Paruresis (shy bladder syndrome): Information, tips and help in Berlin & online

Frequently asked question

Help with paruresis

Paruresis is another topic that is hardly ever talked about. Yet so many people, mostly men, suffer from the so-called shy bladder. To urinate outside the private sphere or even in public toilets, when other people might notice, is perceived by sufferers as extremely unpleasant.

Far too many people suffer from paruresis for too long. This is also a great shame because it is possible to resolve this anxiety disorder with hypnotherapy and Hypnobalancing™.

• The fear to urinate
• Consequences
• Physical correlations with paruresis
  • Basic requirements
  • The bladder
• Mainly men are affected
• Causes and effects
• Treatment of paruresis
• Help with paruresis
• Please read carefully

Consequences

Paruresis is an anxiety disorder with often quite high levels of distress. Whereby there are large variations. Many people affected are completely unable to urinate in the presence of other people, others are “only” uncomfortable. For some people, it only takes a little while until the urine flow starts and for others, it is impossible under pressure. Some go into the cubicle and some are overly cramped even there.

In extreme cases, people with paruresis try to drink as little as possible and hardly ever leave the house. The workplace should be as close as possible to one’s home in order to get there as quickly as possible. Many patients avoid social contact and become increasingly isolated, which has an impact on their professional and private lives. Paruresis can escalate into depression. Thus, paruresis has limiting consequences on the whole life.

Physical correlations with paruresis

Paruresis, (shy bladder syndrome) is a bladder emptying disorder. The symptoms range from a more or less long delay before urination starts, incomplete emptying of the bladder, to the impossibility to urinate at all. Affected persons mainly suffer in public toilets or outside the private environment.

Basic requirements

On average, people empty their bladders four to eight times a day. This is a routine for most people. However, visiting a public toilet triggers physical stress reactions in those affected by paruresis. The body reacts as if it would be in a dangerous situation. The sympathetic nervous system is activated, which causes the inner and outer ring muscles of the bladder to tighten. This makes urination difficult or impossible. A certain degree of relaxation, i.e. also a minimum feeling of security, is necessary for urination.

The bladder

The bladder is a muscle that is closed at the bottom by an internal and an external sphincter. These muscles are primarily controlled by the autonomic nervous system. Voluntary control of bladder function is possible only to a very limited extent. While the bladder is storing, it is relaxed, but the two sphincter muscles are tense and closed. The sympathetic nervous system is responsible for this. The parasympathetic nervous system must then be activated to empty the bladder. It ensures that the bladder muscle contracts and the two sphincters open. But anxiety and stress lead to activation of the sympathetic nervous system instead. The result: even when the bladder is full, the sphincter muscles remain closed and cannot be opened as easily with voluntary effort.

Mainly men are affected

Paruresis seems to occur much more frequently among men than among women. At least with this issue, come into my practice are predominantly men. This is probably also due to the more permissive design of men’s toilets, where men urinate next to each other while standing.

In many clients with paruresis, other contexts need to be considered. Often a social phobia is recognizable, and with prolonged paruresis, there is often also depression and even alcohol abuse. This makes immediate treatment all the more important. Unfortunately, many of those affected wait a long time to seek help, despite the often very great suffering.

Causes and effects

Affected individuals often report a triggering experience where it happened for the first time, and that this experience left such a lasting impression that they have not been able to visit a restroom without embarrassment ever since. It often begins during adolescence in combination with a traumatic or shame-triggering experience in a public restroom. If a triggering experience exists, then it is linked in the unconscious with the tension of the urethral sphincters. This often leads to the problem being attributed to the presence of other people, although the cause may lie somewhere else entirely.

The fear of being seen or heard by others when urinating puts people with paruresis under increasing stress. This causes stress, and this stress activates the sympathetic nervous system, causing the bladder muscles to contract and block the flow of urine. Affected individuals often tense up at the very thought of such a situation, and the expectation of not being able to relieve themselves in public toilets is confirmed.

Overall, the causes vary widely, ranging from feelings of inferiority to stress at school or family conflict. A very large proportion of my patients with paruresis show tendencies towards perfectionism and have above-average success.

Treatment of paruresis

Most sufferers hide their paruresis from other people, which results in paruresis being comparatively unknown. Sufferers rarely talk about their problems because they feel ashamed. The fear of being ridiculed or not taken seriously causes a patient to become increasingly socially isolated. Although there are numerous sufferers, some of whom suffer greatly, very few people know about paruresis. Few therapists are well experienced with paruresis, and thus therapy is largely oriented toward the treatment of social phobias.

Often, paruresis drags on for many years or even decades before sufferers get help. Life is too short for someday. If paruresis is limiting your life, get help. The prospects for successful treatment are very good for the exaggerated fear of urination. Hypnotherapy in combination with hypnobalancing has proven successful in the treatment of paruresis. This is because paruresis is caused by a psychologically induced muscular tension that makes urination difficult or impossible. This tightening of the bladder muscles is caused by psychological factors such as fear and shame. If the patient learns to relax automatically before or during urination or to perceive the situation differently, this tension is relieved. After just a few sessions, the symptoms can usually be completely eliminated or at least significantly improved.

Help with paruresis

Please keep in mind to clarify physical causes by visiting your doctor, and also pay attention to the notes on contraindications for hypnotherapy before booking an appointment.

Many proven interventions are intensified by trance. Helpful mental states can be explored, and unexploited resources can be activated. Learning processes take place faster and deeper and become more memorable. The more convulsive control is discarded, the more inner security is felt. But this is only possible to a limited extent with conscious will. The head cinema is too strong and present. The vicious circle of anticipatory anxiety, catastrophic thoughts, and physical anxiety symptoms can be broken with appropriate psychotherapeutic support.

Hypnobalancing stimulates mental balance. Relaxation exercises can help sufferers regain control over their bladder muscles. There are also a number of other self-help techniques to choose from. Each therapist has different tools that are taught. Through self-help techniques, personal influence can be additionally extended.

The deep trance of Deep Hypnobalancing™ has a positive effect on the self-organizing abilities of the body and mind. Patients more often report feeling tidier and at ease overall.

The number of sessions required varies as much as clients’ personalities and experiences. On average, 7 to 10 sessions are required for treatment. Usually, this can be estimated by patients after the third session.

How to Decide to Ask for Help

Overcoming Doubts About Seeking Support

Are you wondering whether you need professional help to recover? You might feel that you should handle things on your own, or that seeking help means you’re not strong enough. Perhaps you are afraid that discussing your issues could worsen your symptoms. These concerns are natural, but addressing them can clear the way for meaningful progress.

The Value of Reaching Out

Taking the step to seek help doesn’t mean you’ve failed. It’s a sign of emotional strength and self-awareness. Therapy offers the chance to balance personal autonomy with the support of a trusted professional. An experienced therapist will guide you at a comfortable pace, never pressuring you to discuss topics you’re not ready for. Emotional resilience grows through learning when and how to seek support while maintaining independence.

Assessing the Impact of Symptoms

To determine if professional assistance might benefit you, consider how your symptoms affect your daily life:

• Are your relationships fulfilling and healthy?
• Can you focus and perform effectively at work?
• Do you feel joy and satisfaction in your daily life?
• Is there a sense that life could be more fulfilling?

If your symptoms limit your ability to thrive in these areas, reaching out for help could be a valuable step.

Who Can Assist You?

Are you thinking about working with me? If you know someone I’ve helped, their experience might provide valuable insights. If not, explore the resources on this website to get a clear impression of my approach and expertise. Trust is the cornerstone of effective therapy, and I strive to build it through transparency and openness.​

Meet Your Therapist

Specialized Care for Anxiety, Fear, and Trauma

With over 20 years of experience, I have focused my practice on helping individuals overcome fears, anxiety disorders, and trauma. Each week, I dedicate approximately 20 hours to empowering clients to break free from their limitations and achieve a higher quality of life.

A Trust-Based, Personalized Approach

Therapy is a personal journey. To build trust and provide transparency, I offer insights into my professional background and therapeutic philosophy in my profile. This openness sets the stage for a collaborative relationship, ensuring you feel supported and understood.

Flexible Language Options

To meet your unique needs, sessions are available in German and English. This flexibility ensures effective communication and comfort for all clients.

What does hypnotherapy cost?

Here are some organizational details. Please read them before the appointment reservation. People often ask, "How much does hypnotherapy cost?" What is meant by this are the presumed total costs, which result from the fee and the duration of the psychotherapy with hypnotherapy.

Fee for psychotherapy

Hourly Rates

The fees for a 60-minute psychotherapy session during regular business hours (Monday to Thursday, 10:00 a.m. to 6:00 p.m.) are as follows:

A. Online or telephone sessions: €189
B. In-person sessions at my office: €229
C. Flexible scheduling (short-term appointment changes up to 24 hours in advance for A or B: Additional €45 per session.
Psychotherapy services are VAT-exempt according to § 4 No. 14 a) UStG.

Terms and Conditions

Scheduling

General appointments are available Monday to Thursday, 10:00 a.m. to 6:00 p.m.
Sessions outside these hours, on weekends, or public holidays, incur a 35% surcharge.
The minimum session duration is 60 minutes, with additional time billed in 30-minute increments.

Rescheduling Policy

Sessions lasting up to 120 minutes may be rescheduled once, with at least 72 hours’ notice.
Longer sessions or sessions exceeding 120 minutes in a week require at least 14 days’ notice for rescheduling.
Missed or late cancellations are charged in full. Rescheduled sessions must be used within 12 months.

Alternatives for Missed Appointments

If you cannot attend in person, you can switch to an online video or telephone session at the scheduled time.

Payment Terms

Payment must be fully received via bank transfer 7 days before the appointment.
Cash payments on the day of the session may be allowed on a case-by-case basis; please inquire in advance.

Package Offers

Package deals are not available for psychotherapy services.

Travel Expenses

Travel, accommodation, and per diem expenses are charged separately.
For travel within Berlin, a minimum hourly rate applies.
Travel outside Berlin is billed based on time and effort, subject to individual agreement.

Personalized and Non-Transferable Services

All bookings are exclusively for one-on-one sessions and are non-transferable.

Right of Withdrawal

The provisions of the Distance Selling Act (Fernabsatzgesetz) apply to services booked by telephone, letter, email, or online form.

You may cancel a booking within 14 days of purchase without providing a reason.
If the service begins within the withdrawal period, the registration is considered a request to initiate service early.

Cost Coverage by Health Insurance Companies and Other Insurers

National health insurance companies typically do not cover psychotherapy fees. However, policies vary, so you must contact your insurance provider to clarify their specific guidelines and coverage options.

What You Need to Know

• Invoice Classification:
  You will receive an invoice from me, classified according to ICD-10 standards, to assist with any reimbursement claims.
• Prior Approval:
  Please discuss your therapy plans with your insurer in advance to avoid unexpected issues.
• Application Support:
  If additional documentation or applications are required by your insurer, we can address this together during our sessions.

For more information or assistance, feel free to reach out to me directly.

Therapy Duration and Expectations

Initial Session

The first therapy session lasts 90 minutes. This extended duration allows us to establish a foundation, understand your unique concerns, and set goals for your therapy journey.

Follow-Up Sessions

Subsequent sessions are typically 60 minutes long. The number of sessions required varies significantly based on individual personalities and specific circumstances.

Typical Session Range

• For anxiety disorders, clients often attend 3 to 8 sessions.
• By the second session, many clients gain clarity about their commitment and therapy trajectory.

Personalized Guidance

After the initial sessions, I will provide an estimate of the number of sessions you may need based on your progress and my professional experience. This collaborative approach ensures that therapy is tailored to your specific needs and goals.

Just ask me personally.

Let's talk. Please read the privacy policy. If you are interested, you can contact me for questions and appointments via this contact form or by e-mail (mail@berlin-hypnosis.com). Make sure I understand what you are asking for.

You can find answers to frequently asked questions, such as fees, on the home page. There are also lots of articles and details about me (profile) to help you get an idea of who I am. This will also make it easier for you to decide if I am the right therapist for you and your problem.

Message

Remarks:

In the address bar of your browser, the URL should begin with "https://www.berlin-hypnosis.com/...". This indicates a secure connection (SSL). Whether you enter your real name is up to you.

Appointment booking

Please read the important information before making an appointment with me, including the contraindications for psychotherapy with hypnotherapy. I have answered frequently asked questions for you. For the success of your therapy, this information is of crucial importance. If this attracts you, then you can find out about booking your appointment here. The better you are informed, the faster we can focus on you and your wishes.

To make an appointment, you can preferably contact me by e-mail (mail@noack-hypnose.de) or by using the contact form (privacy policy) as well as by phone 01577 704 53 56 or 030 - 864 213 69. You will then receive a confirmation of your reservation by e-mail. In this reply, you will find the details for the first session. This usually happens within 24 hours. If you do not receive a reply, it could be because an email has ended up in the spam filter. In such a case, please call me.

There are only a few practice hours available, and they want to be used well. The fee for individual session hours is therefore always to be paid in full by bank transfer, with payment received at least 7 days before the session.

Why at least 7 days in advance? I would like to do it differently, but this is the best practice. Appointments that have not been confirmed with payment received seven days in advance are noticeably more likely to be canceled. And the repeated callbacks take up a lot of time. Because of this, I'm currently faced with the decision of whether and how to either significantly adjust fees to absorb this or to consistently organize in a way that is fair to all parties. Because of this, I am also offering options in terms of shifting appointments with the fees.

There is a maximum of 20 hours a week available for psychotherapy, and any canceled appointment means patients are unable to benefit from psychotherapy help. I understand that it would be more convenient for you otherwise, but this solution is the fairest for all involved.

You can use real-time bank transfer (costs 25 Ct. at Sparkasse Berlin, for example) for time-sensitive appointments, and the transfer takes a few minutes, or we can make an appointment with appropriate advance preparation. If this is not an option for you, please let me know immediately so that I can assign your appointment. Otherwise, I appreciate your understanding and look forward to intensive cooperation.

You are not in Berlin or prefer an alternative instead of coming to me?

You are not in Berlin or do not want or cannot come to the practice for other reasons? Then it is worth reading the following information about the options:

a. Travel to Berlin

For clients traveling to Berlin, there is the possibility, if booked in advance, to hold 2 sessions on the same day. It should be discussed in advance by telephone whether this is a recommendable option, as it requires appropriate prerequisites. Any sources of additional pressure should be avoided in the interest of the therapeutic success.

Here you will find further information when considering to travel to me in Berlin.

b. Online sessions

At times a personal meeting is not possible. In such cases, a telephone session or a session with video support via the Internet is an alternative or supplement. I have been using this setting for many years, and many clients have achieved excellent results with it. These experiences make it easy to achieve very intensive sessions in this way as well. You are more flexible and can also use my support very promptly. There are currently reduced fees for such sessions.

You are also on the safe side regarding the coronavirus. By the way, this is also an option if you should be unexpectedly unable to attend a session personally.​

Preparation for the first session

With the confirmation of your appointment, you will receive recommendations on how to prepare for your first session with me. With your appointment confirmation, you will receive recommendations on how to prepare for your first session with me. You will also get an overview of what to consider regarding the Coronavirus during in-office appointments and how to prepare best for online sessions.​

The first session: Step by step 

The optimal prerequisites are set right at the beginning. In the first meeting, we create the basis for intensive cooperation. Step by step:

1. Preparation

The first session is generally 90 minutes so that there is enough time for an in-depth preliminary discussion, in which we can clarify questions. Then we begin with a detailed dialogue, with the anamnesis, in order to adapt the therapeutic plan individually to your personal needs. For this purpose, we define your goals and motives and discuss the steps.

2. First intervention

As soon as you are ready for it, we get to work. You set the pace. In the second part of the session, we figure out the easiest way to get you into a comfortable, relaxed hypnotic state. You will experience an introductory trance. This enables access to your unconscious and permits initial suggestions. How far we proceed with this in the first session will be determined by your reactions. Finally, I gently lead you out of the trance.

3. Evaluation, options, and outlook

Following the first trance, I will respond to your questions, and we will discuss how to proceed with your hypnotherapy. In most cases, you will receive recommendations you can apply to complement and enhance the work we do together, even beyond the sessions. It is crucial that you not only feel better in the session, but also have an improvement in your everyday life. The more effectively we work together, the sooner I make myself superfluous as your therapist. That's it!

Self-hypnosis  

When appropriate, I will teach you self-hypnosis to complement the hypnosis sessions. Self-hypnosis is a tool to control unconscious processes and thus mental states by yourself.

After you enjoyed positive trance experiences with my support, you can learn self-hypnosis very quickly. This helps you to progress self-determined. It accelerates the process, deepens, and consolidates what has been achieved in the therapy sessions. Your autonomy is thus fostered. A good therapist makes himself superfluous as soon as possible. Self-hypnosis is an excellent method of self-help that can be used beyond the actual issue.

Important Information Before Contacting Me

Read This First

Before reaching out, please take the time to review the detailed information on the following topics:

• Fees and Booking Procedures
• Contraindications for Hypnotherapy
• Answers to Frequently Asked Questions (FAQ)

About This Page

This page is designed to provide essential information for individuals interested in psychotherapy through hypnotherapy. However, it is not intended to replace professional psychotherapy, medical consultations, examinations, or diagnoses by a licensed medical practitioner.

My Role and Expertise

I am a hypnotherapist licensed to practice psychotherapy under the HPG (Heilpraktikergesetz). My work focuses on helping people manage anxiety and anxiety disorders. It is important to note the following distinctions:

• I am not a medical doctor.
• I do not provide medical diagnoses, prescribe medications, or make promises of healing.
• Hypnotherapy is not a substitute for medical or psychiatric care where such intervention is necessary.

Contact Me

If you have any questions about psychotherapy with hypnotherapy, feel free to reach out. I am happy to provide more information and guide you on how hypnotherapy can support your journey to improved well-being.​

Articles

Published: March 15, 2009
Author: Karsten Noack
Revision: June 21, 2019
Translation: May 26, 2011
German version:
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AN: #64712