Intended for healthcare professionals

Practice What Your Patient is Thinking

I couldn’t pee when people were around

BMJ 2021; 375 doi: (Published 14 October 2021) Cite this as: BMJ 2021;375:n2197
  1. Ian Harris
  1. ian{at}

Ian Harris shares how being unable to pee in public toilets was affecting his life, until his GP told him help was available

Somewhere in my late teens I started to have difficulty peeing in public toilets. I would stand there with nothing coming out, willing myself on with no success. As this problem became more frequent, I stopped going to urinals and used cubicles instead. In my mind this wasn’t normal, and I started to feel inadequate compared with other men. I would try to make as little noise as possible so people couldn’t hear me peeing in the cubicle, as I worried others would think I was weird.

At the pub, I watched others to ensure that I went into the toilet on my own, so nobody saw me hiding away in the cubicle. However, one time a drunken mate followed and banged on the cubicle door calling me a woman. I already felt less of a man, not being able to pee like other guys, so that just made me hit my breaking point. I stopped going out and feared any potential social event.

Work became the worst challenge. I stopped drinking coffee and tea, which was noticed and commented on. I could hide away in my personal life but at work I was thrust into the spotlight continually as vice president of a global business. People were with me all the time, often in close knit situations. I was having to portray public leadership while also living through a private nightmare.

The revelation

During my forties, I went for a routine medical screening. Even that was a problem, as I could never give urine samples “on demand” while the GP or nurse waited outside. At the end of the consultation, the GP asked if there was anything else she could help with. I was so stressed about peeing that I blurted out: “Actually there is something, I can’t pee when people are around.”

She smiled and told me that the problem was very common and that it was called paruresis, or “shy bladder.” I was gobsmacked that she had even heard of it. I had been feeling so alone, totally weird, for more than 20 years. To then find out that other people had it was a total revelation to me.

The GP told me to look up “shy bladder” on the internet, and I came across an organisation called UKPT which ran workshops. Wow, workshops! I booked myself on to one.

Getting my life back

Walking towards the meeting room I felt nervous. This was a weird condition, so surely the workshop would be full of weirdos? I was pleasantly surprised to discover that the others were just normal guys.

The workshop taught me the theory behind what was going on, as well as techniques and ways of thinking to tackle this social phobia. Most importantly, they took me through a structured graduated de-sensitisation programme using the other guys and workshop leaders as “pee-buddies.” My progress astounded me. By the end of the two day workshop, I had actually peed at a urinal in a shopping centre, next to a stranger. Unbelievable! The UKPT has given me my life back and I am very grateful to that health professional who set me on the journey.

What you need to know

  • Paruresis affects male and female patients physically and psychologically; prevalence is 2.8-16.4%1

  • Understanding the mechanism behind the condition can help patients stop blaming themselves and to learn to live with the condition

  • Patients are reassured to find out that they are not unique or alone in living with the condition

Education into practice

  • How can you ensure patients feel able to tell you about symptoms or health issues that might be deemed embarrassing?

  • Where could you find additional information or support for someone struggling to pee in a public toilet?

  • How can you support someone who feels they are alone in living with paruresis?

Additional information


  • Competing interests: none.