.12)".
What the source says
The adjusted odds of ‘severe’ paruresis were higher for men than women (OR 2.60; 95% CI 1.32 to 5.12), lower for those with a lower RSES score (OR 0.90; CI 0.84 to 0.97) and higher for those with at least one anxiety disorder (OR 2.99 (1.18–7.56)).
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
Its authors note: "The sample may be motivated and may not be generalisable to the wider population."
What the source says
The sample may be motivated and may not be generalisable to the wider population.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
That review adds: "Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required."
What the source says
CONCLUSION: Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required.
A systematic review of paruresis: Clinical implications and future directions — Kenley L J Kuoch; Denny Meyer; David W Austin; Simon R Knowles · Journal of Psychosomatic Research 98:122-129. doi:10.1016/j.jpsychores.2017.05.015 · 2017
The publisher's own page for this source
Read on 2026-09-09
"In the American Psychiatric Association Diagnostic and Statistical Manual 5th edition (American Psychiatric Association, 2013), paruresis is even listed as a feature of Social Anxiety Disorder."
What the source says
In the American Psychiatric Association Diagnostic and Statistical Manual 5th edition (American Psychiatric Association, 2013), paruresis is even listed as a feature of Social Anxiety Disorder.
Development and validation of the Shy Bladder and Bowel Scale (SBBS) — Simon R Knowles; Jason Skues · Cognitive Behaviour Therapy 45(4):324-338. doi:10.1080/16506073.2016.1178800. PMC4960499 · 2016
The publisher's own page for this source
Read on 2026-09-09
"There is some contention around the conceptualisation of paruresis (e.g. Hammelstein & Soifer, 2006), however the most common belief is that it is a symptom or subtype of Social Anxiety Disorder (Boschen, 2008)."
What the source says
There is some contention around the conceptualisation of paruresis (e.g. Hammelstein & Soifer, 2006), however the most common belief is that it is a symptom or subtype of Social Anxiety Disorder (Boschen, 2008).
Development and validation of the Shy Bladder and Bowel Scale (SBBS) — Simon R Knowles; Jason Skues · Cognitive Behaviour Therapy 45(4):324-338. doi:10.1080/16506073.2016.1178800 · 2016
The publisher's own page for this source
Read on 2026-09-09
The same article's own conclusion: "the majority are likely to better meet criteria for a specific phobia."
What the source says
Based on the current research, while it is likely that a minority of individuals presenting with either or both of these conditions will meet criteria for mental health disorders such as SAD, the majority are likely to better meet criteria for a specific phobia.
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-09
"paruresis and SAD are likely to be two distinct conditions, as patients with paruresis do not necessarily present with comorbid SAD (approximately 5.1-22.2% of individuals with paruresis also had comorbid SAD)."
What the source says
Nevertheless, paruresis and SAD are likely to be two distinct conditions, as patients with paruresis do not necessarily present with comorbid SAD (approximately 5.1–22.2% of individuals with paruresis also had comorbid SAD).
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-09
Holding on is an active reflex: "The pudendal nerve maintains tonic contraction of the external urethral sphincter (EUS), contributing to continence. This tonic activity increases with bladder filling and is mediated, in part, by the guarding reflex".
What the source says
The pudendal nerve maintains tonic contraction of the external urethral sphincter (EUS), contributing to continence. This tonic activity increases with bladder filling and is mediated, in part, by the guarding reflex, a spinal reflex pathway activated by low-level bladder afferent input, reinforcing EUS contraction
Neurophysiology of Micturition: a Narrative Review on Preventing Mismanagement — Rodrigo Castro Mattos; Luciano A. Favorito · International Braz J Urol 51(3):e20259907. doi:10.1590/s1677-5538.ibju.2025.9907. PMC12052025 · 2025
The publisher's own page for this source
Read on 2026-09-09
The sympathetic nervous system closes the outlet while the bladder fills: norepinephrine activates "α1-adrenergic receptors in the bladder neck and proximal urethra, inducing smooth muscle contraction to enhance closure".
What the source says
During bladder filling, relaxation of the detrusor muscle is mediated by sympathetic innervation. Norepinephrine activates β3-adrenergic receptors in the bladder wall, promoting relaxation, and α1-adrenergic receptors in the bladder neck and proximal urethra, inducing smooth muscle contraction to enhance closure
Neurophysiology of Micturition: a Narrative Review on Preventing Mismanagement — Rodrigo Castro Mattos; Luciano A. Favorito · International Braz J Urol 51(3):e20259907. doi:10.1590/s1677-5538.ibju.2025.9907 · 2025
The publisher's own page for this source
Read on 2026-09-09
Voiding needs three things at once: parasympathetic activation, "sympathetic Inhibition, trough the hypogastric nerve that reduces bladder outlet resistance, and somatic relaxation, through the pudendal nerve that reduces external urethral sphincter tone."
What the source says
Voiding involves parasympathetic activation, trough the pelvic nerve which stimulates detrusor muscle contraction, sympathetic Inhibition, trough the hypogastric nerve that reduces bladder outlet resistance, and somatic relaxation, through the pudendal nerve that reduces external urethral sphincter tone. The synchronized contraction of the detrusor and relaxation of the outlet ensures efficient voiding.
Neurophysiology of Micturition: a Narrative Review on Preventing Mismanagement — Rodrigo Castro Mattos; Luciano A. Favorito · International Braz J Urol 51(3):e20259907. doi:10.1590/s1677-5538.ibju.2025.9907 · 2025
The publisher's own page for this source
Read on 2026-09-09
In adults the voiding reflex "is under strict voluntary control", and the decision to void "is based on a combination of factors, including one's emotional state, an appreciation of the social environment and the sensory signals arising from the bladder."
What the source says
However, in continent individuals the firing of the voiding reflex is under strict voluntary control, enabling one to plan to void at a socially acceptable time and place. The decision to void, which is a crucial aspect of human behaviour, is based on a combination of factors, including one's emotional state, an appreciation of the social environment and the sensory signals arising from the bladder.
The neural control of micturition — Clare J. Fowler; Derek Griffiths; William C. de Groat · Nature Reviews Neuroscience 9(6):453-466. doi:10.1038/nrn2401. PMID 18490916; PMCID PMC2897743 · 2008
The publisher's own page for this source
Read on 2026-09-11
The review suggests the prefrontal cortex "might be responsible for tonic suppression of voiding that is relaxed only when voiding is both desired and socially appropriate."
What the source says
It has strong and direct connections with the PAG, suggesting that it might be responsible for tonic suppression of voiding that is relaxed only when voiding is both desired and socially appropriate.
The neural control of micturition — Clare J. Fowler; Derek Griffiths; William C. de Groat · Nature Reviews Neuroscience 9(6):453-466. doi:10.1038/nrn2401. PMID 18490916; PMCID PMC2897743 · 2008
The publisher's own page for this source
Read on 2026-09-11
What people report in their bodies: "psychosomatic symptoms such as diaphoresis, tachypnea, heart palpitations, muscle tension, blushing, nausea and trembling, which occur during moments of heightened arousal (eg being inside a busy restroom)."
What the source says
Consistent with anxiety, patients may also report avoidance behaviours and psychosomatic symptoms such as diaphoresis, tachypnea, heart palpitations, muscle tension, blushing, nausea and trembling, which occur during moments of heightened arousal (eg being inside a busy restroom).
Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? — Kenley L J Kuoch; David W Austin; Simon R Knowles · Australian Journal of General Practice 48(4):212-215. doi:10.31128/AJGP-09-18-4700 · 2019
Read on 2026-09-09
When it was measured directly: "The bashful bladder syndrome was not associated with any specific urodynamic diagnosis."
What the source says
A total of 40 consecutive symptomatic men with a median International Prostate Symptom Score of 19 (range 1 to 29) and median age of 51.9 years (range 30 to 75) who were unable to void during video cystometrography underwent ambulatory urodynamic monitoring. [...] CONCLUSIONS: The bashful bladder syndrome was not associated with any specific urodynamic diagnosis.
Urodynamic assessment of the bashful bladder — D J Rosario; C R Chapple; P R Tophill; H H Woo · The Journal of Urology 163(1):215-20. PMID 10604351 · 2000
The publisher's own page for this source
Read on 2026-09-09
The same study's other conclusion, which is what makes its negative a narrow one: "A surgically correctable cause of symptoms can be found in about 20% of men older than 40 years."
What the source says
A surgically correctable cause of symptoms can be found in about 20% of men older than 40 years.
Urodynamic assessment of the bashful bladder — D J Rosario; C R Chapple; P R Tophill; H H Woo · The Journal of Urology 163(1):215-20. PMID 10604351 · 2000
The publisher's own page for this source
Read on 2026-09-09
The men voided in private during ambulatory monitoring, and "Pressure flow data were available for the remaining 37 patients" of the 40.
What the source says
Subjects voided in private into a specially designed flow meter, which they connected to the recording device. RESULTS: Of the patients 2 (5%) failed to attend ambulatory urodynamic monitoring, despite multiple reminders, and in 1 (2.5%) the trace was uninterpretable. Pressure flow data were available for the remaining 37 patients with mean plus or minus standard deviation 2.72+/-0.1 storage void cycles recorded per patient.
Urodynamic assessment of the bashful bladder — D J Rosario; C R Chapple; P R Tophill; H H Woo · The Journal of Urology 163(1):215-20. PMID 10604351 · 2000
The publisher's own page for this source
Read on 2026-09-11
In the 2024 survey, "73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder."
What the source says
73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
The direction of that difference, in the authors' own running text: "Scores showed evidence of worse paruresis and lower self-esteem in those with an anxiety condition."
What the source says
All SBS scores and RSES scores showed a statistically significant difference between those participants who reported a self or medically diagnosed anxiety disorder compared with those participants who reported no anxiety conditions. Scores showed evidence of worse paruresis and lower self-esteem in those with an anxiety condition.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
Table 3's medians: a total Shy Bladder Scale score of 8 for the 96 participants with no anxiety disorder, and 19 for the 260 with at least one.
What the source says
Table 3 Median (lower quartile and upper quartile) scores for the SBS, RSES and school toilet experience scales, split by participants who indicated at least one self or medically diagnosed anxiety disorder or not [...] Total Shy Bladder Scale (SBS) score | No anxiety disorder (n=96) 8 (2.25, 16.75) | At least one anxiety disorder (n=260) 19 (8.25, 34) | <0.001
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
"Being male, having a medically or self-diagnosed anxiety disorder, low self-esteem and having a negative school toilet experience increased the odds of having 'mild' paruresis."
What the source says
Being male, having a medically or self-diagnosed anxiety disorder, low self-esteem and having a negative school toilet experience increased the odds of having ‘mild’ paruresis.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
The same paper's own limit on that finding: "there was only a weak correlation between poor toilet experiences in school and paruresis."
What the source says
We found that low self-esteem was associated with worse paruresis symptoms, but that there was only a weak correlation between poor toilet experiences in school and paruresis.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
And: "Poor experience of using school toilets was significant for predicting 'mild' paruresis but not 'severe'."
What the source says
Poor experience of using school toilets was significant for predicting ‘mild’ paruresis but not ‘severe’. Our sample only contained 53 participants with ‘severe’ paruresis and was only able to detect large effects.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
Most respondents did not report bad school toilets: "The school toilet experience scores indicated that most participants (336/356 (94.4%)) had an adequate/positive experience of school toilets in school."
What the source says
The school toilet experience scores indicated that most participants (336/356 (94.4%)) had an adequate/positive experience of school toilets in school.
Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study — Hayley Anne Hutchings; Abi Kehinde · BMJ Open 14(11):e086097. doi:10.1136/bmjopen-2024-086097 · 2024
The publisher's own page for this source
Read on 2026-09-09
Who the older studies studied: "Sixty-three patients (59 M, 4 F) completed the questionnaire."
What the source says
A survey of people affiliated with the "International Paruresis Association" was undertaken using a self-report questionnaire with items that addressed demographic variables, the phenomenology of paruresis, comorbid disorders, and the impact of symptoms on quality of life. Sixty-three patients (59 M, 4 F) completed the questionnaire. The mean age of the subjects was 38.1+/-12 years, with the mean duration of symptoms being 24.5+/-13 years.
Is "shy bladder syndrome" a subtype of social anxiety disorder? A survey of people with paruresis — Bavanisha Vythilingum; Dan J Stein; Steven Soifer · Depression and Anxiety 16(2):84-7. doi:10.1002/da.10061 · 2002
The publisher's own page for this source
Read on 2026-09-09
Paruresis "is a scientifically under-studied phenomenon", in the words of the team who built the Shy Bladder Scale — the instrument behind the 2024 survey's figures.
What the source says
Paruresis, characterized by the difficulty or inability to urinate in a variety of social contexts, is a scientifically under-studied phenomenon. One reason for this state of affairs is the paucity of reliable and valid measures for assessing this problem. [...] Undergraduate students evidenced very low levels of paruresis-related concerns. In contrast, SBS scores were markedly elevated among individuals recruited from an online support network who appeared to meet diagnostic criteria for paruresis-specific social phobia.
Development and validation of the shy bladder scale — Brett J Deacon; Jennifer J Lickel; Jonathan S Abramowitz; Patrick B McGrath · Cognitive Behaviour Therapy 41(3):251-60. doi:10.1080/16506073.2012.658852. PMID 22452544 · 2012
The publisher's own page for this source
Read on 2026-09-09
The source files behind this page also hold 101 entries recording material that was checked and then taken out. Nothing on this site rests on them, so they are not listed here.