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?

Are you thinking about whether you need professional help to recover? You may feel that you should be able to handle things on your own, or that talking to someone means you are not a strong person. You might be worried that talking about your issue during treatment could make your symptoms worse. It is important to get all those obstacles out of the way.

When asking for help

It is good to know that it is important to help yourself. It’s also important to know when you need to reach out for some help. Therapy can be a good opportunity to learn both aspects of emotional strength, autonomy, and reliance on those you trust.

An experienced therapist will let you choose the pace of your therapy and won't force you to discuss things you're not ready for. Emotional strength involves learning on your own and knowing how and when support is helpful.

How do the symptoms influence your life?

One of the best ways to figure out if assistance is good for you is to consider how much the symptoms you are experiencing interfere with your daily life. Do you have limitations in your personal life, or at work? Are you able to focus? Is it easy for you to build and maintain fulfilling relationships with people? Do you enjoy your life? Is there a feeling in you that your life could be more fulfilling?

Who can assist you?

Are you considering getting my assistance? The easiest way for you to find out is if you know someone I've been able to help. Then you will know firsthand what to expect. If that is not the case, you will find on this website some information that will make it easier for you to get an impression of me. Trust is important, and that's why I aim for transparency.

Your therapist

For about two decades, I am specialized in the field of fears and anxiety disorders. I spend about 20 hours a week helping people to free themselves from their limitations and thereby gain a better quality of life. If you want to know how it all started and what you should know about me, please read my profile. And yes, therapy is a very personal matter: Because it is a very intensive collaboration, I reveal some details about myself. So you can get a first impression of me. Trust is important and that is why I focus on transparency.

The sessions are conducted either in German or English.

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

The fee per session hour of psychotherapy (60 minutes) for appointments from Monday to Thursday from 10:00 to 18:00:

• A. Sessions by telephone or online with video support 179,- Euro
• B. Sessions in my premises 199,- Euro.
• C. For options A. and B. plus short-term appointment changes* once up to 24 hours before, add to the hourly fee 35, - Euro.

The fees for psychotherapy are exempt from VAT according to § 4 No. 14 a) UStG.

The first session usually lasts 90 minutes. Outside the mentioned business hours (Monday and Tuesday from 10:00 a.m. until 6:00 p.m.) I add a 35 % surcharge. The minimum duration of a session is 60 minutes, billing beyond that in 30-minute units. The minimum duration of a session is 60 minutes, billing beyond that in 30-minute units.

The fees do not include travel, accommodation, and allowance costs, which will be charged to the client. For traveling on my behalf: The costs for the journey will be charged according to time and effort. Within Berlin, at least an hourly fee is charged. Relevant is the individual agreement.

Postponement of meetings: For hourly fees A. and B. sessions that last up to 120 minutes can be once rescheduled up to 72 hours in advance (only weekdays count Monday till Friday, no holidays), longer sessions, or more than 120 minutes within 7 days at least 14 days in advance. Otherwise, they will be charged in full.

You can't come to my practice? Switch to a session with video or use your telephone.

Method of payment: The fee must always be paid in full by bank transfer 7 days before the session. I will send you details by mail so that you are well-informed.

Right of rescission: If registration by consumers for an event is made by telephone, letter, e-mail, or online form, the provisions of the Distance Selling Act shall apply. If the intended start of the event at the time of registration is within the withdrawal period according to the Fernabsatzgesetz (Distance Selling Act), the registration is considered a request to start the service within the withdrawal period. You have the right to revoke a service order/date without giving reasons. This is possible within 14 days of the order by telephone and in writing.

Cost coverage by health insurance companies and other insurers

Usually, the fee is not paid by national health insurance companies. Please contact your insurance company to find out about their policy details. Please discuss this with your insurer in advance. You will receive an invoice from me with classification according to ICD-10. Should applications etc. be necessary, we can do this together during the meetings.

Therapy duration

The first therapy session lasts 90 minutes, subsequent sessions can also be 60 minutes long. The number of sessions required is as varied as the personalities and situations of the clients. For anxiety disorders, I usually see clients for 3 to 8 sessions. Frequently, this question can be estimated by the clients themselves after the second session. I will then also give you an estimation based on previous experience.

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), phone 030/86421369, and mobile phone 01577/7045356. The best time to contact me by telephone is Monday to Thursday between 9.00 am and 6.00 pm. During sessions, there is an answering machine. Leave a message and your phone number in Germany, and I'll call you back as soon as possible. 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.

Be sure to read the following notice

Before contacting me, please read the detailed information about fees, booking, contraindications to hypnotherapy and answers to other frequently asked questions (FAQ).

These pages are intended to provide information for those interested in psychotherapy using hypnotherapy. It is not intended to replace psychotherapy or personal consultation, examination or diagnosis by a licensed medical practitioner. I am not a medical doctor. I specialize in helping people with anxiety and anxiety disorders. The profession of a hypnotherapist (official license to practice psychotherapy according to the HPG) is fundamentally different from that of a medical doctor. Medical diagnoses are not made, nor are promises of healing made or medication prescribed. Hypnotherapy is not a substitute for medical or psychiatric intervention where this is required.

If you have any questions about psychotherapy with hypnosis, please do not hesitate to contact me. I will be happy to inform you.

Articles

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