I cannot pee in public places. Tearing my life apart. Can't hardly go nowhere and have fun. My penis is not small so I am not worried about that. It's just that my heart starts beating really fast and I get scared. I don't know why. Please help.

The overwhelming fear that you experience when you feel the need to urinate and only in public places is known as paruresis. This condition affects one to two million people in the United States in such a debilitating manner that they simply cannot use a public restroom no matter what. An additional 15 million "low level paruetics" in the U.S. have difficulty but usually can use a urinal or toilet in proximity to somebody else. Combining these two numbers, that means that about 6 percent of the U.S. population has some form of this problem, with about 3 - 4 percent being men. For some unknown reason, more men than women experience paruresis.

Stress over peeing in public places is usually not connected to sensitivity about the size or appearance of one's penis. A percentage of men (and even women) everywhere become physically and/or emotionally distressed when they are in or are about to be in this situation. For some, anxiety is so high that it triggers panic attacks, causing nausea, breathlessness, and rapid heartbeat. Furthermore, rapid heartbeat is a physiological symptom of stress, and fears do not have to be rational to have impact.

These stress reactions cause muscle tension that prevents the urine from flowing easily. When these people feel stressed, their bodies cannot physiologically "relax and release." Of course, telling yourself that there is nothing to worry about, that you can just go ahead and pee, will not work because it creates additional pressure.

Some people benefit from the following stress management exercise called "Quick Calm":

• Close your eyes.
• Take a few deep breaths.
• Think to yourself, "I am warm," when you inhale.
• Think to yourself, “I am calm," when you exhale.
• Add imagery if it helps — you never know what will work — by imagining the sounds and sights of a torrential downpour, a river running through rapids, or the falls at Niagara.

Using a private stall helps some people, by lowering disruption associated with seeing or being too close to others. Some places have individual restrooms, which although "public," are more private.

If this is incapacitating or causing you super-discomfort, it may make sense to talk with your primary care provider about it. S/he may have some suggestions, including medication, seeing a professional, and/or attending a support group, where people learn strategies that assist them in changing their responses to this particular stimulus. Sometimes a triggering event in childhood, such as someone intruding upon a private restroom moment, can cause this response.

The mind plays a powerful role when it comes to normal bodily functions. Perhaps using this information, you can create your own strategies for changing your response pattern. At the very least, it's possible to learn to be less bothered by the way your body responds.

Alice

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