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Assessment for paruresis

Prior to a diagnosis of paruresis, your medical professional may undertake a series of investigations to rule out physical causes of difficulty urinating. These may include attaining a medical history, physical examination, and other diagnostic and/or investigative assessments. Assessments may include the following:

Full medical examination: During a physical examination, your doctor will palpate (i.e., press and feel with their fingers, the lower abdomen for signs of abnormalities). For male patients, the doctor may conduct a rectal examination to check the size of the prostate.

Blood test: Assess signs of overall health and infection that may be causing symptoms, markers of inflammation, and prostate specific antigen in men to screen for prostate cancer.

Urine sample: Identify signs of infection in the urinary bladder/urinary tract.

Pelvic ultrasound: Examine urine volumes within the bladder and potential obstructions.

Computerised Tomography:Check for potential obstructions (e.g., kidney stones also known as renal calculi) impacting the flow of urine.

Neurological investigation: Investigate if neurological dysfunction is contributing to urinary retention symptoms (e.g., impaired nerve signalling) through electromyography (measuring electrical activity of nerve muscles near the urinary sphincter and bladder).

Cystoscopy: A cystoscopy (where a thin tube with a small camera is inserted through the urethra) may be used to help examine the lining of the urethra and bladder. This examination will allow the doctor to see whether there is scarring/narrowing of the urethra, or blockage due to an enlarged prostate, stones, or cancerous tumour.

Urodynamic testing: A series of urodynamic tests may be used to help examine how well the bladder and urethra store and release urine. Tests may investigate the speed, volume, and flow of urine, along with the amount of pressure required for the bladder to initiate urination.

As urinary retention can be a sign of physical illness, it is important that a medical assessment is conducted. For instance, benign prostatic hyperplasia (non-cancerous enlarged prostate) in men has been noted to cause urinary retention symptoms. If you have any concerns, please speak with your medical professional.

Once potential medical causes have been eliminated, the treating medical professional can help to explore the psychological causes of paruresis symptoms. Several psychological conditions are associated with paruresis and are summarised HERE. A referral to a psychologist for psychological treatment may be recommended. In terms of current treatments for paruresis, psychological interventions have been noted to be the best line of treatment. Cognitive behavioural therapy is likely to be helpful in treating paruresis symptoms due to its efficacy in treating other anxiety-based conditions such as social anxiety disorder.


Paruresis and social
anxiety disorder

The shy bladder and bowel scale